What Causes Painful Sex? Understanding Dyspareunia and Relief Options
Painful intercourse, also known as dyspareunia, can show up as pain before, during, or after sex. It can be experienced by people of all genders, bodies, and lived experiences.
While it’s more common than many people realise, it is never something you are expected to tolerate, push through, or normalise.
It’s important to remember that pain is information. It’s your body’s way of communicating that something is out of balance, and a sign that your body is asking for support.
What Causes Painful Intercourse?
Painful intercourse can feel like burning, stinging, sharp or deep aching pain, tightness, tearing, or pressure, and may occur at the entrance, with penetration, certain positions, ejaculation, or even after sex.
There are many reasons pain may occur, including:
Hypertonic Pelvic Floor: Overactive or tight pelvic floor muscles. This can develop in response to stress, trauma, chronic pain, or repeated “holding” patterns in the body.
Recurrent Genital Infections (vaginal or penile): Frequent thrush, bacterial vaginosis, balanitis, or other genital infections can leave tissues feeling inflamed, fragile, burning, or prone to tearing, even after the infection itself has resolved.
Endometriosis: Those with endometriosis may notice pain occurring at specific angles or depths, making certain positions more uncomfortable than others.
Vaginismus: An involuntary tightening of the vaginal muscles that can make penetration painful or impossible. This is often linked with nervous system responses rather than conscious control.
Vulvodynia: Chronic pain or discomfort of the vulva, often described as burning, stinging, or rawness, without an obvious cause after testing.
Penile Tissue or Foreskin Tightness (penile anatomy): Pain during sex may arise from skin or tissue changes, inflammation, micro-tearing, or tightness or retraction issues of the foreskin, particularly during erection or penetration.
History of Trauma: Sexual, medical, or emotional trauma can be held within the body, influencing muscle tone, tissue sensitivity, and nervous system responses, often without conscious awareness.
The Pain-Tension-Fear Cycle
Once the body experiences pain, it tries to protect you from experiencing that pain again.
The brain learns: “this activity isn’t safe.” When this occurs during sex, it can disrupt the ability to feel pleasure or enjoy the experience and it leads to a detrimental feedback loop:
pain → fear of pain → muscle tightening → more pain
This response is an adaptive survival mechanism, and it’s important to know that it does NOT mean that your body is a failure, wrong, or broken.
If you are experiencing painful intercourse, the work is about gently teaching the body that safety is possible again, and breaking out of the negative feedback loop.
How To Reduce Pain During Intercourse
As with all painful experiences, it’s best to consult a team of experts to help bring your body back into balance. This may include:
Naturopathic support to optimise tissue health, restore microbiome balance, support hormones, and nutritional status
Pelvic floor physiotherapists to assess and retrain muscle tone
Somatic therapists to support nervous system regulation and embodied safety
Sex therapists to gently address fear, intimacy, and relational dynamics
Depending on the cause of painful intercourse, the treatment plan may look at supporting the nervous system, increasing specific nutrient intake, identifying personal triggers of pain, and investigating underlying infections.
By supporting the nervous system, you can reduce unconscious muscle guarding, improve blood flow and tissue hydration in the genitals, and interrupt the learned anticipation of pain.
There is also promising research emerging around the role of specific nutrients in conditions such as vulvodynia and chronic vulvar pain. Key nutrients that may support vulvar tissue health, nerve function, and inflammation regulation.
It’s also important to investigate and rule out any underlying infections, past or present, that may be causing tissue damage and contributing to the pain. These investigations are integral, alongside maintaining a balanced vaginal ecosystem.
Remember: Healing rarely happens in isolation and you don’t have to navigate this alone. Call upon your village of support, so that you can work toward safe and pleasurable sex again. With the right support, many people experience profound improvement, relief, and a renewed sense of trust in their bodies.
At Botanical Abundance, we approach painful intercourse not as a single issue, but as a whole-body experience, shaped by tissue health, hormones, the nervous system, emotional history, and lived experience.
Reach out today to book your first appointment and start your journey toward pain-free intercourse.