For many women, pain during sex is a deeply personal and distressing issue that can impact both their physical and emotional well-being. Known medically as dyspareunia, this type of pain is more common than many realise - affecting up to one in four women at some point in their lives. Despite its prevalence, the topic often remains shrouded in silence due to feelings of shame, embarrassment, or the misconception that painful sex is simply part of being a woman.

Fortunately, pelvic floor physiotherapy is emerging as an effective and empowering solution for women experiencing sexual pain. While physiotherapy may not traditionally be linked to sexual health, specialists in pelvic health are helping women manage and overcome sexual pain, improving their quality of life and restoring their confidence. These physiotherapists focus on the pelvic floor muscles - the group of muscles that support the bladder, uterus, and bowels - which can sometimes become tight, weak, or dysfunctional, leading to discomfort and pain during sexual activity.

A solution for pelvic pain

Physiotherapy can address a range of causes of pelvic pain, including medical conditions such as endometriosis, vestibulodynia (pain in the vulvar area), and vaginismus, a condition where the pelvic floor muscles involuntarily tighten, making penetration painful or even impossible. However, many women experience pelvic pain without a clear medical diagnosis, leaving them frustrated, confused, and isolated.

Amy*, a 31-year-old public servant from Canberra, struggled for years with painful sex, believing that it was something she simply had to endure.

“For all my 20s, I suffered through painful sex because I thought it was normal. It felt like my pelvic area was on fire, and sex was very unenjoyable for me. It wasn’t until my GP suggested I see a physiotherapist about it that the pain started to subside,” she explains.

After a few sessions with a pelvic floor specialist, Amy was diagnosed with vaginismus, a condition that causes the muscles around the vagina to involuntarily contract.

“It’s been so helpful to understand the cause of the pain, and I’m so grateful I was able to get to the bottom of it,” she says. “My physio has given me exercises that relax my muscles, and I finally feel like I have a pleasurable sex life.”

Understanding pelvic pain

Pelvic pain during sex can vary greatly in both intensity and location. Some women experience sharp, burning sensations at the entrance of the vagina, while others feel deep, aching pain inside. The causes of this pain can range from medical conditions like endometriosis and chronic pelvic inflammatory disease to functional issues like pelvic floor muscle dysfunction.

For many women, the onset of pain during sex may occur at different stages in life. It can begin with the first sexual experience, or it might develop later, perhaps in a new relationship or following an infection like thrush. Regardless of when it begins, sexual pain can have a significant impact on a woman’s emotional health and relationships.

Amy knows firsthand how painful sex can affect relationships.

“It can be such an awkward subject to bring up, especially when you’re in a new relationship,” she says. “I’ve had some partners who didn’t understand it and took it personally. It really shattered my confidence in the past.”

The importance of seeking help

Though it can feel intimidating to talk about sexual pain, seeking help from a healthcare professional is crucial for both physical and emotional healing. A pelvic floor physiotherapist can assess the root causes of the pain, offering a tailored treatment plan to help alleviate discomfort. This treatment plan may include pelvic floor muscle training, relaxation techniques, breathing exercises, and education on how emotional factors like stress and anxiety can contribute to physical tension in the pelvic muscles.

For many women, understanding the mind-body connection is a revelation. Learning how emotional health affects physical pain can provide a sense of validation and relief, letting women know that they are not alone. Recognising that sexual pain is a treatable issue, not a personal flaw, is an important step toward healing.