What Can Cause Discomfort During Intercourse? A Pelvic Health Specialist Explains
If you’re wondering why intercourse hurts, this guide is written from a pelvic health specialist's point of view and breaks down the medical, muscular, hormonal, dermatological, bowel, bladder, and neurological causes of painful sex and explains how pelvic floor physical therapy helps relieve discomfort.
Let’s talk about something a lot of people experience but very few feel comfortable bringing up: discomfort during intercourse. It can be confusing, discouraging, or even scary when intimacy doesn’t feel the way you think it “should.” Many people assume pain is normal or that experiencing pain during sex is something they just have to live with at some point in their lives. Neither is true.
Just because pain during sex is common does not mean it is normal.
Not if you have had a baby.
Not if you have never had sex before.
Not if you have had sex for years.
Not if someone once told you that you are “too small.”
Not if you think your partner may be “too large.”
Not if you’ve had bladder infections, sensitive skin, or anything else on that list.
Read more about how pain during intercourse is not normal, even though it’s normalized.
Certain factors can make someone more likely to experience discomfort during sexual activity. For example, healing from a tear after childbirth can take time, and postpartum hormones often create dryness and irritation. But even then, pain is not something you should ever be expected to push through.
There are many reasons someone might have pain with intercourse, and almost all of them are treatable once you understand what is happening in the body.
Below are some of the most common causes we see as pelvic health specialists. Our goal at Southern Pelvic Health is to help you improve your sexual health, which in this case means decreasing/getting rid of any pain you are having with intercourse.
Cause #1: Pelvic Floor Muscle Tension
Your pelvic floor muscles support your organs, influence bladder and bowel function, and play an enormous role in sexual comfort. When these muscles are tight, overactive, or unable to relax, penetration may feel sharp, burning, or “blocked.” Some folks describe it as hitting a wall or experiencing a "deep pain."
Pelvic floor tension can develop from stress, chronic clenching, childbirth, high-intensity workouts, repeated painful experiences, or even years of bracing without realizing it. With the right treatment, these muscles can learn to lengthen and relax again.
Cause #2: Decreased Lubrication or Hormonal Shifts
Lubrication affects comfort, and vaginal dryness is one of the most common contributors to pain. It can stem from breastfeeding, postpartum hormone changes, perimenopause, menopause, certain medications, and inadequate time for arousal. Oftentimes, we'll hear this described as "pain during penetration" or "insertion pain".
External lubricants, moisturizers, and occasionally hormonal support can make a huge difference. Pelvic PT can also help you understand how lubrication, tissue health, and muscle tension all interact.
Cause #3: Inflammation, Dermatological Conditions, or Sensitive Skin
Conditions like dermatitis, lichen sclerosus, or general skin sensitivity can make intercourse uncomfortable. Inflammation from previous infections or irritation from products like soaps, lotions, and detergents can also contribute.
These are treatable with the right combination of medical care, pelvic PT, and skin-friendly strategies.
Cause #4: Scar Tissue or Postpartum Changes
Scar tissue from tearing, stitches, or a Cesarean can limit tissue mobility. Even small scars can create pulling, stinging, or stretching sensations during intercourse, which can lead to painful sensations.
Pelvic PT can help improve scar mobility, reduce sensitivity, and restore comfort over time using gentle, evidence-based manual techniques.
Cause #5: Bowel or Bladder Dysfunction
Constipation, pelvic pressure, or bladder irritation can all affect how intercourse feels. Bowel dysfunction can especially create tension throughout the entire pelvic floor. If you are straining often or holding back bowel movements, discomfort during intimacy can show up as a result.
Working on bowel mechanics can make a big difference in sexual comfort.
Cause #6: Orthopedic or Musculoskeletal Factors
Your hips, low back, and abdominal wall all influence pelvic floor tension. Limited hip mobility, low back pain, or core instability can lead to compensations and muscle irritation and relaxation issues, which manifest as pelvic floor muscle tension, as discussed above. All of these show up as discomfort during intercourse.
Pelvic PT evaluates the whole system, not just the pelvic floor.
Cause #7: Conditions like Endometriosis or Painful Bladder Syndrome
Deep pelvic or abdominal pain during intercourse may be related to inflammation or sensitivity within the pelvic organs. This type of discomfort often feels different: deeper, positional, or achy.
Pelvic PT can play a powerful role in reducing pelvic floor tension and improving mobility, which assists with the treatment of these specific diagnoses and, as a result, decreases pain during intercourse.
Cause #8: Nervous System Dysregulation
The nervous system can become overprotective when it has experienced pain, trauma, childbirth, or ongoing pelvic tension. This heightened sensitivity can make intercourse more painful, even when the tissues look normal.
A pelvic health provider can help retrain these pathways through gentle desensitization, movement, and education.
So, What Can Help With Pain During Intercourse?
There are many treatment options depending on the cause. These may include:
Finding the right moisturizers or lubricants for your body
Addressing hormonal changes
Gentle pelvic floor manual therapy
Home exercises tailored to your needs
Scar tissue mobility work
Education on positioning, relaxation, and breathing
Other medical interventions when indicated
Pelvic health physical therapy is often the missing piece. Treatment is gentle, individualized, and focused on helping you feel better for the long term.
Where to Find Pelvic Therapy for Pain with Intercourse in Marietta and Atlanta
Pain during intercourse is not something you need to tolerate.
If intercourse has been uncomfortable, you deserve answers, support, and options that help you feel like yourself again. At Southern Pelvic Health, we offer comprehensive pelvic therapy care for those who are experiencing pelvic pain with intercourse and would love to help you.
To get started or ask more questions, submit our contact form.