Why Does Sex Hurt? Understanding Painful Sex, Vaginismus, and How Sex Therapy Can Help

Why Does Sex Hurt? Understanding Painful Sex, Vaginismus, and How Sex Therapy Can Help

Many people quietly search questions like “Why does sex hurt?”, “Is painful sex normal?”, or “What is vaginismus?” late at night, often feeling confused, frustrated, or alone. Painful sex is far more common than most people realize, yet it is rarely talked about openly.

Our team of experienced sex therapists work with individuals and couples who are navigating painful sex, vaginismus, and the emotional toll these experiences can create. Pain during sex is not something that needs to be tolerated or ignored. With the right support, it is both understandable and treatable.

This article answers the most common questions people ask about painful sex and vaginismus and explains how sex therapy can help restore comfort, confidence, and intimacy.

Why Does Sex Hurt?

One of the most common search queries is simply, “Why does sex hurt?” Pain during sex, clinically referred to as dyspareunia, can have multiple contributing factors. These may include pelvic floor muscle tension, hormonal changes, medical conditions, anxiety, past trauma, or sexual shame.

Painful sex can occur even when someone feels aroused or emotionally connected to their partner. Many people wonder why penetration hurts even with lubrication or why sex hurts sometimes but not others. These experiences often reflect how closely the body and nervous system are connected to emotional stress, expectations, and fear.

Painful sex is not “all in your head,” but it is also rarely just a physical issue. This is where sex therapy becomes an essential part of treatment.

What Is Vaginismus?

Another highly searched question is, “What is vaginismus?” Vaginismus involves involuntary tightening of the pelvic floor muscles, making penetration painful or impossible. People often ask if vaginismus is real or psychological. The answer is that it is very real and involves both physical and emotional components.

Common questions include:

• How do I know if I have vaginismus?

• What does vaginismus feel like?

• Can vaginismus start suddenly or after childbirth?

• Is vaginismus permanent?

Vaginismus can develop due to anxiety, sexual trauma, medical procedures, chronic pain, religious or cultural sexual shame, or fear of penetration. It is not a personal failure or a sign that something is “wrong” with the body.

Is Painful Sex Normal?

While painful sex is more common than you’d expect, it is not something that should be accepted as normal or unavoidable. Pain is the body’s signal that something needs attention.

Questions such as “Why does sex hurt after childbirth?” or “Why does sex hurt after menopause?” are especially common. Hormonal shifts, tissue changes, and life stressors can all play a role. Sex therapy helps individuals understand these changes and develop strategies to reduce pain and rebuild comfort.

Can Anxiety or Stress Cause Painful Sex?

A frequent question is, “Can anxiety cause painful sex?” The short answer is yes. When the nervous system is in a state of stress, the body often responds by tightening muscles, including the pelvic floor. This can lead to pain during penetration or a feeling that the body “shuts down” during sex.

This could explain why tampons may feel fine while sex hurts or why pain appears inconsistently. These patterns often point to nervous system responses rather than structural problems alone.

How Is Vaginismus or Painful Sex Treated?

One of the most common questions people search is, “Can painful sex or vaginismus be treated?” The answer is yes. Effective treatment often involves a combination of emotional, physical, and relational support rather than a single solution.

Painful sex rarely has only one cause. Muscle tension, nervous system responses, anxiety, trauma, hormonal changes, and relationship dynamics often interact. Because of this, treatment is most successful when it addresses both the body and the mind.

How Sex Therapy Helps with Painful Sex

Sex therapy plays a central role in helping individuals understand and heal from painful sex and vaginismus. Our team of Chicago sex therapists provide a safe, nonjudgmental space where clients can talk openly about experiences that are often accompanied by shame, fear, or frustration.

Sex therapy helps by:

Reducing fear and anxiety. Many people notice their bodies tense automatically during intimacy. Sex therapy helps identify fear responses in the nervous system and teaches tools to calm the body, making pain less likely to occur.

Addressing sexual shame and beliefs. Questions such as “Is vaginismus all in my head?” or “Am I broken if sex hurts?” are common. Sex therapy helps clients understand that painful sex is not a personal failure. Challenging shame-based beliefs can significantly reduce muscle tension and avoidance.

Supporting gradual, pressure-free intimacy. Sex therapy does not focus on “pushing through” penetration. Instead, therapists guide clients through gradual, non-penetrative intimacy exercises that build safety, trust, and comfort. This approach often reduces pain by removing performance pressure.

Improving communication with partners. Painful sex can strain relationships. Sex therapy helps individuals and couples learn how to talk about pain, boundaries, and desire in ways that foster understanding rather than guilt or fear.

How Pelvic Floor Physical Therapy Helps

Many people also search questions like, “Does pelvic floor therapy help vaginismus?” or “Do pelvic floor exercises work for painful sex?” Pelvic floor physical therapy is often a crucial part of treatment.

Pelvic floor physical therapists are trained to assess and treat muscle tension, coordination, and pain in the pelvic region. For individuals with vaginismus or painful penetration, therapy may include:

Muscle relaxation and coordination work. Rather than strengthening, treatment often focuses on learning how to relax overactive pelvic floor muscles and improve control.

Education about pelvic anatomy. Understanding how the pelvic floor works can reduce fear and confusion. Many people feel relief simply learning that their symptoms have a physical explanation.

Gentle, gradual exposure. When appropriate, pelvic floor therapists may use manual techniques or guide clients in using vaginal dilators at a pace that feels safe and controlled. These tools are never forced and are introduced thoughtfully.

Collaboration with sex therapy. Pelvic floor physical therapy is most effective when paired with sex therapy. Addressing muscle tension without addressing fear or anxiety can limit progress.

Why Combining Sex Therapy and Pelvic Floor Physical Therapy Works

A common concern is, “Which treatment should I start with?” In many cases, combining sex therapy and pelvic floor physical therapy leads to the best outcomes.

Sex therapy addresses the emotional and relational aspects of pain, while pelvic floor physical therapy focuses on the physical patterns contributing to discomfort. Together, they help retrain both the nervous system and the muscles to respond differently during intimacy.

Clients often find that as anxiety decreases through therapy, physical treatment becomes more effective. Similarly, as physical discomfort lessens, emotional safety and desire increase.

How Long Does Treatment Take?

Another frequent question is how long treatment will take. The answer varies depending on the individual, the severity of symptoms, and contributing factors such as trauma history or medical conditions.

Some clients notice improvements within a few months, while others benefit from longer-term support. Progress is rarely linear, and setbacks are normal. What matters most is moving at a pace that feels safe and sustainable.

Can You Heal Without Penetration Being the Goal?

Many people worry that treatment will pressure them toward penetrative sex. Effective treatment does not treat penetration as the goal. Instead, the focus is on comfort, agency, and pleasure.

Many individuals discover that redefining intimacy and expanding their understanding of sexual connection reduces pressure and supports healing. Penetration often becomes easier when it is no longer the central focus.

When to Seek Support

If painful sex or vaginismus is affecting confidence, desire, or relationships, seeking support sooner rather than later can prevent symptoms from becoming more entrenched. Working with a sex therapist and, when appropriate, a pelvic floor physical therapist can provide clarity, relief, and a clear path forward.

Painful sex and vaginismus are treatable conditions. With compassionate, coordinated care that addresses both emotional and physical experiences, individuals and couples can move toward intimacy that feels safe, comfortable, and connected.

How to Handle Pain During Sex: Tips from a Sex Therapist

Sexual pain is a difficult and often misunderstood issue that many individuals and couples face. Whether it's caused by pelvic pain, physical conditions, or psychological factors, painful sex can strain relationships and emotional well-being. Fortunately, there are ways to address this discomfort, both physically and emotionally, to help you reclaim intimacy in your relationship. In this blog post, we'll discuss how to respond when sex is painful, explore some of the common causes, and explain how professional help from a sex therapist or couples counseling can help.

Understanding the Causes of Painful Sex

Pain during sex, or dyspareunia, can arise from multiple causes—some physical, some emotional. Understanding the underlying reasons for the pain is key to addressing it effectively. Research has shown that these causes can be broad, ranging from physiological conditions to psychological stressors.

• Physical Conditions: A variety of conditions can contribute to painful sex, including vaginismus (involuntary pelvic muscle spasms), endometriosis, and pelvic inflammatory disease. These conditions have been shown to cause significant discomfort during penetration and may require medical intervention

• Infections or Medical Issues: Common causes of painful sex include vaginal dryness, often related to hormonal imbalances (such as during menopause), or infections like yeast infections or urinary tract infections (UTIs). Research indicates that these conditions can directly affect comfort during intercourse

• Psychological Factors: Anxiety, stress, trauma, and relationship issues often contribute to pain during sex. Studies show that psychological and emotional factors can manifest physically, leading to muscle tension and discomfort during intimacy 

The First Step: Rule Out Physical Causes

When painful sex is persistent, it’s essential to first rule out medical conditions. This involves seeing a healthcare professional like a gynecologist, urologist, or pelvic pain specialist. A thorough evaluation may include a physical examination, imaging, and lab tests to diagnose conditions such as vaginal atrophy or pelvic floor dysfunction.

Pelvic floor therapy is often recommended for conditions like vaginismus and pelvic pain, where physical therapy techniques help relax and retrain the pelvic muscles. Peer-reviewed studies support the efficacy of pelvic floor physical therapy in treating sexual pain.

When the Pain Is Psychological: How to Respond

If the pain persists despite addressing physical conditions, the next step is considering the psychological aspects. Research shows that emotional trauma, anxiety, and relationship dynamics can contribute significantly to painful intercourse.

• Communication: Having open and non-judgmental conversations with your partner is critical. Emotional intimacy and trust are foundational in overcoming psychological factors contributing to sexual pain. Research on sexual communication in couples indicates that couples who communicate openly about their needs are better able to resolve sexual difficulties.

• Focus on Emotional Intimacy: Instead of focusing on intercourse, emphasize non-sexual touch, like kissing, cuddling, or simply spending time together. Studies have shown that improving emotional intimacy can reduce anxiety about sex and improve sexual satisfaction.

Seeking Professional Help: The Role of a Sex Therapist

When painful sex is partly or entirely psychological, seeking help from a sex therapist can be a game changer. Sex therapy helps individuals and couples explore the emotional, relational, and physical aspects of sex in a supportive, nonjudgmental environment.

Sex therapists are trained to help address not just the physical discomfort of sexual pain but also the emotional blocks that may be contributing. Cognitive Behavioral Therapy (CBT) and mindfulness-based therapy have been shown to effectively treat sexual pain by addressing the emotional components and helping individuals reduce the pain intensity.

Research supports the benefits of sex therapy for treating both physical and psychological sexual dysfunctions. Therapy can include education about body awareness, relaxation techniques, and gradual exposure to sexual activity to reduce anxiety and discomfort.

The Benefits of Couples Counseling for Painful Sex

Sexual pain can affect not only the individual experiencing discomfort but also the relationship as a whole. It’s important to recognize that sexual difficulties are often a shared challenge in a partnership. Couples counseling can help both partners navigate the emotional and relational aspects of sexual pain.

In couples counseling, a therapist can facilitate discussions about sexual expectations, boundaries, and emotional needs, helping both partners feel heard and supported. Studies suggest that when couples engage in therapy together, it can improve both their emotional and sexual connection.

Addressing Pain During Sex: Practical Tips

Alongside professional support, there are practical steps that individuals and couples can take to manage painful sex in the short term:

• Lubrication: Research confirms that the use of lubricant can alleviate vaginal dryness and reduce friction, making sex more comfortable

• Take Your Time: Slowing down, focusing on foreplay, and communicating about comfort levels are all important strategies for reducing anxiety and pain during sex.

• Pelvic Floor Exercises: Strengthening pelvic floor muscles through Kegel exercises have been shown to reduce discomfort for some women experiencing pelvic pain. Women with overactive (hypertonic) pelvic floor muscles would benefit from pelvic floor physical therapy to manage pelvic pain, which typically includes techniques like biofeedback, relaxation exercises, stretching, and manual therapy to help retrain the muscles and reduce tension.

• Try Different Positions: Experiment with sexual positions that reduce pressure on sensitive areas, allowing both partners to enjoy intimacy without causing pain. Research suggests that modifying sexual positions can help reduce pain and improve sexual function.

Finding the Right Support: “Sex Therapy Near Me”

If painful sex is affecting your relationship, seeking professional support is crucial. Whether you search for "sex therapy near me" or explore couples counseling options, finding the right therapist can provide the tools you need to navigate this issue. Sex therapy is designed to address both the physical and emotional components of sexual pain, while couples counseling can improve communication and connection. With the right support, you can find ways to manage painful sex and improve your overall sexual wellness.

TLDR

Painful sex, whether due to physical issues like pelvic pain or emotional factors, can be overwhelming, but it’s something that can be addressed. The first step is understanding the underlying causes, whether medical or psychological, and seeking help from a healthcare provider. If emotional or relational factors are contributing, seeking guidance from a sex therapist or engaging in couples counseling can provide invaluable support. Remember, sexual pain is not something to face alone—professional help can guide you back to a fulfilling, comfortable, and intimate relationship.

Postpartum Pelvic Pain: What You Need to Know

Giving birth takes a huge toll on the body, especially the pelvis. This means that giving birth has the potential to cause postpartum pelvic pain. The pelvis is the ring of bones at the bottom of your spine, which functions to stabilize muscles and protect organs.

When you have your hands full with a newborn, pain is the last thing you want to be dealing with, but it is a relatively common part of the postpartum healing process. The first six weeks postpartum are considered your “recovery period,” but everyone’s body heals at a different pace. It is normal for your body to need time to heal but you can proactively address pelvic pain instead of trying to wait it out. In this article, we will explore tips for preventing postpartum pelvic pain, potential causes, and how to manage pain when it emerges.

Symptoms of Postpartum Pelvic Pain

Some of the symptoms related to pelvic pain after childbirth are persistent pain in the pelvic area, hips, lower back, or pubic bone; difficulty walking or standing; and urinary or bowel issues. Factors such as type of delivery, the presence of complications, and the strength of the pelvis before childbirth will all influence which symptoms you experience. There are multiple possibilities for causes of pelvic pain, so a medical professional can help determine which one is contributing to your symptoms. The following section describes a few of the potential causes. 

Causes of Postpartum Pelvic Pain

Changes in the Pelvic Floor

Pregnancy and childbirth stretch and weaken pelvic floor muscles, which are connective tissues supporting pelvic organs like the bladder, rectum, and uterus. They serve to stabilize the spine and assist with continence. 

Pelvic Girdle Pain/Symphysis Pubis Dysfunction

Pelvic Girdle Pain (also known as Symphysis Pubis Dysfunction) happens when the ligaments that keep your pelvic bone aligned are too relaxed due to the hormone relaxin. While your body is supposed to produce relaxin before birth to allow for the baby to pass through, sometimes it produces too much, meaning your pelvic bones do not have the appropriate support and in turn, cause pain afterwards.  

Trauma from a vaginal delivery

There is, unfortunately, an association between vaginal delivery and ensuing urinary incontinence and pelvic organ prolapse. Pushing out a baby puts strain on the pelvic floor and weakens those muscles, leading to postpartum pelvic pain.

How to Prevent Postpartum Pelvic Pain

If you have yet to give birth, there are steps you can take to prevent or mitigate pelvic pain both during pregnancy and postpartum. These tips are not guaranteed to help you avoid pelvic pain altogether, but they may decrease the odds of experiencing it, or at least decrease the intensity of the pain you experience.   

Exercise your pelvic floor

Since pelvic pain is in part due to a weakened pelvic floor, working on strength building both before and after giving birth helps with postpartum recovery. Everyone’s body and postpartum challenges are unique to them, so it is best to do these under the guidance of a professional pelvic floor physical therapist. If that is not accessible to you, there are plenty of resources online that demonstrate some of these exercises. It is important to be aware of your body’s limitations and to stop if you experience an inordinate amount of discomfort or pain.      

Maintaining good posture

Though good posture is challenging to maintain when you have the weight of a pregnant belly pulling down, it will alleviate strain on the pelvic area. Good posture is also important postpartum, especially since early parenthood involves lots of lifting and bending.  

Move gently interspersed with rest

Staying active during pregnancy is vital to prepare your body for the strenuous nature of labor. Gentle forms of exercise like walking and stretching promote flexibility and blood flow without putting too much strain on the body. Equally important as exercise is to rest and avoid overexertion.

Wear comfortable footwear

Everything in the body is connected and affects other parts of the body. Even though your feet are not close to your pelvis, supportive shoes support spinal alignment and in doing so, reduces strain on the pelvis.

Use supportive devices

Maternity belly bands provide support for your belly and back can alleviate strain on your spine and pelvis.   

Treatments for Pelvic Pain

If you have already given birth and are experiencing postpartum pelvic pain, you have options for addressing it. The tips can still support your recovery if it is too late to prevent the pain. Additionally, you can take NSAIDs like acetaminophen, use a heating pad, get rest, and work with a pelvic floor physical therapist. Note that you should speak to your doctor as soon as possible about your concerns; they can give you specific guidance for the treatment options best suited to you    

The bottom line 

Understanding the potential causes, incorporating prevention strategies, and seeking appropriate treatment are the best ways to approach postpartum pelvic pain. Every person’s experience and body is unique, and healing timelines and trajectories will vary, which is why it is important to consult a qualified pelvic floor physical therapist and/or a sex therapist. Finally, though easier said than done, try to be patient with your body. It has just been through significant trauma and challenges, so health complications as a result are to be expected. By educating yourself and using available resources, you may feel more supported on the journey of postpartum recovery.