Sexual Pain & Dysfunction

Sexual pain is never something to simply endure

Pain with sexual activity, whether at the entrance to the vagina, deeper in the pelvis, or during arousal, is one of the most common yet most underreported pelvic health concerns. Many patients have been told pain is "normal" or "just stress." It is neither.

Presentations we treat

• Painful sex, painful intercourse, either at penetration or with deeper contact. Can be associated with pelvic floor muscle tightness, scar tissue, hormonal changes, or nervous system sensitization.
• Vaginismus, involuntary muscle contraction that makes penetration difficult or impossible. The pelvic floor muscles tighten as a protective response, often related to pain anticipation, anxiety, or past trauma.
• Vulvodynia and pain at the vaginal entrance, chronic pain, burning, or sensitivity at the vaginal entrance without a visible cause. Strongly associated with nervous system sensitization.
• Postpartum sexual pain, pain during intercourse after birth, whether from scar tissue, hormonal dryness, or pelvic floor changes. Common and very responsive to treatment.
• Peri and post-menopausal pain, the vaginal dryness and discomfort that can come with (peri) and post-menopause causes tissue thinning and dryness that makes intercourse painful. Over-the-counter vulvar and vaginal moisturizers can nourish the skin and be soothing. Physiotherapy to address muscle integrity alongside appropriate medical management is often highly effective.

Our treatment approach

• Pelvic floor down-training, learning to release and lengthen chronically guarded pelvic floor muscles.
• Graded desensitization, a carefully paced program that gradually reduces tissue and nervous system sensitivity.
• Scar tissue mobilization, as needed, and always gently, for any pelvic scars affecting comfort.
• Pain education, understanding how the nervous system amplifies threat responses, and how to interrupt this cycle.
• Dilator therapy guidance, where appropriate, structured use of graduated dilators as part of a progressive treatment program.