Painful Sex 101: Why Sex Hurts?

Why Sex Hurts?

That’s right, we’re talking painful sex 101! This topic can feel ~taboo~ but people at all different stages of life have asked why sex hurts? There can be lots of different causes, so we hope this article helps you to figure out what is standing between you and pain-free sex. Keep reading for reasons behind ‘why sex hurts’ and what you can do to improve your sex life!

Before we get into all the good stuff, we want to reassure you that we are NOT going to tell you to just give it time, have another glass of wine, take a hot bath, or any of the other bad advice that is floating around out there. To be blunt, this is ridiculous and prevents people from getting the help they need!


Most women are unfamiliar with female anatomy, especially their own! The main components of female anatomy include the labia majora, labia minora, clitoris, and vagina. Beyond that, you have superficial pelvic floor muscles, lots of nerves, the perineal body, and your deep pelvic floor muscles. All of these could be potential sources of pain, so it is important to have a good understanding of their location. Check out the video if you want to learn a little more about anatomy and where pain sources can occur.    

Pain with sex can also stem from issues outside of the pelvis. Specifically, it can begin at your diaphragm (breathing muscle) and your abdominal fascia. Deep belly breathing uses your diaphragm and stretches your pelvic floor as well as your abdominal fascia. When you don’t utilize your diaphragm regularly, your pelvic floor and your abdominal fascia develop increased tone due to lack of stretching. Keep reading to see why increased tone, or overactivity, can cause pain with sex!

Causes of Painful Sex?

Because so many people aren’t comfortable discussing it, you’d be shocked how common it really is! 50% of women report pain with sex!  We’re going to dive into some of the most common causes of painful sex that we see including overactive pelvic floor muscles, vulvoodynia, vaginismus, scar tissue, and dryness.

Overactive Pelvic Floor

Think back to a time when you slept weird and woke up with a sore neck. Can you picture how painful the neck felt and how it would radiate pain all the way up to your head or down to your shoulder blade? That is a trigger point—essentially a knot within the muscle that can send pain elsewhere.

Most people don’t realize that you can also get trigger points within the pelvic floor muscles that can lead to pain. Many times, the pain is felt during intercourse when pressure is being applied to the trigger point. They can also send pain to other locations including the groin, hip, or low back region. The longer that your muscle is tight and flared up, the more painful the trigger point will become.

These trigger points in the pelvic floor can stem from changes in hormone levels, such as during your period or menopause, as well as emotional and physical stress. You can also develop trigger points as a result of tightness in surrounding areas such as abdominal fascia, inner thigh muscles, or pelvic fascia.


Vulvodynia is a condition where the woman feels sharp pain near the entrance of the vagina that can be pinpointed to a specific location or sometimes more widespread throughout the vulva. This is the result of a nerve entrapment in the pelvis which results in overly sensitized tissues that perceive most stimuli as painful. Typically, there will be pain with light touch, the fabric of underwear, or tampon usage.

Scar Tissue

If you had any vaginal tearing or an episiotomy during childbirth, this would result in scar tissue as the area heals. Scar tissue is a normal response of the body to heal an injury, but it can also be problematic. It often is painful or tender to the touch so a woman can feel pain at the vaginal opening (or the location of the scar tissue) upon penetration. The more severe the tearing, the deeper the scar tissue and the pain goes.


Vaginismus is a condition where the superficial pelvic floor muscles spasm, making the vaginal opening very constricted. This often causes severe pain upon penetration and the woman is likely unable to tolerate any intercourse or penetration. This can happen as a result of trauma, anxiety, or pelvic floor muscle activity.

Vaginal Dryness

So many women are told that they just need to “use more lube” when they express concern about pain with sex.  While this tends to be used as an overgeneralized excuse, dryness is definitely a cause for why sex hurts. Women typically experience vaginal dryness when their estrogen levels are low, commonly during the postpartum and menopause phase. The dryness can cause pain with penetration due to the friction but can be helped by adding a good quality lubricant. It is possible that if you have been using a lubricant, that it is not the right kind for you and it might soak in too quickly, leading to increased discomfort.

The Road to Pain-Free Sex

The most important thing that you need to know is that you don’t have to tolerate this, and it can get better! No, the pain won’t magically disappear, but you can start tackling this issue by identifying the root of your pain! Because there are several different potential causes for why sex hurts, it is best to have an evaluation by a pelvic floor physical therapist to determine the exact cause.

It is difficult to treat these issues on your own since there aren’t any specific exercises that will eliminate the pain. However, I want to stress that most women find relief within a few sessions of pelvic floor physical therapy where they are able to perform manual techniques that address the issue. We have found that the women we work with are able to improve to a point where they can have sex without pain. It is not something that is all in your head, and you don’t just need to relax more. Your pain is real and there are treatment options available to help you get rid of it!

If you are ready to take the next step towards a pain-free sex life, request a FREE Sex Assessment with one of our physical therapists and learn more about what we can do for you.