Yet so many people suffer in silence for months, sometimes years, before seeking help. They push through the discomfort, avoid sex altogether, or quietly wonder if something is permanently wrong with them. Some have been told there’s nothing physically wrong, and left with no idea where to turn.
If this sounds familiar, I want you to know: sexual pain is real, it has causes, and it can be addressed.
Sexual pain, clinically referred to as dyspareunia, is the experience of pain before, during, or after sexual activity. It can occur with penetration, arousal, orgasm, or even at rest. It can be sharp or burning, deep or superficial, constant or intermittent.
For people with vulvas, common presentations include vaginismus (involuntary muscle tension that makes penetration painful or impossible), vestibulodynia (localised pain at the vaginal opening), and pain related to conditions like endometriosis or pelvic floor dysfunction. For people with penises, sexual pain can relate to tight foreskin, prostatitis, or skin conditions, among other causes.
The point is, it’s not one thing. And it’s not all in your head, even when a physical cause isn’t immediately obvious.
Sexual pain is almost always multifactorial. That means there’s rarely a single, simple explanation. It tends to involve a combination of physical, psychological, and relational factors, often intertwined in ways that make it harder to untangle on your own.
Physical causes can include hormonal changes (particularly low oestrogen around perimenopause or postpartum), pelvic floor muscle dysfunction, skin conditions, infections, scarring, or anatomical factors. These are worth investigating with a GP or specialist who takes a thorough, non-dismissive approach.
Psychological and emotional factors play a significant role too. Anxiety about sex, whether that’s fear of pain itself, past experiences of trauma, or performance pressure, can create a cycle that’s hard to break. When the nervous system anticipates pain, the body tends to brace. That bracing creates more tension, which creates more pain. It becomes self-reinforcing.
Relational dynamics matter as well. Feeling rushed, not being able to communicate what you need, or carrying unresolved tension with a partner can all contribute to how the body responds during sex. Safety — feeling emotionally safe as much as physically safe — is not a minor factor. It’s often central.
Sexual pain is still under-discussed in medical and therapeutic settings. Many people are seen briefly by a GP who rules out infection and then sends them on their way. Some are told to “just relax” or “use more lubrication” advice that, while occasionally useful, completely misses the complexity of what’s happening.
Others feel too embarrassed to raise it at all, or assume that sex is just supposed to hurt sometimes. It doesn’t. Pain during sex is the body’s way of communicating that something needs attention, it’s not a normal baseline to accept.
Good treatment for sexual pain addresses the full picture. That usually means a combination of approaches, tailored to what’s driving the pain for that specific person.
A pelvic floor physiotherapist is often a crucial part of the team. Pelvic floor dysfunction is a significant contributor to many types of sexual pain, and a skilled physio can make an enormous difference.
Sex therapy or psychosexual therapy can help address the psychological and relational dimensions, the anxiety cycle, communication patterns, and beliefs about sex that may be keeping the problem locked in place. This isn’t about talking endlessly about your past; it’s about practical, evidence-based work that changes how you experience sex in the present.
Medical support may also be needed, whether that’s hormonal treatment, topical therapies, or further investigation of underlying conditions.
One of the most important things I tell clients is this: avoidance rarely makes sexual pain better. The longer we step away from intimacy entirely, the more the body and mind learn to associate sex with pain or fear. Gentle, graduated re-engagement, with the right support, is usually part of the path forward.
If you’ve been living with sexual pain, please don’t wait for it to resolve on its own. It is worth getting help. And with the right support, things can genuinely change.
If you’d like support navigating Sexual Pain and the impact it may be having on your relationship, you’re welcome to book a consultation with our team.
We are here to help wherever you are located.
🔗 Brisbane Couples Counselling
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