Love, Intimacy, and When Sex Hurts
Dr. Mallorie Hopkins, PT, DPT
February brings a lot of attention to sex and intimacy, Valentine’s Day, Sexual and Reproductive Health Awareness Day (Feb 12), and National Condom Week (Feb 14–21). Love is in the air… and often, so is the expectation of sex.
But what happens when intimacy doesn’t feel loving or pleasurable at all, when it hurts?
Historically, Valentine’s Day has roots far less romantic than chocolates and cards. The ancient Roman festival of Lupercalia (celebrated mid-February) centered on fertility, purification, and ritualistic practices that included whipping women with animal hides to “promote fertility” (See History.com: “Lupercalia”).
Thankfully, we’ve evolved past that. What hasn’t evolved enough, though, is how openly we talk about pain with intercourse.
This blog is about the part of intimacy that often goes unseen: the confusion, frustration, and isolation that come with painful sex, and how understanding your body can be the first step toward comfort, agency, and pleasure.
Intimacy Is More Than Penetration.
Many people are taught, explicitly or implicitly, that sex equals penetration. Penis-in-vagina intercourse becomes the gold standard of intimacy — but intimacy is much broader than that.
Think of sex like a four-course meal. Penetration is the entrée, but there’s also the appetizer, the salad, and yes, dessert. Skipping straight to penetration without preparation, safety, or desire can leave the body unready and overwhelmed.
Sexual intimacy is a whole-body experience, not just a genital one.
The Physiology of Sex: Why the Body Matters
Sex is guided by the sexual response cycle, which involves the brain, nervous system, hormones, blood flow, pelvic organs, and pelvic floor muscles working together.
Desire begins in the brain and is shaped by safety, emotional connection, stress levels, and sensory input.
Arousal increases blood flow to the pelvis, heightens sensation, and supports natural lubrication.
Orgasm involves rhythmic pelvic floor contractions and the release of feel-good neurochemicals.
Resolution allows the body to soften, calm, and return to baseline.
When this sequence flows smoothly, sex can feel pleasurable and full of connection. But when something disrupts the process — muscle tension, hormonal changes, trauma, stress, or nervous system over-activation —sex can become uncomfortable or painful.
What is important to understand is, pain is not a failure. It’s information.
Painful Sex 101: Vaginismus vs. Dyspareunia
Pain with intercourse generally falls into two main categories: vaginismus and dyspareunia.
Vaginismus
Vaginismus is defined as the inability to insert anything into the vaginal canal, a finger, penis, tampon, toy, or speculum.
The key word here is inability. This condition involves involuntary pelvic floor muscle guarding, driven by nervous system activation. It’s a mind–body response, often rooted in fear, pain anticipation, trauma, or learned protection.
Treatment is not just physical. It involves:
Pelvic floor education
Hip mobility
Nervous system regulation
Pain processing and emotional support
Importantly, once insertion becomes possible, even if there is still pain, the diagnosis often shifts. This matters because even though you may still experience pain, the shift reflects progress.
Dyspareunia
Dyspareunia simply means pain with intercourse and can occur in two primary ways:
Superficial Pain (At the Vaginal Opening)
This involves the vulvar and perineal muscles that circle the vaginal entrance. When these muscles are tight, the opening may feel blocked, many people describe it as “hitting a wall.”
Helpful strategies may include:
Slowing down insertion
Inhaling deeply during entry
Rocking the hips back to allow the pelvic floor to soften
Deep Pain (With Penetration)
Deep pain often involves muscles at the back of the pelvic floor, such as the levator ani, coccygeus, or obturator internus, which are closely connected to hip and pelvic positioning.
A simple support, like placing a pillow under the pelvis, can sometimes reduce tension and discomfort by changing hip alignment.
When discussing conditions like these, it can be helpful to have an understanding of your pelvic anatomy. Check out our recent blog:
Supporting Yourself: Before, During, and After Sex
There is no one-size-fits-all solution, but here are gentle ways to support your body throughout the sexual response cycle:
Before
Extended foreplay to allow desire and arousal to build
Sensory stimulation to the vulva
The Pelvic People’s Kiwi Device: increases circulation and supports arousal
During
Open communication with your partner
Slower pacing and controlled depth
Positions where you control penetration (such as being on top)
Support tools like the The Pelvic People’s Ohnut to limit depth if needed
After
Allow heart rate and breathing to settle before jumping up
Cuddling and connection to support nervous system regulation
Deep breaths to encourage pelvic floor relaxation
Gentle vulvar massage, ice, or topical lidocaine if helpful
For lingering muscle tension or post-intercourse discomfort, some people find CBD suppositories helpful. We love Kunda Blossom Drops as a recommendation for support.
Redefining Pleasure
Pleasure is not universal. Intimacy is personal.
There is no playbook for how sex should look or feel. The goal is not performance, it’s curiosity, communication, and connection. Understanding your body’s signals allows you to move away from expectation and toward what actually feels good for you.
Painful sex is common. It is treatable. And you are not broken.
If intercourse is painful, support exists, and you deserve care that honors both your body and your lived experience.
If you’re ready for guidance, we’re here to help at Tonic & Phasic Holistic Pelvic Health.
Until next time,
The Tonic & Phasic Holistic Pelvic Health Team
