Painful Intercourse

Many issues related to pelvic floor pain during and after sex (called Dyspareunia) often go untreated.

How to Treat Painful Intercourse

Ryan Mcwhorter, MD

When I ask my clients who have endured painful sex for years why they didn’t seek help sooner, most of them say they were too embarrassed to discuss it with their doctors.   And, sadly others just considered it “normal” after having children or after menopause.

It doesn’t have to hurt!  You can enjoy sex again.  Pain during or after intercourse is not normal, and you don’t have to live with it anymore!

It’s important to know that you are not alone and should be talking about painful sex and ways to treat it without shame or embarrassment.

It is important to see a physician to rule out infection if you experience pain with intercourse.  Once we know that it is not infection, it could be one of the following issues that are easily treatable at Female Pelvic Health Care.

Muscle tension of your pelvic floor (“kegel”) muscles: 

Just like other muscles in your body, the muscles that make up your pelvic floor (the sling of muscles from your pubic bone to your tailbone) can get tight and sore.

This happens if they are worked too hard (too many kegels), held tightly throughout the day (fear of leaking or feeling like your insides are falling down), or if they are overused to support the pelvis and back (compensation for weak or uncoordinated core muscles). 

A simple exam in our office can help to determine what is causing over activation and pain in these muscles, and can reduce the tension and eliminate the pain…once and for all. 

Nerve irritation: 

The pudendal nerve innervates the perineum and vaginal region, and it can be injured during labor/delivery, or with chronic constipation.  Some patients may irritate the nerve via direct pressure (from sports like biking, or prolonged sitting in an office, etc).

Burning, itching or general pain in certain areas of the perineum may indicate nerve irritation.

While the pudendal nerve is usually blamed for burning, itching perineal pain other nerves can certainly cause similar symptoms.

This is particularly true in postpartum women as some labor positions or c-section incisions can cause injury to other nerves creating symptoms of pelvic pain. When these nerves are irritated or injured, intercourse can be excruciating and often not even possible. A pelvic health physical therapist can help determine which nerve is injured and help facilitate healing by protecting the nerve through postural and behavioral modifications and manual therapy techniques if scars are contributing to neural irritation.

Hormonal changes: 

Hormonal changes are often a significant factor for females who have pain with intercourse. Estrogen makes tissue plump, soft and pink. Low estrogen levels can cause vaginal tissue to be dry, thin and fragile. Postpartum and perimenopausal women are likely to experience changes in vaginal tissue which can sometimes lead to pain with intercourse. If this is the case, using a good amount of high quality lubrication and speaking with your doctor about the possibility of topical estrogen cream can be helpful.

Scar tissue: 

Tissue around the pelvis, perineum and vagina is meant to be mobile. Imagine trying to move around in jeans that are way to tight in the pelvic region- it is uncomfortable and limiting! When scars form around the perineum, vagina or pelvis (c-section or other abdominal surgeries), motion can be restricted causing pain with movement. This is particularly true around the perineum and vagina as the vaginal tissue must slide and glide during intercourse. Sometimes even sitting with the legs in a more open position (butterfly or criss-cross applesauce position) is enough to create pelvic pain. Gentle scar tissue mobilization or other manual therapy techniques can improve scar tissue mobility reducing or eliminating pain with movement or intercourse!


Sex is intimate and emotional. Whether we recognize it or not, engaging in a sexual relationship can elicit emotions that can make the body tense up or react in a way that makes sex uncomfortable. The mind and the body both play a role in painful sex- maybe pain is causing an emotional reaction or visa versa. At Female Pelvic Specialty CareI we frequently ask people to explore emotions/feelings around intercourse to discover if this may be a contributing factor.

If you are suffering from painful sex, know that you don’t have to!


Suzy S. / Montgomery, AL

Dr. McWhorter saved my marriage!  He is such an amazing healer and is compassionate, understanding, and gets to the root cause of what you are dealing with.  So grateful for his help!

Jane Peros / Auburn, AL

I was a mess.  Had no desire, pain during sex…I thought my days of enjoying sex were over.  I am so glad I came in to see Dr. McWhorter.  I am back to enjoying sex, feeling more confident and just overall feel better.  Best thing I ever did.

Gayle S.

“They are all so caring and helpful. He’s so personable and we’re so glad to be able to turn to him.”


Hands down he’s the best Doctor! Such a God fearing and understanding man thats very compassionate about his job.


I have had several HOCATT appointments and it has been Awesome!! I have really noticed the difference in my overall health.

Ashley M.

Dr McWhorter and his staff are incredible. They have surely impacted my health and my life in all positive ways.

Windy W.

All staff are very professional but at the same time very personable. You feel like your well being is their main concern.

Who is a good candidate for diVa®?

Women who are experiencing menopause are excellent candidates for diVa®. Women who have gone through vaginal childbirth can also benefit. diVa® can also work for women who have had medical treatments, such as radiation or chemotherapy, which have changed their overall vaginal health.

What to expect during diVa® treatment

Patients, for the most part, have very little discomfort. Some will experience a slight pressure against the vaginal wall during laser resurfacing. Some patients may experience some sensitivity near the vaginal opening and providers can apply a topical anesthetic to alleviate any discomfort or anxiety.

diVa® recovery

Women may return to their daily routine with minimal to no discharge, spotting, or discomfort; however, they should avoid sexual intercourse for up to 48 hours. Talk to us about your recovery during your consultation and after your treatment.

We want you to thrive and live your fullest life! Contact us today to learn more about diVa® laser vaginal therapy and what it could mean to your sexual and overall health and confidence.

Diva Process


How Does diVa® Work?

diVa Laser Vaginal Therapy utilizes the revolutionary Hybrid Laser Technology developed for Halo™, the world’s first and only Hybrid Fractional Laser, to treat the vaginal tissue so that women can feel more like their younger, vital selves.

Major life events like childbirth and menopause can cause changes in vaginal health. Excessive stretching of the vaginal tissue commonly happens from childbirth. 

Diva Patients


diVa® Patient Experience

Vaginal tissue may not fully recover to its pre-pregnancy state and through aging may lead to pelvic floor disorders. Menopause symptoms such as dryness, thinning and inflammation of the vaginal walls, and painful sex often lead women to seek out quality of life solutions. diVa™ helps give women control over their bodies again, empowering those treated to be as active as they like. 

Maureen’s Story


Maureen’s diVa® Experience


Vaginal dryness


Painful intercourse


Vaginal laxity (stretching of the vaginal canal and surrounding tissues due to childbirth)


Stress urinary incontinence


Mild pelvic organ prolapse

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