When Nicole started having pain during intercourse nearly a decade ago, she was determined to find a solution.
After consulting with multiple specialists, she was diagnosed with labial hypoplasia, a condition in which her outer labia were only partially formed. Following surgery to correct the issue, she found significant relief and remained relatively pain-free, incorporating yoga into her routine to further support her healing.
But the pain returned six years later, this time during the initial stages of penetration.
The 33-year-old California resident has been fighting for three years to receive a formal diagnosis, as the root of her discomfort remains unclear. She requested that only her first name be used out of privacy concerns.
“I get a lot of ‘it’s probably anxiety or related to mental health,’” she said. “It’s disappointing since I made a ton of progress and now feel like I’m being tossed aside.”
Nicole’s experience of painful sex isn’t unique. Nearly 3 in 4 women will experience painful intercourse at some point in their lives, whether it’s a temporary or long-term problem, according to the American College of Obstetricians and Gynaecologists.
“Sex should never be painful,” said Eva Dillon, a sex therapist based in New York City. “It’s something that women should never have to endure.”
What causes pain during intercourse?
Painful intercourse can be caused by several common issues.
Women who experience pelvic pain or pain with sexual activity, gynaecological exams or tampon use may have tight pelvic floor muscles.
The condition can increase tension and cause pain, according to Dr. Anna Falter, a physical therapist specialising in pelvic floor therapy at the Cleveland Clinic, via email.
Pelvic pain can also be linked to tightness in other areas of the body, including the neck, lower back and hips — issues that might not immediately seem connected to sexual discomfort. Stress, previous surgeries, traumatic experiences or even unconscious muscle tensing can also contribute to this pain.
Additionally, hormonal changes, such as decreased estrogen levels during menopause or postpartum, especially while breastfeeding, can lead to vaginal dryness, which can make intercourse uncomfortable or painful.
Getting treatment
For women experiencing pelvic floor muscle tension, pelvic floor physical therapy is often an effective treatment option to reduce pain and prevent muscles from becoming overly tight in the future, Falter said.
One commonly used technique in pelvic floor physical therapy is trigger point therapy, which involves applying pressure to tight muscles to help them relax. A pelvic floor physical therapist may perform this method vaginally, using a gloved and lubricated finger to target and massage specific tight areas or trigger points, Falter said.
Patients can also learn to perform self-trigger point release at home using their own fingers, a partner, a pelvic wand or vaginal dilators to help relax the internal muscles.
Falter also noted that partners are welcome to attend pelvic floor therapy sessions, where they can learn strategies to support their partner if both parties are comfortable.
Another approach is pelvic floor lengthening exercises, which differ from the more commonly known Kegel exercises, Falter explained. Lengthening involves relaxing the pelvic floor muscles, often paired with diaphragmatic breathing, where the patient inhales deeply, allowing their abdomen, rib cage and pelvic floor to relax.
This movement is more challenging, so Falter recommends seeking help from a pelvic floor physical therapist to ensure you’re using the proper form.
Falter also advises women to check in with their bodies throughout the day, especially during activities such as brushing their teeth or sitting on the couch, to check that they aren’t unconsciously tensing their pelvic muscles.
Certain yoga poses and stretches, such as child’s pose, butterfly stretch and deep squat, can help release pelvic tension.
Still, it’s good to remember that seeking individualised treatment is always the best approach, Falter said.
Supporting a partner experiencing pain
If your partner is experiencing pain during sex, there are steps you can take to provide comfort and support.
Most importantly, if there’s any pain during intercourse, it’s crucial to stop immediately. Continuing despite discomfort can create negative associations between sex and pain, making future encounters even more challenging.
“At the end of any sexual encounter, you want to be able to look forward to the next time with anticipation and delight,” Dillon said. “And, if sex is painful, you can begin to dread the next time, and it sets up a cycle, which you don’t want.”
Communication is also key, and it’s important for both partners to be open and understanding about the pain and treatment journey, especially if shame or feelings of inadequacy arise.
“It can be helpful if the partner takes time to learn about what their partner is experiencing, as well as the treatment strategies they are working on, so they can support and encourage them through the treatment journey,” Falter said.
For couples who are temporarily unable to engage in intercourse, there are still many ways to stay connected physically. Dillon recommends trying outercourse — non-penetrative sexual activities like manual stimulation or oral sex — to maintain intimacy and pleasure.
If intercourse or other forms of sexual activity are off the table, simple gestures such as a meaningful kiss or affectionate hugs can strengthen the emotional bond between partners.
“These (forms of touch) are really important for us,” Dillon said. “They tell our nervous systems we’re safe and not alone.”
Physical intimacy is still important
Despite the lack of a clear diagnosis, Nicole has not given up on her desire for a fulfilling intimate relationship. Alongside her partner, she has taken matters into her own hands, exploring alternative solutions.
“I tend to feel really frustrated with my body and the pain since I don’t want to have these issues,” Nicole said via email. “Physical intimacy can be such a huge part of a relationship, and sometimes I feel like I’m missing out.”
Nicole and her boyfriend have found creative ways to maintain intimacy without intercourse or penetration. They have also incorporated pelvic floor therapies into their routine, which have helped alleviate some of the pain during their intimate moments. But that doesn’t mean she lives without disappointment.
“There was a lot of education that had to be done, which cannot be so fun and sexy when things are new,” she said. “In the end, it has really brought us closer together and created a more emotional, intimate connection pretty early on since we had to have these less fun and pretty technical conversations.”
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