A substantial proportion of women experience pain during intercourse at some point, and for many it persists for years. It is also among the least reported symptoms in medicine — people assume it is normal after childbirth or menopause, assume nothing can be done, or simply cannot face raising it.
Very often it has a specific, identifiable, mechanical cause: a tender scar, an overactive pelvic floor, tissue changes from reduced oestrogen, or a combination. Once identified, these respond well to treatment.
Nothing about this appointment requires you to have tried anything first, and there is no expectation that you will discuss more than you want to.
Where it hurts tells us a great deal
Entry pain (superficial dyspareunia) — burning, stinging, tearing or a sensation of hitting a wall at the vaginal opening. Usually points towards pelvic floor overactivity, a perineal or episiotomy scar, vestibular sensitivity, or tissue changes from low oestrogen.
Deep pain — a deep ache or sharp pain with deeper penetration or in certain positions, sometimes lasting hours afterwards. More often associated with endometriosis, deep pelvic floor muscle trigger points, bladder pain, or post-surgical scarring.
Pain afterwards — burning or aching for hours or days following intercourse, characteristic of a sensitised pain system and muscle guarding rather than acute tissue damage.
Many women have more than one type, and the pattern usually changes over time as a protective cycle develops: pain leads to anticipatory tensing, tensing produces more pain, and the pelvic floor becomes progressively more overactive. Breaking that cycle is central to treatment.
Common causes
Overactive pelvic floor
The most frequent finding. Muscles held in sustained contraction are tender, restrict the opening and hurt on stretch. See chronic pelvic pain.
Perineal scar tissue
Tearing or episiotomy can leave a specific tender point or tethered scar. Frequently the entire cause, and highly responsive to scar work. See perineal tear recovery.
Menopause and low oestrogen
Vaginal tissue becomes thinner, drier and less elastic. Very common, often improved considerably by topical oestrogen alongside physiotherapy. See menopause physiotherapy.
Breastfeeding
Lactation lowers oestrogen, producing the same tissue changes temporarily. Under-explained to new mothers, and a very common cause of postnatal pain.
Endometriosis
A classic cause of deep pain, often worse around menstruation. See endometriosis physiotherapy.
Vestibulodynia
Localised sensitivity at the vaginal entrance, painful on light touch. Responds to a combination of desensitisation and pelvic floor treatment.
Vaginismus
Involuntary tightening that can prevent penetration entirely. See vaginismus treatment.
After surgery
Hysterectomy, prolapse repair, mesh procedures and cancer treatment can all cause scarring and shortening that make intercourse painful.
How it is treated
Assessment
Where exactly it hurts, when it started, what makes it better or worse, and your obstetric, surgical and hormonal history. With your consent, examination locates the specific tender points — reproducing your pain precisely is usually what makes the cause clear.
Pelvic floor downtraining
Learning to release and lengthen the pelvic floor rather than strengthen it. Uses breathing, positioning and often biofeedback. This is the opposite of standard pelvic floor exercises, which typically worsen this condition.
Manual therapy and trigger point release
Direct treatment of tender points and restricted tissue in the pelvic floor, always at a pace you control and stop.
Scar treatment
Mobilisation and desensitisation of perineal, episiotomy or surgical scars. Where a scar is the cause, this alone frequently resolves the problem.
Desensitisation and graded exposure
Progressively reintroducing touch and, where appropriate, dilators or trainers — starting well below the level that provokes pain and advancing only as comfort allows. You set the pace entirely.
Lubrication and moisturisers
Practical, and frequently under-used. Choosing an appropriate product matters — some over-the-counter lubricants are irritating in their own right.
Working with your GP
Where low oestrogen is contributing, topical vaginal oestrogen is often transformative and is prescribed by your GP. Physiotherapy and hormonal treatment work considerably better together than either alone.
What the appointment is actually like
Mostly talking. You will be asked where it hurts, what it feels like, when it started and what you have already tried. You control how much detail you give and can decline any question.
Examination is offered because locating the specific tender structure usually identifies the cause — but it is entirely optional, and many patients with pain choose to start with external assessment, education and downtraining, and consider internal assessment at a later appointment once they feel more comfortable. Declining does not limit your treatment.
You are welcome to bring your partner if you would find that helpful, and equally welcome to come alone. If your pain relates to previous trauma, you can say so or not say so — either way, the pace is set by you and nothing happens without your explicit agreement.
See your GP for: bleeding after intercourse, unusual discharge, a lump or visible skin change, or pain with fever — these need medical assessment first.
Frequently Asked Questions
Is painful sex normal after having a baby?
Common, but not something you have to accept. Some discomfort when first resuming intercourse after birth is usual, but ongoing pain months later generally has a specific cause — most often perineal scar tethering, an overactive pelvic floor, or reduced oestrogen from breastfeeding. All three are treatable, frequently within a few sessions.
Why has sex become painful since menopause?
Falling oestrogen makes vaginal tissue thinner, drier and less elastic, which is very common and very treatable. Topical vaginal oestrogen prescribed by your GP often produces a substantial improvement, and physiotherapy addresses the pelvic floor overactivity that usually develops alongside it as a protective response. The two together work considerably better than either alone.
Will pelvic floor exercises help?
Usually not, and often the opposite. Painful sex is most commonly associated with a pelvic floor that is overactive rather than weak, and strengthening exercises add tension to a muscle already unable to relax. Treatment focuses on releasing and lengthening. If Kegels have made your pain worse, that is a useful diagnostic clue rather than a mistake on your part.
Do I have to be examined?
No. Examination is offered because locating the specific tender structure usually identifies the cause, and reproducing your exact pain is often what clarifies the diagnosis. It is entirely optional and can be stopped at any moment. Many patients begin with history, education and external work, and consider internal assessment later — treatment is not limited by declining.
How long does treatment take?
It varies with the cause. Where a specific scar or trigger point is responsible, improvement often comes within three to six sessions. Where there is longstanding pain with a well-established protective cycle and a sensitised pain system, three to six months is more typical. Most women improve substantially either way.
Can my partner come with me?
Yes, if you would find it helpful — some people prefer their partner to hear the explanation directly, particularly where graded reintroduction is part of the plan. You are equally welcome to attend alone, and you can bring your partner to some appointments and not others.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
This Is Treatable
Painful sex almost always has a specific, identifiable cause — and most women improve substantially with the right treatment.
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