Sex & Your Pelvic Floor Muscle

Mature couple that resolved painful sex walking on the beach - Duffy & Bracken, NYDid you know that physical therapy can help your sex life? 

Duffy & Bracken, Physical Therapy, a Division of Maiden Lane Medical has a unique specialty called Pelvic Floor Physical Therapy that can benefit both men and women. There are very few physical therapy clinics that specialize in this and Duffy & Bracken was one of the first to do so. We have been treating the pelvic floor since 1988. 

Although painful sex is not normal many people both women and men experience ongoing pain during sex resulting in both emotional and physical pain in relationships. The longer you let this go on, the more chronic and stubborn it may become. 

Why do women have Painful Sex?

A frustrated couple because of painful intercourse lying in bed - Duffy & Bracken, NYWe all know that a woman’s first sexual experience of vaginal penetration is usually painful. This is because the hymen, which is very sensitive may still be intact, covering the entrance of the vaginal opening. Normal variations of the hymen range from thin and stretchy to thick and somewhat rigid. A rigid hymen may have difficulty breaking and the guidance and help of a pelvic physical therapist can often offer a simple solution. The hymen normally bleeds a little when tearing free. 

Why do some women have pain-free, blood-free initial intercourse or tampon use?

The hymen is not always intact during penetration as it may be broken by tampons, GYN exams with a speculum to look at the cervix, or sometimes with vigorous high impact physical activity. This is actually a good thing as the breaking or removal of the hymen makes the initial use of a tampon and the first vaginal penetration significantly less painful or pain-free.  

Besides an extremely sensitive intact hymen, some women are unable to use tampons or have sex due to pelvic muscle spasm or nerve pain (neuralgia) in the vulva. Pelvic Floor conditions do not only affect women; men can have pain with ejaculation which may also be caused by painful pelvic muscles.

Male and Female Painful Sex

A couple in bed with painful sex problems - Duffy & Bracken, NYDysfunction in the low back, pelvis, hips or even the feet causing a chain reaction up the muscular-skeletal chain can cause spasm and pain in the pelvic muscles and nerves. An example of this is through a hip muscle called the obturator internus that attaches to the pelvic floor muscles through a ligamentous and fascial attachment, which, when tight can pull the pelvic muscles tight causing pain. 

Issues in the gastrointestinal system such as constipation, in the urinary system such as frequent urination, infections, or hormone loss as in menopause can all cause painful sex and should be evaluated by your physician. Pelvic physical therapy to clear out the leftover joint and muscle dysfunction, spasm, sensitivity, and weakness can help to return you to pain-free sex. 

Fear-avoidance is understandably normal as everyone is afraid of pain, but if the pain becomes chronic it can become mapped on your brain (seen on scans in pain research) and this adds to this problem. Fear acts like cement to pain and makes it more difficult to overcome. Understanding where the pain is and why it’s there, in addition to learning techniques to decrease it, can significantly help reduce pain with research in the neuroscience of pain showing up to 50 to 70% reduction after explaining pain. Physical Therapists are great at giving home programs focusing on helping you help yourself with pain-reducing techniques. 

How do Pelvic Physical Therapy treatments help?

Gently stretching the vaginal opening using a graduated program of dilators ranging from a pinky size to the size you need to be functional can help (links below). Sometimes requiring some doctor-prescribed lidocaine cream to reduce the pain and the help of a pelvic physical therapist can be great options. A little bleeding during this is normal and no need to fear. This process can be quite quick if you do your homework, and usually resolved in 6 to 12 visits or sometimes even less! Even chronic cases sometimes resolve quickly.

Identifying and treating stiffness, weakness, and abnormal movement problems in the back, sacral iliac, pubic symphysis, coccyx, and hips, legs and feet can stop the chain of reactions that cause the pelvic floor muscles to spasm and nerves to become irritated. An example of this is a coccyx that has been knocked into flexion, side bending, or rotation through a fall or snowboarding. This can cause “a twist” in the pelvic muscles and fascia that attach to it causing spasm and pain. A simple correction by a pelvic physical therapist can sometimes give incredible relief. 

Painful trigger points in the pelvic muscles can be treated with retraining and massaging of the muscle. Additionally, getting an education that explains ‘pain’ can aid in reducing the fear and hopelessness that sometimes exacerbates pelvic pain.

Pelvic pain and dysfunction may also cause urinary and bowel problems or vice versa, the “culprit or the victim scenario”, since the pelvic floor is a major factor in controlling voiding. Pelvic physical therapists can help with these issues along with your physician’s treatment through massage, positional treatments, education in bowel and bladder function, and advice. 

Poor posture causes muscular-skeletal issues, direct impact on the pelvic muscle and genitalia, and can affect visceral (organ) problems. Improved posture, which is a physical therapist’s expertise can make a huge difference.

Pelvic floor muscle biofeedback administered by a pelvic floor physical therapist can identify and teach the patient to reduce tension in the pelvic floor and correct normal function.  Home electric stimulation units can be used to break the pain and tension cycle by blocking pain signals from the pelvic floor and genitalia to the brain.

How pelvic PT has helped – a patients story:

A patient was having her shoulder treated by another physical therapist and shared her heartbreaking story of wanting a baby but not being able to have sex with her husband due to pain. After only 6 Pelvic PT treatments she was pain-free! She not only shared pictures of her beautiful baby, also shared her experience with friends and colleagues who came to see us. Sadly, the shame and fear of a painful OBGYN visit can stop patients from seeking help. 

Feel free to call our office or just book an appointment online!

We can see you at any of our locations in Soho, Midtown, and Downtown NYC.

Text us to make an appointment or for general questions: 646-518-9711

Call us: (212) 402-5430

Make an appointment so that you can get rid of painful sex


Current Medical Technologies

Intimate Rose vaginal dilators use a smooth, body-safe, medical-grade silicone that is BPA-free and designed to glide into the vaginal opening for more comfortable use.  


USA Made BPA Free Heat Sealed in Safety Bag VuVatech™ Original Smooth Plastic Set of 5 Dilators with Instructions Lubricant and Travel Pouch
by VuVa Tech LLC