5 Ways To Make Sex Less Painful & More Pleasurable, From A Pelvic Floor PT

Nothing makes me angrier as a pelvic floor physical therapist than hearing that when a patient went to the doctor about pain with sex, the doctor said to "have a glass of wine."

This suggestion is harmful on many levels, but most importantly, it doesn't work. Many vagina-owners experience pain with penetrative intercourse, meaning sex that involves inserting something into the vagina, such a finger, a penis, or a vibrator. And while this symptom is common, it isn't normal, and there are lots of effective treatment options (that don't involve wine).

You have control over your pelvic floor muscles like you have control over your fist. You can squeeze your pelvic floor and relax it. Try it right now as you read this: Squeeze your anus like you are trying to hold in a fart, and then let it go.

I often find that my patients who experience painful intercourse hold their stress in their pelvic floor muscles, meaning they grip their pelvic floor muscles frequently when they don't need to. If that sounds like you, try checking in with your pelvic floor muscles throughout your day and relax them when you notice you're clenching.

Have you ever worked too long on a project and realized that your shoulders and neck have gotten extremely tense? And when that happens, do you ever massage the tops of your shoulders to ease that tension? That's exactly what you can do for the pelvic floor muscles.

Lying down in a private space, take freshly washed fingertips to the skin between your genitals and anus and gently massage. Try to use lighter pressure than you think you need—I promise it will still be effective! Remember that we don't want to cause soreness or bruising in an area that is already experiencing pain.

If we stretch the pelvic floor muscles regularly, they will change in length and will be able to accommodate penetration. To do this, wash your hands and lie down comfortably in a private space. Imagine that your pelvic floor muscles are loops of rubber bands hanging from the pubic bone and wrapping around the vaginal canal.

Lubricate the thumb of your dominate hand and insert it into your vagina just to the first knuckle, with the pad of your thumb facing your anus. The pad of your thumb now rests against the loops of your pelvic floor muscles. Gently pull those muscles away from the pubic bone, toward the anus. Stop as soon as you feel discomfort and take six slow, deep breaths.

Release the stretch, and angle your thumb a little toward the left and pull toward what would be the back left corner of your vaginal opening, if your vagina had corners. Again, hold while you take six deep breaths and release. Repeat the stretch toward the back right corner of your vagina.

Then, repeat all three directions—back, back/left, back/right—one more time. Notice if it feels like you are able to stretch your muscles farther the second time through.

This isn't so much an exercise to be done on its own as it is a layer to add to the massage and self-stretch above. Even though the pelvic floor muscles are the same type of tissue as your quads, hamstrings, and traps, I find that pain caused by benign muscle stretching has a different "flavor" at the pelvic floor.

It's as if the nervous system wants to categorize any discomfort experienced at the pelvic floor as danger, as a major concern. It will turn the volume up on anything happening in the area. I believe this is because of the pelvic floor's proximity to vital organs such as the bladder, uterus, and rectum.

For example, when you ride in the car too long and then get out and stretch your legs, you experience slight discomfort in your hamstrings. But because you know it's just leg stiffness, you don't think anything of it and you continue walking. When the pelvic floor muscles experience a stretch, it might feel just like that leg stiffness, but because of the proximity to vital organs, the nervous system will turn up the volume on your experience of discomfort.

If the previous exercises did not ease your pain with penetration, it may be that you need a larger circumferential stretch or a deeper stretch, both of which are hard to achieve with your own digits. For most of us, penises and vibrators are bigger and longer than our thumbs, which is where a dilator can come in handy2.

You can think of dilators as penis- or vibrator-shaped stretching tools. They come in lots of sizes and textures, and some even vibrate to help you relax. The goal of using dilators is to progress the gentle massage and stretching you've already started in a way that helps the muscles continue to lengthen to accommodate whatever size your goal object is.

Yes, this does mean that if your goal is penetrative intercourse with a penis-owner, you might want to measure said penis for length and girth to help you buy the right size dilator. If your goal object is a vibrator, you can use the vibrator as your dilator, but you may also want a smaller-size dilator to help you work to the full-size vibrator.

When looking for a dilator (I like the ones from CMT), you want to think about your own sensitivity and stretch strategy—specifically how many steps you want to take to get to the size of your goal object. You'll notice that you can buy single dilators or packs with several sizes, which will allow you to progress at regular size intervals over time. Then, you will also want to consider texture. There are hard, smooth plastic dilators that will offer you a stretch but won't feel anything like a partner, versus silicone dilators, which are more expensive but feel soft and firm, a little more like a partner.

To stretch with a freshly washed dilator, you will, again, want to lie down in a private space. Cover the end of the dilator in lubrication (be sure not to use silicone lube with a silicone dilator). As you go to insert it, if you feel nervous, just rest it at your entrance and let your nervous system desensitize to the new tool. If you feel comfortable, insert it but only as far as you can without discomfort. That might be just the tip, halfway in, or all the way in. Don't feel rushed. Whatever you achieve is perfect for that day.

Wherever the dilator is (resting at the entrance or inserted), leave it there for 5-15 minutes. You will probably start out at 5 minutes and, as it gets easier, build to 15 minutes. Again, aim to stretch three days per week, progressing the dilator deeper and leaving it in for longer (up to 15 minutes) each session.

Once you are able to insert the dilator fully for 15 minutes without discomfort, you can either move up in dilator size if you bought a progressive set, or you can start to stretch with the dilator. To do so, hold the end of the dilator and gently press it toward your anus, like you did previously with your thumb. Hold for six slow, deep breaths. Release and then stretch the dilator toward the back left corner of your vagina. Hold for six breaths. Release and repeat toward the back right corner of your vagina.

Painful sex can be caused by a large variety of things—including a tight pelvic floor. The pelvic floor muscles are a hammock of muscles at the base of your pelvis that close the openings and lift to support the organs. During penetrative intercourse, the muscles need to relax and stretch to allow the object to enter the vagina.

Relaxing a tight pelvic floor won't happen overnight. You can think about it like you're training to do the splits. It might be pretty painful to attempt the splits today, but with regular, gentle stretching, your muscles will accommodate. In time, you'll gain the mobility to do the splits without pain. The pelvic floor muscles will also respond to stretching3, and stretching them can make sex not only pain-free but pleasurable.