Painful sex isn't normal. Here's how to heal it

You can heal. Painful sex is not a life sentence.

Painful sex is common, but it’s not normal.

And if sex hurts, that doesn’t mean your body is broken. It means your body is speaking to you. And it’s time to start listening—with care, curiosity, and compassion.

Here’s what I need you to know: You’re not alone. You don’t have to push through. You can heal painful sex and get back to experiencing pleasure.

Pain during sex is more common than you think

Almost half of Australian women (47%) have experienced pelvic pain in the past five years, according to the 2023 Jean Hailes National Women’s Health Survey.

But what’s really alarming is this:

• 50% of those women didn’t talk to a doctor about it.

• 35% felt there was nothing that could be done.

• 69% didn’t think their symptoms were “bad enough” to justify seeking help.

• Only 19% felt they had the information they needed to manage their symptoms.

Painful sex is often a side effect of pelvic pain conditions.

This breaks my heart. Pain during sex is not something you just have to live with. It’s a signal, not a life sentence.

What is painful sex?

The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh). Sexy! It refers to pain that occurs before, during, or after sex. You might feel:

• A sharp, stinging sensation at the vaginal entrance

• A deep, aching feeling in the pelvis or lower belly

• Burning or cramping sensations; sometimes after orgasming

• Pain that makes penetration difficult or impossible

These pain sensations can last throughout the full duration of penetration or can disappear or lessen in intensity after a while.

Causes of painful sex

1. Physical causes

• Lack of lubrication (due to low arousal, hormones, breastfeeding, medications, perimenopause/menopause)

• Infections or irritation (thrush, UTIs, eczema, dermatitis)

• Pelvic floor dysfunction or vaginismus

• Endometriosis, adenomyosis, fibroids, IBS

• Scarring from surgery or childbirth

• Hormonal shifts or vaginal atrophy
  

2. Emotional causes

• Stress and anxiety (and when you’re feeling stressed, your pelvic floor muscles tend to tense, which tightens the pelvic floor)

• Shame, fear, or trauma around sex

• Low self-esteem or relationship tension

• Negative past experiences with sex or intimacy
  

Understanding the fear/pain cycle

If you experience painful sex, it can feel like your body is working against you. But what’s actually happening is that your nervous system is trying to protect you from a perceived threat, even if that threat isn’t “rational.” The first step to healing painful sex is understanding the fear/pain cycle.

Let’s unpack what’s going on in the brain and body during this cycle:

Phase 1: Anticipating pain Painful sex activates your amygdala, the fear centre of the brain. Even if you want to be sexual, your brain goes into high alert, interpreting sex and penetration as a threat. 

Phase 2: Muscle guarding/bracing In response to the perceived threat of penetration, your pelvic floor muscles tighten reflexively, especially around the vaginal opening. This is called muscle guarding or muscle bracing. It’s your body’s way of trying to protect itself. Over time, this tension can become chronic and your pelvic floor muscles stay in a clenched, hypervigilant state even outside sexual contexts.

Phase 3: Vulvovaginal pain When penetration is attempted (by a finger, penis, sex toy, tampon, or menstrual cup), the tightness in your pelvic floor makes penetration difficult or impossible. You might feel burning or stinging, a sensation like “hitting a wall”, or sharp or throbbing pain afterwards. 

Phase 4: Negative reinforcement If you experience the pain that your body was guarding against, this intensifies the reflexive muscle guarding response. This confirms your brain’s belief that sex is dangerous. Over time, the brain and nervous system begins to associate any sexual or intimate cue with danger.

Phase 5: Sexual avoidance Eventually, you start to avoid sex altogether. This might look like:

• Avoiding intimacy, cuddling, and affection out of fear it might lead to sex

• Flinching when touched

• Feeling guilt, shame, grief, or like you’re “broken”

• Losing interest in sex entirely

Avoiding sex may seem like the only safe option, but it can also reinforce the cycle. The amygdala gets “proof” that sex is dangerous, and continues to blare the alarm.

TLDR: Pain during sex creates anxiety. Anxiety creates muscle tension. Tension makes sex more painful. And the cycle repeats.

It’s not all doom and gloom, though. The fear/pain cycle can be broken, and you can rewire your responses from pain into pleasure.

Low libido? Or just trying to avoid pain?

Unsurprisingly, many people who experience painful sex also experience low desire. Often in session, women and vulva-owners will present with low desire, wondering if there’s something wrong with them for their declining interest in sex. Then I discover that the sex they’re having really fucking hurts.

Low desire isn’t the problem here; painful sex is. Desire is a motivational state; it’s an interest in or a wanting for sex. Who is going to yearn for something that hurts? Not many, if any.

Painful sex makes it hard to feel safe. And when you don’t feel safe, desire doesn’t stand a chance.

Why pleasure is vital to heal painful sex

You do not need to force yourself to “push through.” You do not need to tolerate unwanted pain. You do not need to override your body to keep your partner sexually satisfied.

The key to healing painful sex is reconnecting with your pleasure in small, gentle, non-threatening ways.

This might look like:

• Slow, intentional touch with no goal of penetration

• Exploring what feels good, not what looks “normal”

• Understanding how your arousal process actually works

Pleasure is one of our greatest resources, and healing painful sex means rewiring our relationship with pleasure.

The importance of arousal

It takes vulvas 20–40 minutes to become fully physiologically aroused. In that time, your body:

• Lubricates

• Swells with blood flow, sensitising erectile tissue

• Tents (the vagina lengthens and widens, and the cervix moves up and out of the way)

• Relaxes the pelvic floor

• Becomes receptive to penetration

If penetration starts before your body’s ready, pain is almost guaranteed.

So what can you do about it?

• Take penetrative sex off the table temporarily. It’s okay to pause. This can reduce pressure and anxiety around sex.

• See a pelvic floor physio or sexologist. (Or ideally, both!)

• Use a high-quality lubricant. Every time. No exceptions.

• Explore non-penetrative pleasure. Sensual touch, massage, play.

• Try products like the OhNut to help manage depth and pressure.

• Learn how to regulate your nervous system. Breath, movement, presence.

When you work with a pelvic floor physiotherapist or sexologist, your treatment for painful sex will include things like: pelvic floor desensitisation and relaxation exercises, breathwork, dilator therapy, pain education, and addressing unhelpful beliefs or fear and anxiety around sex.

The role of cannabis in healing painful sex

Cannabis can be a powerful ally—especially for those dealing with chronic pain, pelvic tension, or anxiety. Cannabis is a vasodilator, meaning it opens up blood vessels, resulting in increased blood flow to the pelvic floor, which supports sexual arousal. The cannabinoids in CBD and THC have potent anti-inflammatory and analgesic effects. Some ways it may help:

• Topical cannabis (e.g. balms, pessaries or suppositories) for localised pain relief

• Ingested cannabis (if legal and suitable) to reduce anxiety and enhance pleasure

• Heightened body awareness, making it easier to notice what feels good vs what doesn’t

Cannabis is not a magic fix, but it can be part of a multi-pronged approach. Consult your healthcare provider for guidance on whether cannabis is suitable for you and abide by all local regulations.

You don’t have to do this alone—and you’re not broken

If you’ve been silently pushing through painful sex…

If you’ve felt disconnected from your body…

If you’ve been told “it’s all in your head” or “just have a glass of wine and relax”…

Please know this: Your body is not broken. You are worthy of pleasure. Healing is possible.

Painful sex can be heartbreaking, confusing, and isolating—but it is treatable. You deserve sex that feels good.

Let’s rewrite the story (and get back to pleasure) together. Book a 1:1 session with me to explore gentle, practical, personalised support to help you heal painful sex and reclaim your pleasure.