If You Struggle With Painful Sex, This Could Be The Root Cause

Having sex is a fun and intimate way to get closer to your partner(s). But if you're experiencing pain, it can make sexual activities less enjoyable and more unbearable. One possible cause of pain during sex is pelvic floor tightness.

Here's a deeper look into what causes pelvic floor tightness and tips for managing this sexual health condition to make sex more pleasurable.

Defining pelvic floor tightness

Pelvic floor tightness, or hypertonic pelvic floor, is when your pelvic muscles are in temporary or constant contractions. When you cannot coordinate or relax your pelvic floor muscles, it can cause challenges with urinating and having bowel movements, alongside other symptoms of pain and discomfort. 

"The pubococcygeus, iliococcygeus, and puborectalis are the main muscle groups that provide support to the pelvic organs," says Stephanie Hack, M.D., a board-certified obstetrician and gynecological surgeon and the founder of Lady Parts Doctor. "These muscles can tighten and become stiff from trauma and overuse, similar to other muscle groups after a workout."

Other symptoms of pelvic floor tightness are:

How tight pelvic muscles affect sex

In addition, pelvic floor tightness can lead to sexual dysfunction and painful intercourse.

Painful sex, known as dyspareunia, is recurring or persistent genital pain1 that can occur before, during, and after sexual activity, according to a 2022 review. Hack mentions that dyspareunia can "lead to an inability to orgasm" and cause women to "develop a fear of sex due to discomfort," which could cause vaginismus—another sexual health condition causing vaginal muscles to suddenly tighten from the fear of penetration.

Although both conditions cause the pelvic floor muscles to tighten, vaginismus should not be confused with pelvic floor tightness. "Vaginismus is a type of pelvic floor dysfunction during which the vaginal muscles spasm involuntarily," Hack says. "This is different from pelvic floor tightness, in which the muscles are constantly contracted."

What are the treatments for pelvic floor tightness?

Pelvic floor tightness is a treatable condition; it's totally possible to regain control of your pelvic floor muscles. One treatment Hack notes for treating pelvic floor tightness is targeted pelvic floor physical therapy (PFPT).

As reported by a 2019 review, PFPT is a first-line treatment2 for pelvic floor dysfunction. The goal of PFPT is retraining pelvic floor muscles to relieve painful symptoms and encourage muscle relaxation.

"Targeted pelvic floor physical therapy can treat pelvic floor tightness and provide a cure for many," Hack adds. If PFPT isn't effective, Hack mentions additional treatments for pelvic floor tightness, such as "​​nerve stimulation, trigger point injections, or additional specialist care."

Here are a few more strategies for minimizing painful sex with pelvic floor tightness.

Adopt relaxation techniques: "Learning techniques to relax your pelvic floor muscles as much as possible prior to, during, and after sex is key," Hack says. One relaxation technique Hack recommends is diaphragmatic breathing. Diaphragmatic breathing involves slow, deep breathing using your diaphragm and abdominal muscles. This relaxation technique can relieve stress and pain and helps your pelvic floor muscles relax throughout sexual activities. 

Set the stage for a comfortable sex life: If you have pelvic floor tightness, it's important to communicate this condition with your partner(s). It's best to have understanding partners willing to make adjustments to ensure you're comfortable throughout physically intimate moments. Hack says that "selecting a patient partner and having lubricant available" are must-have components of having enjoyable sex with pelvic floor tightness. 

Contact your doctor to discuss treatment options if you're experiencing pelvic floor tightness. You can also visit a pelvic floor physical therapist to begin therapy sessions

The takeaway

Sex shouldn't have to be a painful experience, so try exploring ways to regain control of your pelvic floor muscles. "It's important to recognize the significance of a tight pelvic floor and how it can affect your health," Hack says. "Our muscles contribute significantly to the way our body functions and our enjoyment of it."