Pain With Sex During Vaginal Penetration (Dyspareunia): Causes and How Pelvic Floor PT Can Help

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Pain with vaginal penetration — whether during sex, tampon use, or a pelvic exam — can be confusing, isolating, and deeply frustrating. The medical term for this is dyspareunia, and although it affects millions of people, it’s rarely talked about openly.

Dyspareunia can feel sharp, burning, crampy, or achy. It might happen only with certain positions or activities, or it may linger long after the activity ends. For some, the pain is superficial — felt right at the vaginal opening. For others, it’s deeper in the pelvis. No matter how it shows up, it can affect your relationships, your self-image, and your connection to your own body.

Unfortunately, many people who bring this pain up to healthcare providers are told that it’s “normal,” or worse — that it’s all in their head. That response misses the mark.

Why traditional pelvic floor PT may not fully address pain with vaginal penetration

Many people with dyspareunia have tried physical therapy before — sometimes even pelvic floor PT — and still feel like they didn’t get the results they were hoping for. That’s not because their pain isn’t real or treatable. It’s often because the care they received didn’t fully address the complexity of what was going on.

Dyspareunia is rarely caused by just one issue. Pelvic floor muscle dysfunction may be part of the picture, but factors like nervous system sensitization, bowel or bladder dysfunction, hormonal shifts, orthopedic movement patterns, or trauma history often play a role too. If pelvic floor physical therapy focuses only on releasing tight muscles or strengthening the pelvic floor — without addressing these interconnected systems — progress may stall or plateau.

In some cases, people may have only received internal work without movement integration. In others, they

may have done general orthopedic rehab without connecting symptoms to the pelvic floor. This isn’t a failure of effort — it’s a sign that more individualized, whole-person care is needed.

At Empower PT, we’re trained to look at the full picture. We combine pelvic floor expertise with orthopedic skill, trauma-informed care, and nervous system support to help you move beyond “just managing” pain — and toward lasting, meaningful change.

How we assess dyspareunia at Empower PT

Our first priority is helping you feel safe and heard. We begin with a thorough conversation, not just about your symptoms, but about your medical history, hormonal shifts, bowel and bladder patterns, and any injuries, surgeries, or traumas that may be relevant that you are comfortable sharing — even if they seem unrelated.

We then assess how your body moves with and without load — including your breathing patterns, abdominal coordination, and the way your pelvis, spine, feet, and hips interact. We examine muscle and fascial tension in the surrounding areas and may assess pelvic floor muscle function either externally or internally, depending on your comfort. Internal assessment is never required — and many clients make meaningful progress with external-only care.

What sets our evaluation apart is the way we connect all these dots. We don’t treat one isolated muscle or symptom — we treat the person as a whole.

How we treat dyspareunia at Empower PT

No two people with dyspareunia have the exact same needs — which means no two care plans are the same.

For some, treatment begins with downtraining overly active pelvic floor muscles and learning how to fully release. For others, it’s about rebuilding strength, timing, and coordination. We often address bowel and bladder habits that may be contributing to pelvic tension, and we use breathwork and nervous system techniques to help reduce sensitivity and increase a sense of safety in the body.

Movement and strength work are a key part of our process — not just to build capacity, but to reconnect you to your body in a way that feels empowering and clear. We also use somatic and sensory reintegration techniques to support embodiment and connection, especially if there’s a history of trauma or disassociation.

Healing timelines vary depending on how long symptoms have been present and what factors are involved, but most people start to feel shifts within the first few sessions — not just in terms of pain, but in confidence, connection, and understanding of their body. 

Our goal isn’t just to reduce pain during vaginal penetration — it’s to help you rebuild trust in your body and feel grounded, capable, and in control again.

Simple Starting Point for Pain with Sex: Releasing Protective Tension

While every treatment plan is different, a foundational place many people begin is learning to recognize and release unconscious pelvic tension. Gentle, diaphragmatic breathing with attention to the pelvic floor can be a powerful tool. We often pair this with supported positions, like lying down with feet elevated or child’s pose, to help create a sense of safety and ease.

The Empower PT Approach to Pelvic Health

Pelvic pain doesn’t exist in a vacuum. It’s connected to how we move, how we relate to our bodies, how we manage stress, and how our systems have learned to protect us over time. That’s why we take a multi-dimensional approach to care — one that includes education, strength, embodied awareness, and nervous system support alongside any needed manual therapy or pelvic floor work.

We also believe in making this care sustainable — meaning we teach you tools you can continue to use and adapt over time, whether you’re navigating physical or sexual intimacy, returning to exercise, or just learning to feel safe in your body again.

Reclaiming Connection and Confidence with Physical Therapy

Dyspareunia can make you feel like your body is working against you, especially when you’ve been dismissed, misunderstood, or told to “just relax.” But pain with penetration isn’t something you have to push through or figure out on your own. With the right care, it’s possible to understand what’s going on, unwind the layers contributing to your symptoms, and start to rebuild trust in your body.

At Empower PT, we don’t just treat pelvic floor muscles; we support the whole person. That includes movement, strength, nervous system regulation, and restoring a sense of connection to your body and your life. Healing is not linear, but you don’t have to go it alone. We’re here to walk alongside you every step of the way.

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Want to Learn More? Start Here

If you’re looking to understand more about how stress, desire, and nervous system regulation affect sexual comfort, we recommend:

• Come As You Are by Emily Nagoski, PhD – a must-read for understanding desire, arousal, and context in sexual health

• My Grandmother’s Hands by Resmaa Menakem – a powerful look at how trauma lives in the body and how somatic healing can begin

  
  

Ready to feel like yourself again? Book a free consultation call to learn more about working with Empower PT.