Painful Sex Isn’t Always “In Your Head”

If sex has started hurting, or has always hurt and you’ve just quietly gotten used to it, I want to say something before anything else: this is far more common than you think, and it is very, very treatable. Somewhere between one in five and one in three women deal with painful intercourse at some point. Most of them never bring it up with a doctor. Not because it isn’t serious, but because it feels awkward to say out loud, or because someone once told them it’s “just stress” and they believed it.

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It’s usually not just stress. And it’s almost never something you have to live with.

First, you’re not overreacting, and it’s not “normal”

A lot of women get told, directly or indirectly, that some discomfort is just part of the deal. It isn’t. Sex isn’t supposed to hurt. If it does, whether it’s a burning feeling, a tearing sensation, deep pelvic pain, or just a tightness that makes penetration difficult, that’s information your body is giving you, not something to push through.

The good part is, pain like this almost always has a specific, findable cause. Once we know what it is, treating it is usually far more straightforward than women expect.

So what’s actually going on?

There isn’t one single cause, which is exactly why “just relax” or “it’s probably anxiety” is such unhelpful advice. Here are the things I actually look for in a consultation:

Vaginismus. This is when the pelvic floor muscles involuntarily tighten at the idea of penetration, making it painful or sometimes impossible. It’s a real, physical muscle response, not a woman “not wanting it enough” or being uptight. It responds well to a combination of pelvic floor therapy and, in some cases, gentle medical guidance.

Vaginal dryness or atrophy. This shows up a lot postpartum, during breastfeeding, and around perimenopause and menopause, when estrogen drops. The tissue becomes thinner and less lubricated, and friction that never used to be an issue suddenly is. This one is often the easiest to treat. Sometimes it’s a simple, non-surgical fix.

Infections or skin conditions. Recurrent yeast infections, bacterial vaginosis, or certain skin conditions in the genital area can cause pain that gets mistaken for something else entirely, especially if it’s been going on for a while and started to feel “normal.”

Scar tissue. From childbirth, an episiotomy, or a previous surgery, scar tissue can pull or restrict in ways that cause pain specifically during penetration, even when everything else feels fine.

Pelvic floor tension unrelated to vaginismus. Sometimes it’s not about fear of penetration at all. The pelvic floor muscles are just tight or overactive, often connected to stress held physically in the body, or to other conditions like endometriosis.

And yes, sometimes there is a psychological layer too. Past experiences, anxiety, or relationship context can absolutely contribute. But here’s the thing: even when there’s a psychological piece, there’s very often also a physical one sitting underneath it. Treating only the mind when the body also needs attention rarely solves it completely. That’s why I don’t start with “let’s talk about your feelings” or “let’s just look at your anatomy.” I start with an actual examination to see what’s really happening, and go from there.

Why this gets missed so often

Because it’s uncomfortable to bring up, women often don’t mention it until years in. And when they do bring it up, it sometimes gets brushed off with “that’s just how it is after childbirth” or “you’ll adjust.” You don’t have to adjust to pain. That’s not a reasonable standard for anyone to hold you to, including yourself.

What actually happens in a consultation

It starts with a conversation, not an exam first, a conversation first. I want to understand when the pain happens, what it feels like, when it started, and what else is going on for you (postpartum, menopause, a specific incident, or nothing you can point to at all). Then an examination, done gently and only with your comfort in mind, to actually see what’s going on physically.

From there, treatment could be pelvic floor physiotherapy, addressing dryness or atrophy, treating an underlying infection, managing scar tissue, or occasionally a referral alongside a pelvic floor specialist or therapist if the psychological piece needs its own dedicated support. It’s rarely one single fix, but it’s also rarely as complicated or as permanent as it feels right now.

If this has been sitting with you quietly for a while, that’s a completely reasonable place to be starting from. You don’t need to have it all figured out before you come in. That’s actually my job to help with, not yours.

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FAQ

Is painful sex always a sign of something serious? Not necessarily. Many causes, like dryness or mild vaginismus, are very manageable and not a sign of anything dangerous. But it’s always worth getting checked, since some causes (like endometriosis or infections) do need proper treatment rather than just time.

Can painful sex go away on its own? Sometimes mild, situational discomfort resolves on its own, but ongoing or recurring pain usually needs some form of treatment to actually go away, rather than easing with time alone.

Is this something I need surgery for? Rarely, as a first step. Most causes are treated with non-surgical options: physiotherapy, topical treatments, or addressing an underlying condition. Surgery is only relevant in specific situations, like significant scar tissue.

I’ve had this for years, is it too late to do something about it? No. It’s genuinely never too late to address this, whether it started once or has been there for a decade.