The Frankly Pelvic Blog

What Could Be Causing Your Pain?

Pain with intercourse can happen for many different reasons. Here are the most common causes I see:

Pelvic floor muscle dysfunction – Your pelvic floor muscles might be too tight, too weak, or uncoordinated. When muscles can’t relax properly, penetration becomes painful.

Scar tissue or adhesions – If you’ve had a cesarean section, perineal tearing during childbirth, or gynecological surgery, scar tissue can create painful restrictions.

Hormonal changes – Postpartum, breastfeeding, perimenopause, and menopause can all cause vaginal tissue to become thin, dry, or less elastic.

Nerve sensitivity – Sometimes nerves become hypersensitive and send pain signals even when there’s no tissue damage. Conditions like vulvodynia fall into this category.

Past trauma or stress – Your body remembers. Physical or emotional trauma, chronic stress, or anxiety about pain can all contribute to pelvic muscle tension.

Medical conditions – Endometriosis, PCOS, interstitial cystitis, vaginismus, and infections can cause or contribute to painful intercourse. The American College of Obstetricians and Gynecologists provides comprehensive information about these conditions.

When Should You Call Your Doctor?

You should reach out to your gynecologist if you’re experiencing:

– Any unexpected bleeding not related to your period
– Unusual discharge, odor, or signs of infection
– Severe, sudden pelvic pain (especially with fever or nausea)
– New pain after a specific event like surgery or childbirth

Your doctor can run tests and rule out conditions like infections, cysts, or fibroids that need medical treatment first.

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When Should You See a Pelvic Floor Physical Therapist?

You should consider pelvic floor physical therapy if:

– Your doctor ruled out infections but you’re still in pain
– You’ve been told “everything looks normal” but sex still hurts
– You’re postpartum and experiencing pain that wasn’t there before
– You have pain during tampon use or pelvic exams
– You’ve tried lubricant and different positions but nothing helps
– You’re avoiding intimacy because you’re afraid it will hurt
– You have scar tissue from childbirth or surgery causing discomfort

You don’t have to wait months or years to get help. The sooner you address pelvic pain, the easier it typically is to treat.

What Does Treatment Look Like?

At Frankly Pelvic in Orlando, I take a compassionate, whole-body approach to treating pain with intercourse. Every session is designed to be safe, shame-free, and productive.

We start with your story – I’ll ask about your history, symptoms, and goals. We only move forward with your full consent at every step.

Comprehensive assessment – This might include internal pelvic floor assessment (only with permission), checking your breathing patterns, posture, and how your muscles coordinate.

Personalized treatment – Treatment might include manual therapy to release tight muscles or scar tissue, pelvic floor retraining, breathing techniques, dilator training, and education about positions and pacing.

Collaborative care – Sometimes healing requires a team. I work with mental health therapists, sex therapists, and gynecologists to ensure comprehensive care.

Your body isn’t broken, and you deserve intimacy without pain, fear, or frustration.