FREE Pregnancy

Request A Callback

Fill in your details and our team will get back to you shortly.
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Request A Callback

Effective help for painful intercourse – Physiotherapy

May 17, 2022

Have you ever had painful sex, even when you go overboard on lubricants?  Then you complain you feel extremely itchy down there. All of this kind of ruins everything about sex, I just can’t get 100 percent comfortable. What can I do?

Its Pelvic floor myalgia (muscle soreness) is otherwise known as Vaginismus. It is a common cause of sexual pain and is the condition associated with the involuntary tightness of the pelvic floor muscles. For many women, the state of their pelvic floor muscles is not obvious unless there is an attempt to introduce something into the vagina. Then the muscles can contract or clench leading to pain with vaginal penetration. This can be experienced commonly with intercourse, tampon use or speculum insertion. The pain is often described as soreness, burning pain or dull ache. Some women feel like there is a “blockage or wall” inside the vagina preventing penetration. Occasionally urination and defecation can also be affected and become difficult or abnormal.

Prevalence is thought to be up to 15% of women who suffer with vaginismus. However, the literature states that 1 in 4 women have pain with sex regardless of what the cause is.

Book an Appointment with Ms. Shazia Shadab for all the concerns related to physiotherapy.

Vaginismus Types:

There are various types of vaginismus that can affect women at any age. The types include:

  1. Primary Vaginismus:

This is a condition in which the pain has always been present lifelong at any hint of vaginal penetration i.e., while inserting tampons, penetration during sex etc. Women suffering from this condition experience pain during their first attempt at sexual intercourse and very often their relationship remains unconsummated. It’s also called lifelong vaginismus.
Their male partners often get the feeling of hitting against a wall when attempting to insert the penis into the vagina. These women also experience pain while attempting to insert a tampon. The pain disappears as soon as the attempts to penetrate the vagina stops.

  1. Secondary Vaginismus:

This is a condition which occurs when vaginal penetration is extremely painful due to a specific event such as gynecological surgery, menopause, yeast infection, childbirth, any traumatic event or some sudden relationship issues. Women suffering from secondary vaginismus usually have already experienced normal sex life. Some women develop vaginismus after menopause which occurs when there is a decrease in estrogen levels in the body and the vagina becomes dry and loses its elasticity. Adequate lubrication in the vagina does not happen which makes sexual intercourse painful. It’s also called acquired Vaginismus.

  1. Situational Vaginismus:

Situational vaginismus as the name itself suggests occurs in certain situations. In this form of vaginismus, pain may occur while having a sexual intercourse but not while inserting a tampon. Or it may occur only during pelvic exams. The pain may also occur while having sex with one partner but not with others.

  1. Global Vaginismus:

This type of vaginismus can be triggered by any object in all situations, for example, pelvic exam, tampon insertion, and sexual intercourse.

Vaginismus - cause and effect:

"Over movement of the pelvic floor muscles can occur step by step, or as the result of a trigger inside the body - potentially an infection, or something that might have caused inconvenience in the genital region."

Other possible triggers for Vaginismus include:

  • A traumatic gynecological examination.
  • Sexual abuse or an episode of painful sex.
  • A belief that sex is shameful and unpleasant.


Source: InviTRA

 Some of the more common causes of vaginismus (tight pelvic floor muscles) include anxiety, stress, and back pain, abnormal holding patterns with urine or breath, traumatic childbirth experience, injury to the hips, SI joints or menopause. After the initial onset is put into play, a pain spasm cycle often is set into motion; unfortunately, this can become a self-perpetuating process.


  • Pain with tampon insertion
  • Pain with annual gynecological pelvic exam or pap smear
  • Pain with vaginal penetration
  • Pain with sex
  • Often pain is described as “It feels too tight down there”, “sharp pain”, “burning pain”, “aching and throbbing pain” during and after intercourse attempts.


Unresolved vaginismus can negatively affect a woman's sexual life and present a challenge for a couple.

  • Risk Factors
  • rape, other sexual assault, or attempted sexual abuse or assault
  • knowledge of (or witnessing) sexual or physical abuse of others, without being personally abused
  • domestic violence or similar conflict in the early home environment
  • fear of pain associated with penetration, particularly the popular misconception of "breaking" the hymen upon the first attempt at penetration, or the idea that vaginal penetration will inevitably hurt the first time it occurs
  • chronic pain conditions and harm-avoidance behavior
  • any physically invasive trauma (not necessarily involving or even near the genitals
  • generalized anxiety, stress
  • negative emotional reaction towards sexual stimulation, e.g. disgust both at a deliberate level and also at a more implicit level
  • strict conservative moral education, which also can elicit negative emotions
  • fear of losing control
  • not trusting one’s partner
  • self-consciousness about body image
  • misconceptions about sex or unattainable standards for sex from exaggerated sexual materials, such as pornography or abstinence
  • fear of vagina not being wide or deep enough / fear of partner’s penis being too large
  • undiscovered or denied sexuality (specifically, being asexual or lesbian)
  • undiscovered or denied feelings of being transgender (specifically, a trans man)

  • Vaginismus Treatment

Research published in the Journal of Sexual Medicine in 2018, indicated that 'women with vaginismus benefit from a range of treatments in almost 80% of cases'. NHS guidelines for vaginismus treatment focus on the use of graded vaginal dilators and desensitization with the help of the Pelvic floor physiotherapist, psychosexual counseling, relaxation techniques and sensate focus.

  • Proven assistance for painful sex

As a women’s health physical therapist, I see numerous women crushed by pain during sex. Kindly realize that there is hope, there is help—in most cases, there is even a fix/cure.

You probably think of painful sex (dyspareunia) and vaginal pain (provoked vestibulodynia or vulvodynia) as gynecological problems. So you might be shocked to learn that physical therapy is a big part of the solution.

This isn’t traditional physical therapy, of course. It’s a specialized type called pelvic floor physical therapy, and it’s provided by specially trained physical therapists. Pelvic floor physical therapy can dramatically reduce—even eliminate—vaginal and sexual pain. Its safe, delicate techniques have helped countless women enjoy pain-free, pleasurable intercourse.


When sex hurts, it is usually more than just skin-deep. Usually, it is a web of interconnected factors that affect the muscles, tissues, joints, bones, nerves, and skin.

Some patients subconsciously tighten their pelvic and vaginal muscles during sex in order to guard against more pain. Yet, the result is muscle spasm and even more pain. This is called secondary vaginismus.

Pelvic floor physical therapy reverses this vicious cycle and unravels the web of pain. It increases pelvic blood flow, releases trapped nerves, and reduces pain sensitivity. It relaxes, balances, stretches, and tones pelvic and vaginal muscles, restoring them to health

After pelvic floor physical therapy, most women begin to enjoy pain-free, pleasurable intercourse.

How does pelvic floor physical therapy work?

Each woman's circumstances vary, so each woman's treatment plan may differ. Here are some general guidelines:

Must Read: How to Address Stress and Depression During Pregnancy

Relax, release, and stretch

Your physical therapist will use manual (hands-on) therapy—for example, soft-tissue massage, trigger-point release, and myofascial release—to release tightness in your back, pelvis, abdomen, hips, and thighs. When you're ready, she will introduce these techniques inside your vagina. Both outside and inside, manual therapy increases blood flow, restores elasticity and mobility, reduces pain sensitivity, corrects structural imbalances, and melts away tender points and trigger points.

Additionally, your physical therapist will teach you pelvic floor exercises, such as pelvic drops, to relax your pelvic muscles and open your vagina. She may use a biofeedback machine to train you to isolate and release your vaginal muscles, as well as to track your progress. The process is safe and painless.

On the off chance that your hips, back, and legs are tight—maybe from sitting behind a work area consistently—your advisor might show you stretches to loosen up these spaces and open your pelvic floor.

If you’ve had a hysterectomy, C-section, or other pelvic surgery, your physical therapist may use manual therapy techniques to release adhesions (scar tissue). She may also use ultrasound or cold laser to heal and soften any painful vaginal tears or thick, sore scars.

-Overall, physical therapy, biofeedback and dilatory therapy are a successful and accessible treatment for pelvic floor muscle pain. Through careful evaluation and dedicated therapy, many women have had a reduction in their pelvic floor muscle pain and improvement in their ability to have sexual intercourse.


Kegels are not the solution

Contracting already tight pelvic floor muscles will likely make it worse and cause further spasming, perpetuating the cycle (as shown in the below image). 


It’s important speak out and seek help instead suffering silently   

Must Read: Behind Closed Doors: The Importance of Sexual Health Counselling

Want to consult the Best Physiotherapists in India? Please find the links below.

  1. Best Physiotherapists in Bangalore
  2. Top Physiotherapists in Chennai
  3. Best Physiotherapists in Mumbai
  4. Top Physiotherapists near me in Pune
  5. Best Physiotherapists in Chandigarh
  6. Top Physiotherapists near me in Gurgaon
  7. Best Physiotherapists in Noida

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.