How Tight Pelvic Floor Muscles Can Cause Pain During Sex

Tight pelvic floor muscles can cause pain during sex. Tight pelvic floor muscles are common for women but often overlooked as a cause of painful sex. This blog explains how muscle tension can lead to pain, pressure, or burning during intimacy and what treatment options, like pelvic floor therapy, can do to help your body relax, heal, and enjoy sex again. The Pelvic Awareness Project blog explains how tight pelvic floor muscles can cause pain during sex.

Tight Pelvic Floor Muscles and Painful Sex

Sex is most often an act to be enjoyed and cherished. 

For some of us, however, sex can be painful, taking away its physical pleasures. 

If you’re suffering from pain, pressure, or burning during intercourse, you are likely wondering why sex is painful. Tight pelvic floor muscles and painful sex could be the problem. 

There are several pelvic floor tightness symptoms, and intercourse that hurts is one of them. Read on for more information on how a tight pelvic floor can cause painful sex.

Why the Pelvic Floor Matters

It helps to start by understanding how important the pelvic floor is when it comes to bodily functions, including sexual intercourse.

The pelvic floor is a series of muscles and ligaments that stretch within and across our pelvis. This hammock-like structure holds our pelvic organs in place, including the bladder, vagina, and bowel. 

The pelvic floor also helps to stabilize the core, and assists with essential bodily functions, like pooping, peeing and having sex. Finally, these muscles help your body absorb outside pressure from activities like heavy lifting, while protecting your spine and your organs.1 

Here’s a summary of the functions performed by a woman’s pelvic floor:¹

• Support the bladder, urethra, vagina, uterus, bowel, rectum and anus.
• Squeeze and relax to control when you pee, poop or pass gas, and help move waste from the body.
• Help maintain continence, or control over bowel and bladder function.
• Assist with blood flow and vaginal contractions during sex and orgasm.
• Support vaginal delivery during childbirth.

What Can Go Wrong With the Pelvic Floor?

Most of the time, we never even think about our pelvic floor muscles. That’s because they are known as “voluntary muscles,” meaning you can decide to switch them on and off. 

You tighten them when you need to hold in pee until you reach the bathroom. You release them when you sit on the toilet. These kinds of actions are usually done without even having to think about it, as the muscles do their job in the background.

But things can and do go wrong with the pelvic floor.

The most common problem suffered by women when it comes to the pelvis is a weakening of those muscles. Pregnancy, childbirth, weight gain, injury, and the natural process of aging can cause them to lose strength and lead to problems like urinary incontinence or pelvic organ prolapse. You’ve probably heard that you should be doing “Kegel” exercises regularly to help strengthen the pelvic floor.

However, not everyone should do Kegels. Some women suffer from the opposite problem: pelvic floor muscles that are too tight.

Hypertonic Pelvic Floor

A hypertonic pelvic floor, also known as high-tone pelvic floor dysfunction, occurs when pelvic floor muscles are in a constant state of contraction, or the muscles spasm. The tightness can be temporary or constant. 

This tightness and spasm result in muscles that can’t relax and coordinate those important bodily functions. You may feel pain, have trouble peeing or pooping, and/or suffer from painful intercourse.²

How The Pelvic Muscles Become Too Tight

There are several reasons why your pelvic muscles may have become tight or are in spasm. Sometimes the causes are complex, and as is often the case, stress, depression, and anxiety can contribute to the problems.

Some factors can increase your risk:²

1. Holding in your urine or stool on a consistent basis.
2. Suffering injury or trauma to the pelvic muscles, such as during surgery, an accident, pregnancy, or childbirth.
3. Muscular dysfunction can arise if you have uneven pelvic bones or an irregular gait, for instance, or if you have an abnormal posture or sit for long periods.
4. Pain-causing conditions can lead to spasms, such as irritable bowel syndrome or endometriosis.
5. Suffering from sexual or physical abuse.

Looking for more information on pelvic floor disorders? Here’s a look at the main causes of pelvic health issues. 

Why Does Sex Hurt for Some Women?

Some women find that sex hurts or can be painful. Tight pelvic floor muscles can lead to problems related to pooping and peeing. But the most common problem seems to be tight pelvic floor pain during sex. Like with any sore muscle, physical contact can cause pain. As a result, any penetration attempt during intercourse can hurt, which might make you further tighten the muscles. 

It’s a natural reaction for your body to tighten up to try and prevent pain. Even the thought of sex might make you go into “protective tightness” mode, which can lead to more pain.

This condition of painful sex is also known as dyspareunia. Even if you don’t suffer pelvic floor tightness pain during intercourse, those tight muscles can contribute to pain during an orgasm, or even in the moments after sex, following the strong muscle contractions that often automatically occur during intercourse.

And since your pelvic floor muscles are vital for orgasm and sexual function, you may have trouble experiencing orgasms because of muscle tightness. Healthy pelvic floor muscles help ensure good blood flow, hydration, and natural lubrication to your tissues. They also encourage the sensations needed for arousal and orgasm.³

What Can Women Do About Tight Pelvic Floor Muscles and Painful Sex?

What can women do about tight pelvic floor muscles and painful sex? If you have pelvic floor tightness symptoms and/or pain during sex, the first step is to see a doctor for a proper diagnosis. Use our Physician Finder tool to find a doctor near you with expertise in women’s health. A treatment plan can be tailored to your specific needs and help alleviate the symptoms of a tight pelvic floor.

The primary treatment for a tight pelvic floor causing pain during sex is physical therapy by a therapist trained in treating pelvic floor dysfunction. The goal is to retrain your muscles using strategies such as relaxation techniques, massage, muscle stretching, joint movement, and possibly biofeedback to guide contraction and relaxation of your muscles.²

Other possible treatment options include:²

• Acupuncture.
• Medications for the underlying issue, such as those for pain, anxiety, constipation, or frequent urination.
• Nerve stimulation.

A physical therapist may also combine other treatments with a tool called a vaginal dilator. These custom “tubes” can be introduced into the vagina, and help guide pelvic floor muscle relaxation. In cases where you have burning or very strong pain, you may need medication just to begin therapy.

Depending on other side effects, you may also consult a gastroenterologist if you experience constipation, for instance, or a urologist to address urinary problems. If you’re suffering from emotional or other mental health issues, then a psychologist or other therapist may be able to help.²

How Women Can Prevent a Tight Pelvic Floor

Most of us have heard of the famous Kegel exercises, a contraction technique designed to strengthen the pelvic floor muscles. But if you have a hypertonic pelvic floor, Kegels can make it worse.

There are some steps you can take to reduce your risk of developing a tight pelvic floor. The first caution is to seek medical care if you’re having any type of pelvic or anal pain. 

Healthcare providers recommend these possible actions to help reduce or prevent pelvic floor tightness and pain during intercourse:²

1. Avoid constipation and straining when you poop.
2. Avoid prolonged periods of holding in poop and pee.
3. Seek psychological support after trauma.
4. Practice mindfulness and relaxation techniques.
5. Do pelvic floor exercises during and after pregnancy.
6. Strengthen your pelvic floor and core by doing yoga, which often includes a bonus in controlled breathing and other relaxation techniques.

Don’t suffer in silence if sex hurts. Even if you’re not sexually active, a tight pelvic floor can cause pain and other problems. See your doctor for diagnosis and treatment so that you can be on the road to good pelvic health.

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1- https://my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles

2- https://my.clevelandclinic.org/health/diseases/22870-hypertonic-pelvic-floor
3- https://www.theoriginway.com/blog/10-symptoms-of-a-tight-pelvic-floor

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