For many women, the experience of painful intercourse is a deeply personal and often isolating struggle. Nicole, a 33-year-old California resident, has been on a decade-long journey to understand and manage her own experience of sexual pain. Her story highlights the multifaceted nature of this issue and the importance of comprehensive, empathetic care in addressing it.

Nicole’s journey began nearly a decade ago when she first experienced pain during intercourse. Determined to find a solution, she consulted multiple specialists and was eventually diagnosed with labial hypoplasia, a condition where the outer labia are only partially formed. After corrective surgery, she found significant relief and remained relatively pain-free for several years, incorporating yoga into her routine to support her healing. However, six years later, the pain returned, this time during the initial stages of penetration. Despite seeking medical advice for the past three years, the root cause of her discomfort remains unclear.

Nicole’s experience is far from unique. According to the American College of Obstetricians and Gynecologists, nearly three in four women will experience painful intercourse at some point in their lives. This can be a temporary or long-term problem, and its causes are often complex and varied. “Sex should never be painful,” said Eva Dillon, a sex therapist based in New York City. “It’s something that women should never have to endure.”

Painful intercourse can stem from several common issues. One of the most frequent causes is tight pelvic floor muscles, which can increase tension and cause pain during sexual activity, gynecological exams, or even tampon use. Dr. Anna Falter, a physical therapist specializing in pelvic floor therapy at the Cleveland Clinic, explains that pelvic pain can also be linked to tightness in other areas of the body, including the neck, lower back, and hips. Stress, previous surgeries, traumatic experiences, or even unconscious muscle tensing can contribute to this pain. Additionally, hormonal changes, such as decreased estrogen levels during menopause or postpartum, especially while breastfeeding, can lead to vaginal dryness, making intercourse uncomfortable or painful.

For women experiencing pelvic floor muscle tension, pelvic floor physical therapy is often an effective treatment option. One commonly used technique is trigger point therapy, which involves applying pressure to tight muscles to help them relax. A pelvic floor physical therapist may perform this method vaginally, using a gloved and lubricated finger to target and massage specific tight areas or trigger points. Patients can also learn to perform self-trigger point release at home using their own fingers, a partner, a pelvic wand, or vaginal dilators to help relax the internal muscles.

Another approach is pelvic floor lengthening exercises, which differ from the more commonly known Kegel exercises. Lengthening involves relaxing the pelvic floor muscles, often paired with diaphragmatic breathing, where the patient inhales deeply, allowing their abdomen, rib cage, and pelvic floor to relax. This movement is more challenging, so Falter recommends seeking help from a pelvic floor physical therapist to ensure proper form.

Falter also advises women to check in with their bodies throughout the day, especially during activities such as brushing their teeth or sitting on the couch, to ensure they aren’t unconsciously tensing their pelvic muscles. Certain yoga poses and stretches, such as child’s pose, butterfly stretch, and deep squat, can help release pelvic tension. However, it’s important to remember that seeking individualized treatment is always the best approach.

If your partner is experiencing pain during sex, there are steps you can take to provide comfort and support. Most importantly, if there’s any pain during intercourse, it’s crucial to stop immediately. Continuing despite discomfort can create negative associations between sex and pain, making future encounters even more challenging. “At the end of any sexual encounter, you want to be able to look forward to the next time with anticipation and delight,” Dillon said. “And, if sex is painful, you can begin to dread the next time, and it sets up a cycle, which you don’t want.”

Communication is also key, and it’s important for both partners to be open and understanding about the pain and treatment journey, especially if shame or feelings of inadequacy arise. “It can be helpful if the partner takes time to learn about what their partner is experiencing, as well as the treatment strategies they are working on, so they can support and encourage them through the treatment journey,” Falter said.

For couples who are temporarily unable to engage in intercourse, there are still many ways to stay connected physically. Dillon recommends trying outercourse—non-penetrative sexual activities like manual stimulation or oral sex—to maintain intimacy and pleasure. If intercourse or other forms of sexual activity are off the table, simple gestures such as a meaningful kiss or affectionate hugs can strengthen the emotional bond between partners. “These (forms of touch) are really important for us,” Dillon said. “They tell our nervous systems we’re safe and not alone.”

Despite the lack of a clear diagnosis, Nicole has not given up on her desire for a fulfilling intimate relationship. Alongside her partner, she has taken matters into her own hands, exploring alternative solutions. “I tend to feel really frustrated with my body and the pain since I don’t want to have these issues,” Nicole said via email. “Physical intimacy can be such a huge part of a relationship, and sometimes I feel like I’m missing out.”

Nicole and her boyfriend have found creative ways to maintain intimacy without intercourse or penetration. They have also incorporated pelvic floor therapies into their routine, which have helped alleviate some of the pain during their intimate moments. But that doesn’t mean she lives without disappointment. “There was a lot of education that had to be done, which can be not so fun and sexy when things are new,” she said. “In the end, it has really brought us closer together and created a more emotionally intimate connection pretty early on since we had to have these less fun and pretty technical conversations.”

Nicole’s journey underscores the importance of comprehensive care and the role of both medical professionals and partners in supporting women experiencing painful intercourse. It highlights the need for greater awareness and understanding of the various causes of sexual pain and the available treatment options. Through education, empathy, and a willingness to explore alternative solutions, couples can navigate these challenges and maintain a fulfilling, intimate relationship.

In a world where sexual health is often shrouded in silence and stigma, Nicole’s story serves as a powerful reminder that seeking help and advocating for oneself is crucial. For women like Nicole, the path to healing and intimacy may be complex, but it is not insurmountable. With the right support, education, and perseverance, it is possible to overcome the challenges of painful intercourse and reclaim one’s sexual well-being.