How to Have Sex Without Pain: Prepping for Pain-free Pleasure

A brief disclaimer before we dive in: at Origin, we know that sex is so much more than intercourse between a penis owner and someone with a vagina. Much of mainstream society, and even medical research, still assumes that vaginal penetration is the only “real” sex, but we know better.

(Side note: people with penises can also have pain with sex. Since Origin specializes in helping folks with vaginal anatomy, though, we’ll be focusing this conversation on those individuals.) 

Why does it hurt when I have sex?

The answers to this question are about as numerous as the people who experience painful sex. Sex, in all its forms, affects us on so many levels: our bodies, brains, and hearts can all get involved. If you have an underlying problem in any (or all) of these systems, you may experience pain with sex. 

Let’s start with the body. Here are some common physical causes of painful sex:

• Vaginal dryness and/or genital changes, often driven by shifting hormones
  
  • Common in postpartum and postmenopausal people
• Vulvar skin conditions
• Gynecologic infections, including STIs
• Physical trauma and scar tissue from surgery or injury
  
  • Includes perineal trauma from childbirth
• Injury to or changes in nerves in and around the pelvis
  
  • Includes neuroproliferation, the overgrowth of new, highly sensitive nerves that can cause pain; this is common in people with endometriosis and related pelvic pain conditions. 
• Tissue changes due to medical conditions and their treatments
  
  • Common in cancer survivors
• Increased tension in the pelvic floor muscles
  
  • Common in conditions such as vaginismus and vulvodynia 
• Gynecologic and pelvic conditions that cause chronic pain, such as:
  
  • Endometriosis
  • Painful bladder syndrome (PBS)
  • Pelvic inflammatory disease (PID) 
  • Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)

This list is by no means comprehensive, and for many people, several factors are at play.

What about the emotional and social contributors to painful sex? 

Our thoughts, feelings, and external pressures can haveRegardless of the kind of sex you have or prefer, you’re in the right place. If you experience pain during or after any form of sex, the content of this article is for you.  impact on how we feel during and after sex. A history of trauma, particularly sexual trauma, can lead to pain during subsequent sexual encounters, even if they are positive and affirming.

Anxiety and fear are common reactions to previous experiences of painful sex, and they can cause pain to recur or even worsen on subsequent attempts. This doesn’t mean the pain is “all in your head”: it’s just a sign that your body and mind are trying to protect you from potential future pain.

Why do I (still) hurt: a quick primer on persistent pain

Let’s take a step back to understand how pain itself works. From an evolutionary perspective, pain is part of our natural self-preservation instinct: it’s meant to help us determine how serious a potential threat is and how we should respond to it. 

Unfortunately, the pain messaging system isn’t foolproof. In some cases, it can become distorted, sending pain signals even when we aren’t under threat. This is exactly what happens in many cases of chronic pain, including persistent pain with sex.   

Your body thinks it’s protecting you by sending pain signals…but it can’t accurately tell the difference between a real threat and a perceived one.

If you’re having sex with a trusted, loving partner, you know, at least intellectually, that you’re not in any danger. Your body, however, may not know this. Your bodily tissues, including some of your nerves, might still associate intimacy with severe threat.

This is where the disconnect happens. You’re trying to enjoy sex, but your central nervous system is in full fight-flight-freeze mode, poised to run away or fight back against oncoming danger. Your muscles are tense, and your arteries are shunting blood to your limbs, away from your organs (including your genitals). 

How are you supposed to relax and have fun with sex if your body is getting ready for a battle royale?!?

In some cases, you might feel “frozen”: unable to express your desire to stop an unpleasant sexual encounter, even with someone you trust. Pain and trauma responses are complex and can present in many ways, but they have one thing in common: your nervous system thinks it is protecting you, even if you aren’t being threatened. 

Good news: it’s possible to quiet this chaotic nervous system signaling and calm the body so you can enjoy sex again.

How to have sex without pain

Because many variables can contribute to painful sex, there are also many different ways to ease and prevent that pain. Let’s discuss some helpful strategies.

Setting the scene

Nearly all approaches to pain-free sex share a common thread: creating a physically and emotionally safe environment in which to engage in sex and sex-adjacent activity.

Your central nervous system is heavily involved in your experiences of sex. If that system feels that you are unsafe in any way, it will go into overdrive, kicking you into fight-or-flight mode.

By taking the time to ensure that your environment feels inviting and safe, you’ll address one of the biggest obstacles to pain-free sex. The privacy, temperature, noise level, and even the lighting in your space can all contribute to its relative sense of safety. The more of these factors you can match to your preferences, the better.

While you’re prepping your space, grab any props or other tools you’ll want to have on hand. At a minimum, we recommended a high-quality lubricant, pillows or other cushions for supporting your body, and any tools you’ve been using for pelvic floor care, such as vaginal trainers and vibrators.

Getting your head in the game

A positive, safe headspace is just as important as a physical one. No number of cozy pillows and soft sheets will compensate for a mind that’s busy relieving past negative experiences with sex.

This is where mind-body techniques can really shine. Physical therapy for painful sex frequently includes mindfulness techniques that help you connect with your body and tap into the “rest and digest” side of your nervous system. Mindfulness strategies may include guided relaxations, body scans, breathing exercises, and more.

If you’re new to mindfulness-based techniques, check out this recording of a guided pelvic floor relaxation routine made by Origin physical therapists.

Once you’ve settled into a calm, connected mindset, take a few minutes to visualize a positive sexual experience. Picture yourself enjoying painfree, pleasurable sex (solo or with a partner). Guided imagery and visualization techniques can help you effectively manage pain and reduce the fear and anxiety it can cause.

Warming up your body

Your mind isn’t the only thing that can benefit from some pre-sex prep. Your body is a big piece of the painful sex puzzle, particularly if you deal with increased tone and tightness of the pelvic floor muscles.

If you’re already working with a pelvic physical therapist, you may have learned some techniques to relax and gently stretch your pelvic floor tissues. Performing these pelvic floor exercises for painful intercourse is a great way to prepare your body for a positive experience.

Vaginismus therapy and dyspareunia exercises often include techniques to reduce tightness and tenderness in the pelvic floor muscles. If you’ve learned how to use a pelvic wand, now is the perfect time to self-treat tender internal muscles. The same goes for using vaginal dilators to gently stretch and soften these muscles.

Combining these self-treatments with the mindfulness and relaxation techniques we’ve just discussed is an efficient, powerful strategy to release tight pelvic tissues. Whether or not you’re planning on penetration, decreasing excess muscle tension is good for your pelvic and sexual health!

Let’s talk about sex, baby: bringing in a partner

If you’ll be engaging in sex with a partner, involve them in your prep process. Take the time to explain why you’re arranging your space and preparing your body just so; you can even share this article with them!

If you haven’t yet told your partner(s) that you experience painful sex, check out our tips for starting the conversation. The more they understand, the more they can help you reduce and eliminate sexual discomfort.

Take a moment to remind each other that there’s no specific “end goal” for the encounter. Despite what the media and porn would have us believe, intercourse isn’t the best or only way to have sex.

Factoring in (lots of) foreplay

Let’s banish the notion that foreplay is what comes before the “main event” of penetration. (In all honesty, the word “foreplay” itself is problematic: it self-defines as coming before, rather than being something that can stand on its own…but we didn’t choose the term.)

Spend time (like, a LOT of time) engaging in pain-free touch and stimulation with your partner. This may not even involve explicitly sexual touch. Gentle contact to other, less sensitive parts of your body can help your nervous system uncouple your partner’s touch from pain. 

Additionally, non-genital body parts still contribute to arousal. Research suggests that these regions, such as the neck and inner thighs, are particularly important for arousal during partnered sex.

If and when you feel ready for more intimate contact, go If you don’t feel ready for an internal approach, your therapist may suggest something like the Kiwi tool. Vibrating devices like these can help your muscles relax, promote blood flow to the pelvic floor, and reduce tissue sensitivity that contributes to pain.. It takes time to become fully aroused: a cursory sweep over the clitoris isn’t cutting it!

A study of 58 healthy young people found that it took an average of 11-12 minutes to reach peak arousal regardless of the person’s sex and anatomy. If you experience pain with sex, you may need a little more time, so be patient with yourself! 

If you have pelvic pain or other conditions that cause painful sex, you might worry that you can’t get aroused at all. Here’s the good news: research shows that you can!you can still get aroused. 

In fact, a study of 75 women found that those who experienced dyspareunia (pain and/or a burning feeling during intercourse) could become equally aroused as those who didn’t have pain with sex. 

Note that this study used erotic imagery, not touch, to stimulate arousal in the participants. You may find that starting with non-physical forms of stimulation, such as watching a sexy show with your partner, is a less intimidating way to get things started.

Gettin’ busy with it: achieving penetration without pain

Remember, intercourse isn’t the end-all-be-all of sex. If penetration isn’t a good fit for you, don’t sweat it: you can still have plenty of fun, pleasurable sex without inserting anything inside your body.

If you do wish to engage in intercourse, though, use all the tools at your disposal to make penetration painless. A few helpful tips:

Pay attention to body position

The angle of your partner’s penis, strap-on, or sex toy relative to your vagina can significantly impact how you feel during penetrative sex. If you have pelvic floor pain during sex, a funky angle can take you from “wow” to “oww” in seconds. 

Check out our handy guide to sex positions for people with penetration pain, and experiment to find the positions that work best for you and your partner(s). Props and supplies such as a chair and extra pillows can help you get perfectly comfy before and during intercourse.

If deep penetration is a pain trigger for you, the OhNut wearable is a handy tool to limit depth during intercourse.

Lube it up

Repeat after me: lube is your friend! A high-quality, vagina-friendly lubricant can be the difference between sex that sucks and sex that rocks. Find a comprehensive guide to Origin’s favorite lubes here.

For folks dealing with vaginal dryness from hormonal changes or other conditions, it helps to combat dryness on a daily basis with moisturizing creams or suppositories such as the Revaree brand. If your vulvar skin is feeling parched, too, an external lotion such as Kindra’s Daily V or a serum such as their V Relief can help replace moisture and reduce irritation.

Note that some moisturizing products, such as Julva’s oil-based cream, contain DHEA, a compound that your body can convert to the sex hormones estrogen and testosterone. If you’re avoiding hormonal products due to an underlying medical condition, consider DHEA-free salves instead.

How to ask for help

If you take away nothing else from this article, let it be this: you do NOT have to live with painful sex! You don’t have to “just suck it up” or “grin and bear it”. 

The information here is meant to help you interrupt the painful sex cycle, but it’s not a replacement for personalized clinical advice and care. If you struggle to have sex with vaginismus or any other pelvic pain condition, you aren’t alone, and Origin is here to help. 

Ready to build a comprehensive sexual health plan? Book your first visit with an Origin clinician and start your journey to better sex today!

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