Pain with Sexual Activity

Painful intercourse, also known as dyspareunia, can occur before, during, or after sexual intercourse (penetrative or non-penetrative) and generally refers to any pain in the genitals with sexual activity.  Some people may have pain with external touch, initial penetration, deep penetration, during/after orgasm, or following intercourse.  In addition to painful intercourse, people commonly have pain with gynecological exams and feminine product use as well.  We know this can be a very embarrassing topic to talk about, however we believe that no one should have to suffer from painful intercourse, gynecological exams, or feminine products.  Our pelvic health specialist is highly trained in these issues and is ready to help you get out of pain and get back to your active lifestyle.

One of the most common reasons for pain with intercourse, gynecological exams, or feminine product use is a combination of pelvic floor tightness/muscles spasms and vaginal dryness.  Vaginal dryness is most common during the first few months postpartum or post-menopause due to hormone imbalances that can affect the hydration of vaginal tissue, however some people may have it from an early age with no specific incident causing it.  Due to the body’s protective response to pain, it can be common to also see pelvic floor tightness/muscles spasms.  Both issues can usually be resolved with the help of a pelvic health physical therapist who will help find the proper vaginal lubrication and assure the pelvic floor muscles are functioning appropriately for decreased pain.

Postpartum women who have had any perineal tearing (grade 1-4) or an episiotomy during child delivery (whether recent or several years ago) are also more likely to experience painful intercourse and gynecological exams due to possible scar tissue build-up and/or tissue sensitivity.  Regardless of how extensive the scar and how long you have had it, pelvic health physical therapy can help to decrease the pain and tightness, which will help to minimize pain with intercourse.

Vaginismus is another common reason for pain with intercourse, gynecological exams, or feminine product use, and is the involuntary contraction or spasm of pelvic floor muscles around the opening and inside of the vagina.  This condition is commonly due to tight pelvic floor muscles and can be exacerbated by anxiety, fear, or previous history of trauma.  Regardless of why you are having these issues, a trained pelvic health physical therapist can help you work through this pain in conjunction with your primary care doctor and therapist if requested.

Other things that can contribute to painful intercourse include injury/trauma, vulvar tissue sensitivity, inflammation/irritation, congenital abnormality, reproductive organ diseases/illness, prolapse, post-surgical, and various psychological factors.  If you have not found what you are looking for in the above descriptions, please feel free to reach out to our specialty trained pelvic health physical therapist for more information and to address your specific concerns. 


Do I need a referral from my physician?

North Carolina is a direct access state for physical therapy services therefore a physician’s referral is not required unless you are using Medicare insurance. We do communicate with your medical providers as needed to improve your care.

What will happen at the initial consultation?

A complete physical evaluation is completed based on your concerns. Often this includes examination of your movement, core and pelvic floor muscles as indicated. Treatment and begin the same day as the initial consultation.

How many sessions will I need?

Together we will develop your treatment plan based on your needs. The exact number of visits is unique to symptoms but on average our patients benefit from 6-8 treatment visits.