Sex Shouldn’t Hurt! A Guide to Overcoming Sexual Pain
Pain with sex isn’t something you should have to endure, but it is something that’s far more common than many of us realise.
Research on the prevalence of painful sex suggests that as many as one in four people with vulvas/AFAB folks will experience sexual pain (known as dyspareunia) at some point in their lives. In this post, I’ll explore the common causes of painful sex, what you can do to start to move away from sexual pain and toward more pleasure, and how to talk about it with your partner.
You Are Not Broken
First things first, please know if you’re experiencing pain with sex that YOU ARE NOT BROKEN!
Pain is our body's way of asking us to pay attention.It’s trying to tell us something, so if we pay attention and explore with curiosity and a regulated nervous system, we can move toward more understanding of our pain which can help us to overcome pain, rather than ‘pushing through’ it.
In fact, we know that attempting to ignore or push through pain only increases the neurological and physical risk factors for more pain, as well as fear and avoidance. Instead, by paying attention to your body and incorporating the right education, support and evidence-based tools, you can begin to shift out of pain and into presence, safety, and intimacy.
For many of us we began hearing the following lie as early as our teenage years and before we’ve ever even experienced any type of sex:
Penetrative sex WILL hurt the first time or times you do it, thisat is ‘normal’ and expected.
This is one of the most harmful myths that circulates about sex for people with vulvas.
Because of this misinformation, many of us have an inbuilt either unconscious or conscious belief that pain with sex is normal and to be tolerated. Let me tell you loud and clear, PAIN DURING SEX IS NOT NORMAL. Common, yes, but normal or something that we should just accept or push through’? Absolutely fricken not!
I believe the most overlooked early contributor to painful sex is the sex negative, or lack of, sex education we’ve received throughout our lives, the shame associated with sexual concerns, and the inbuilt belief that sex hurting is normal which is, I’m sure you guessed it, founded in patriarchal views on sex and the overarching lack of knowledge and research on vulvar anatomy that we have, still in 2025. In reality, for those with a vulva, pain during sex can arise from a number of physical, neurological, psychological, emotional, and relational causes.
Working with painful sex presentations has been an area of special interest for me since I first started working as a Sex Therapist.
For something that is so infrequently spoken about, there are so many people out there just pushing through pain duringsex, either because they heard it was normal for it to be painful, or because they think their own body is fundamentally broken in some way because “sex should just work.”
It honestly breaks my heart, especially because with the right support, painful sex is in most cases very treatable!
We need to delete the view that sex and pain is normal and remind ourselves that sex can, and should be, safe, pleasure-centred and enjoyable.
Understanding the Causes of Painful Sex
The possible causes for someone's sexual pain depend on the type of pain they’re experiencing, as well as a number of physical, psychological, neurological, relational and behavioural factors. Because of this, it’s important to take a holistic approach to overcoming sexual pain.
Here’s a breakdown of common causes based on these categories, which will paint a picture of the extensive causes and complexities of sexual pain.
Psychological and Emotional Factors
Anxiety or fear relating to sex - this can include fear of pain and performance pressures
Body and sexual shame (usually resulting from poor or no sex positive information) which can create fear and/ or disgust of genitals. If this is the case, you may have experienced pain or inability to insert a tampon from early menstruation.
Past trauma which can include sexual trauma and other violations of bodily autonomy, medical trauma, birth trauma and other injuries to the pelvic and genital region.
Previous associations of pain and genitals/penetration which could include pain with tampon insertion, painful previous sexual experience (even if consensual) or pain resulting from infection, injury or surgery to the genital region.
Negative sexual messaging including cultural, religious or familial beliefs that create shame, guilt or fear around sexuality.
Relational and Other Context Dependent Factors
Not feeling emotionally and/or physically safe in the relationship
General relational issues including conflict, resentment and disconnect
Lack of understanding and awareness of desire, arousal and pleasure for you and/or your partner
Lack of pleasure-focused sex education, or sex education that promoted abstinence and shames masturbation and pleasure.
Lack of arousal, lack of foreplay or rushing foreplay, or lack of lubrication
Mismatched sexual interests, desires and pleasure needs
Physical, Neurological and Medical Factors
Pelvic floor conditions including hypertonic (tight) or hypotonic (underactive) pelvic floor. Vaginismus is the involuntary spasms of vaginal and pelvic floor muscles which can make penetration painful, difficult or impossible.
Vulvodynia and other unclear causes of pain that could include burning or stinging (often related to neurological and nerve-hyperactivity reasons).
Pelvic and reproductive conditions such as endometriosis
Skin conditions that can cause irritation, tearing, or scarring of vulvar tissue such as lichens sclerosis or dermatological issues
Infections or previous infections that cause inflammation and discomfort. The neurological impacts of infection can remain after the infection or irritation has recovered and can present as burning and/or stinging.
Hormonal changes during menopause, postpartum or even birth control can reduce estrogen and thin vaginal tissue which can lead to dryness and pain
Chronic pain conditions like IBS and fibromyalgia, or sensitisation of the nervous system which can perceive pain without tissue damage.
Scarring from surgeries or injuries
Medication side effects like antidepressants that can affect lubrication, arousal or muscle tone
In my experience working with individuals and couples with sexual pain, I find there’s usually a combination of the above factors, particularly when we’re looking at sexual fear or pain that has been present for more than a few months.
It’s also important to note here that if we experience pain in any part of our body, or we are stressed/anxious or scared, our body involuntarily adopts a “brace”/ tensing or guarding stance as part of our sympathetic nervous system response (fight-flight-fawn). This tension is mainly seen in the jaw and pelvic floor, and means that if you’ve experienced genital pain for any reason, the chances of you involuntarily tensing your pelvic floor in anticipation of pain (a condition called Vaginismus) is more likely, and can then be an additional source of sexual pain (particularly in penetrative sex).
Healing Painful Sex: Tools for Overcoming Sexual Pain
Healing from painful sex isn’t about pushing through the pain, it’s actually about creating safety and regulation in your nervous system (i.e. parasympathetic dominance), understanding and honouring your boundaries, and responding to your body with compassion and curiosity.
There are lots of different approaches that can be taken to overcome sexual pain, but here are some that I use in clinic, as well as a brief outline of what is included in my upcoming sexual pain course Overcoming Sexual Pain (stay tuned).
Understanding and Creating Safety in Your Nervous System
The first step is understanding your nervous system, and building your own ‘toolkit’ of nervous system regulation tools for yourself. Check out our free resources on the nervous system here for more information.
Building nervous system awareness and safety in your body is the most essential part of overcoming painful sex, something that is almost always overlooked because the focus is on the physical pain. If we don’t approach genital and sexual touch from a place of safety and regulation, our body will be more likely to perceive any touch/stimulation as painful and unsafe (which then causes tension in the pelvic floor).
One specific tool that can support this include practicing deep belly breathing (known as Diaphragmatic Breathing). This helps calm the nervous system, reduce pelvic floor tension, and increase your capacity for arousal and sensation. It’s a foundational tool for reconnecting with your body after trauma or shutdown.
Understand Desire, Arousal and Pleasure for YOU
It always surprises me how many people leave out one of the key elements in pain free and pleasurable sex, actually being turned on and aroused. If you’re not aroused, your body is quite simply not going to be able to have pain-free sex!
This means that learning about what turns you on and what feels best for your body is going to support pain free sex, because your body is going to be aroused and actually wanting and ‘ready for sex, rather than fearful and preparing for pain (neither of which are sexy or supportive of your pleasure).
Our brain is our biggest sex organ, and bringing awareness to what turns your brain on will turn your body's arousal process on and support pleasure and pain free touch and intimacy.
Body Neutrality and Awareness
Further to learning about your turn-ons,, encouraging body neutrality and pleasure awareness is a way of reducing the shame, disgust and fear around bodies, pleasure and sex, and can help us relax more into pleasurable sex. Exploring body gratitude practices, pleasure mapping and five-senses exercises (explanations of these can be found here) is a great starting point.
Physical Practices
Pelvic floor awareness and stretches such as cat/cow, happy baby, child's pose and figure-four to stretch and relax the pelvic floor and can help with vaginal and anal tightness causing pain with sex.
Furthermore, if you are experiencing pain with penetration, exploring genital pleasure and touch using dilators in a slow graded structure can gently stretch and relax the vaginal or anal muscles and help reframe that penetration can be pleasurable/not painful.
A dilator is a smooth, cylindrical tool designed to gently stretch and relax the vaginal or anal muscles. It’s often used in a therapeutic context to help people experiencing pain with penetration and is usually sold in a set of 5-6 different sizes so you can start by exploring touch and penetration with the smallest dilator and gradually work your way up based on comfort.
Dilators are best used in conjunction with water-based lubricant, diaphragmatic breathing and where possible, arousal and pleasure.
How to Talk About Pain During Sex with Your Partner
One of the most important yet overlooked elements of painful sex is the role that a partner plays in it.
So many people experiencing painful sex believe that it is their ‘problem’ alone to solve because it’s their body experiencing the pain. This is not true, and is actually very unhelpful for overcoming sexual pain in a partnered context.
The person you are having sex with is equally as responsible as you are in creating a safe context where your nervous system can be relaxed and not feeling under threat and therefore ‘bracing’ for pain. A sexual partner is ALSO equally responsible for building desire and arousal and prioritising pleasure.
Safety, arousal and pleasure are the most essential elements in pain free sex, as and maintaining steps in healing from painful sex is learning how to talk about it with presence, clarity, and vulnerability. Communication builds trust, and when you share what’s happening in your body, you open the door for support, not judgment.
Here are some tips for opening up to your partner and moving to overcome sexual pain as a couple:
Choose a time outside of sexual activity to talk, where there’s no pressure.
Try saying: “I’ve been feeling discomfort or pain during sex, and I’d love to talk about it with you.”
Name what you need (if you know), whether that’s more lubrication, a slower pace, a break from penetration, or just emotional support. If you’re not entirely sure, suggesting to remove the sexual activity that’s painful while you seek further support will mean that you don’t continue to build a sex = pain belief which ends in a fear avoidance cycle. You can encourage gentle, non-penetrative touch with a focus on exploring pleasure together to rebuild a sense of connection and safety.
Ready to Start Your Healing Journey?
Painful sex does not have to define your relationship with your body or with your partner. Healing is possible, and it begins with awareness, safety and exploration. You deserve a sex life that brings pleasure, not pain!
Overcoming sexual pain is a very common goal for clients we support at Good Vibes Clinic.If you’re experiencing pain with any type of genital touch or sexual intimacy, we want to support you so reach out to us to schedule a session.
If you’re not quite sure about, or not in a position to commence individual or couples sessions, but you want to build awareness, tools and practices to overcome sexual pain, my Overcoming Sexual Pain course is cumming very soon (pun intended). It will be available online and it’s self-paced.
If you're experiencing genital or sexual pain and/or avoiding sex altogether, this 6-step trauma-informed course includes all the relevant physical and psychological education on sexual pain, a personal plan to overcome your sexual pain, reflective exercises and evidence-based tangible tools and guided practices for individuals and couples. It’s designed to help you feel more at ease, more in touch with your body, and more empowered in your pleasure.
Join our mailing list to get notified when Overcoming Sexual Pain opens! This is set for release in the next 6-weeks!
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PMID: 32965830