Sex Isn't Meant to Hurt: 5 Reasons It Might Be (And What Actually Fixes It)

by Heather Foord, Core Restore Co

Painful sex is one of the most common things women bring to me in clinic. It is also one of the most silently endured.

Women push through, blame themselves, avoid intimacy for years and often assume this is just how sex is going to be for them from now on.

It is not. Sex is not meant to hurt. And in almost every case, there is a real, clinical reason for the pain, and a real, clinical fix for it.

Here are some of the most common reasons sex is hurting.

1. Not enough time spent in foreplay

The most common cause I see. When you are not properly aroused, your body has not had time to produce enough natural lubrication, blood flow to your genitals is lower and your pelvic floor has not released. Penetration into a tight, dry vagina is going to hurt. This is not a character flaw. This is physiology.

What fixes it. Extended foreplay. External clitoral stimulation before any penetration is attempted. A generous water-based lubricant. And slowing down.

2. A hypertonic (too tight) pelvic floor

A tight pelvic floor is one of the most missed reasons for painful sex. Women are often told to do more Kegels, which makes it worse. A hypertonic pelvic floor needs to be taught to relax and lengthen, not to squeeze harder.

What fixes it. Pelvic floor relaxation (try our Floor Ball for a non-invasive, at-home fix), working with a pelvic floor physiotherapist, breath-based release work, gentle stretching, and often a set of graduated dilators to teach the muscle safety. Not more contracting.

3. Hormonal dryness (breastfeeding, perimenopause, some medications)

Prolactin during breastfeeding, dropping oestrogen in perimenopause, some antidepressants and the pill can all cause the vaginal tissue itself to become thinner, drier and less resilient. Sex feels sore, burning or 'catching.'

What fixes it. A daily vaginal moisturiser to support the tissue over time, a good water-based lubricant in the moment, and a GP conversation about vaginal oestrogen if you are in perimenopause. This one is fixable.

4. Endometriosis, adenomyosis or another underlying condition

Deep, sharp, recurring pain during sex (especially with deep penetration) can point to endometriosis, adenomyosis, ovarian cysts, pelvic inflammatory disease or pelvic organ prolapse. This kind of pain is not the 'need more lube' kind. It deserves proper investigation.

What fixes it. A GP referral to a gynaecologist. Do not accept 'just push through' or 'it is normal for you' as answers. It is not normal, and Australian women wait an average of seven years for an endo diagnosis. Push earlier.

5. Vaginismus

Vaginismus is an involuntary tightening of the vaginal muscles that makes penetration feel impossible, burning or excruciating. It is more common than most women realise, often has a psychological component (past trauma, anxiety, cultural shame) alongside the physical, and is treatable.

What fixes it. Pelvic floor physiotherapy, dilator therapy, and often working with a clinical sexologist or psychologist alongside. This is a very treatable condition, even when it has been going on for years.

Tools that help while you sort the cause

A generous water-based lubricant is your best friend. External clitoral stimulation (including with a vibrator) before penetration primes arousal and preps the tissue. Positions that give you control of depth and angle (you on top, for example) let you steer away from pain. Communication with your partner about stopping any time it hurts. And permission to stop, always. Pushing through pain teaches your body that sex means pain, which makes the whole thing worse.

When to see someone

If pain lasts more than a couple of sessions, if it is sharp, deep or getting worse, if it is affecting your relationship or your desire to have sex at all, or if you have any bleeding, unusual discharge or other symptoms alongside it, please see your GP. Ask specifically for a referral to a pelvic floor physio, a gynaecologist or a clinical sexologist. All three exist, all three help, and all three are covered by rebates in many cases.

Sex is meant to be pleasurable. If penetration does not give you pleasure? Treat it as information, not a verdict, and reach out for help.