COMMON CONCERNS

Painful Sex (Dyspareunia) & Vaginismus Therapy in Sydney

First things first, please know if you’re experiencing pain with sex that YOU ARE NOT BROKEN!

Pain with sex isn’t something you should have to endure, or ‘push through’, and is far more common than you may 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.

What counts as painful sex?

Painful sex, sometimes called dyspareunia, can show up in a few different ways. Some people feel entry pain, right at the point of penetration. Others feel deep pain during thrusting. It might be burning, aching, or throbbing, and it can happen before, during or after sex.

Vaginismus is one specific and common cause of sexual pain, where the muscles of the pelvic floor involuntarily tighten around the vagina, making penetration difficult or painful. It's not the only cause though, painful sex can happen for a number of physical and psychological reasons, which we'll get into below.

What is vaginismus?

Vaginismus is the involuntary contraction, or spasm, of the vaginal and pelvic floor muscles, which can make penetration painful, difficult or impossible. There are two types: primary vaginismus, where penetration has never been possible, and secondary vaginismus, where penetration was possible before but isn't anymore.

It's worth understanding that if you've experienced genital pain for any reason and even if initially it were not related to overactive muscles, your pelvic floor is more likely to involuntarily tense in anticipation of pain, which can then become an additional source of pain itself. This is a normal nervous system response, not a sign that anything is wrong with you.

What causes painful sex

The causes of sexual pain depend on the type of pain and usually involve a combination of physical, psychological, neurological, relational and behavioural factors, especially when the pain or fear has been present for more than a few months.

A holistic approach considers all of these together.

1. 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.

2. 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.

  • Pelvic and reproductive conditions such as endometriosis and PCOS (poly-cystic ovarian syndrome).

  • 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.

3. 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.

Talking to your partner about painful sex

Painful sex isn't just ‘your problem’ to solve because it's your body experiencing it. If you are in a sexual relationship and experiencing pain, your partner is equally responsible for helping create a safe, pleasure-focused context, and for building desire and arousal together.

If you’re experiencing pain with sex and want to speak to your partner about it, there are a few ways we recommend to open the conversation:

  • Choose a time outside of sexual activity to talk, without pressure.

  • Try something like: “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 it, whether that's more lubrication, a slower pace, a break from penetration, or emotional support. If you're not sure yet, it's okay to pause the activity that's painful while you get support, and lean into non-penetrative touch and pleasure together in the meantime.

  • Share that you’d like to explore what’s happening, together. This might look like “I want us to have a pleasureable sex life so I’d love if we could figure out what’s going on together. Are you open to seeing someone with me?'“.

If speaking to your partner about pain in sex feels overwhelming, or you have tried and it hasn’t gotten anywhere, reach out to us for individual support first.

How we approach this at Good Vibes Clinic

An initial session includes a holistic review of what's contributing to your pain, physical, psychological, relational, or a combination, and a plan for evidence-based support built around nervous system safety, understanding your own arousal and pleasure, and practical tools, alongside a referral to a pelvic floor physio where relevant.

If you're not ready for individual or couples sessions yet but want to start building awareness and tools on your own, Christine's self-paced Overcoming Sexual Pain course is a trauma-informed program covering the physical and psychological education and guided practices for individuals and couples. You can also check out our free nervous system basics resource.

Meet our specialised therapists

Katherine Rolfe (she/her)

Sex and Relationship Therapist (Online)

Katherine creates a space where clients can gently explore both current concerns and the deeper emotional patterns influencing how they experience closeness and intimacy.

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Christine Rafe (she/her)

Sex, Relationship Therapist & Director

Christine has a holistic view of overall wellbeing, and can see that intimate relationships, sexual enjoyment and sexual expression are foundational parts of overall wellbeing.

FIND OUT MORE AND JOIN THE WAITLIST

Grace Crawford (she/her)

Sex Therapist and Counsellor

Grace with therapeutic and practical awareness of the mind body connection relating to sex and intimacy, and Grace believes when we become connected to our bodies, we are able to access more presence, pleasure and overall wellness.

FIND OUT MORE AND JOIN THE WAITLIST

Common myths about painful sex

  • 100% myth. This is one of the most harmful and common myths out there. Painful sex is common than you might think (because of myths like this where people believe they need to ‘push through’), but it is not normal, and it's not something you should have to push through.

  • Myth. Painful sex is almost always an interplay of physical, psychological and relational factors. There's often a real, involuntary physical response happening, even if the trigger is psychological.

  • Myth! Secondary vaginismus can develop later, even after penetration was previously fine.

  • 100% Myth!!! Pushing through tends to increase the risk of more pain, fear and avoidance. This usually needs proper support, not just repeated attempts.

  • Myth. While individual therapy and pelvic floor support can certainly improve sexual pain and build awareness of your body, if you are in a relationship, your partner is equally responsible for creating safety and building pleasure TOGETHER.

Frequently asked questions

  • You're welcome to come straight to therapy, especially if you suspect that your concern is situational, psychological or relational in nature. We will always recommend connecting with a pelvic floor physiotherapist if our assessment identifies there may be any physical factors at play, and we would be happy to provide a referral and recommendation if this is suitable.

  • No. We are a talk therapy clinic so there is no touch or observation required. Any physical exercises that are recommended and discussed will happen privately at home, not during a session with us.

  • Vaginismus is one specific, common cause of painful sex, not the only one. If you're not sure which applies to you, that's exactly what we can help with.

  • Only if you want them to be. Sexual functioning concerns that happen in a couple's sexual relationship are a couple's sexual issue, not something wrong with you.

    Even if it's your body experiencing the concern, there is almost always a complex interplay of relational factors that contribute to it showing up in partnered sex.

    All individual sessions are completely confidential and there is no requirement for your partner to attend, but we do find faster success if the partner is open to attending or engaging in activities needed to support overcoming the concern.

  • Absolutely. All our sessions, regardless of what you share, are required by law to remain confidential. If we receive your explicit consent to contact other relevant treating parties we're happy to do this, but it's not essential if it doesn't feel comfortable for you.

  • Yes, our sessions can be completed online or in person in Surry Hills.

  • Yes, although it depends on the therapist. Get in touch with the clinic and we can talk you through what applies to your situation.

Want to read more about painful sex and how to overcome it?

Taylor’s blog “Sex Shouldn't Hurt! A Guide to Overcoming Sexual Pain” goes deeper into the nervous system side of healing and includes more of her own reflections from working with clients on this.