Painful Sex: A Pelvic PT's Guide to Healing
If you're struggling with painful sex (dyspareunia), please know you are not alone, and healing is possible. This condition is far more common than you think, affecting up to 21% of women and 5% of men, yet it's often shrouded in shame, silence, and confusion. In this episode of Bottoms Up, expert pelvic health physical therapist Dr. Kerry Winge pulls back the curtain on why intercourse might be painful and what you can do about it. We explore the core question: what are the hidden causes of painful intimacy, and how can you find a path to relief and pleasure?
This episode is a comprehensive guide for anyone experiencing pelvic pain, whether it's burning, sharp sensations, or deep aching during or after intimacy. Dr. Kerry Winge of Pelvic Health Physical Therapy of Morgantown shares powerful, anonymous stories from real patients - from teens unable to use a tampon to new mothers experiencing pain after childbirth, and even men dealing with perineal aching after orgasm. We dive deep into the causes of painful intercourse, which often involve a complex mix of physical factors (muscle tension, hormonal shifts, scar tissue) and the emotional impact of pelvic pain (fear, anxiety, trauma, and relationship stress). Dr. Winge explains that your body isn't broken; it's trying to protect you. We also demystify the dyspareunia treatment process, explaining that relief often comes from a combination of therapies. You'll learn what to expect during a diagnosis, including the gentle "Q-tip test," and why clear communication with your practitioner is vital. The conversation highlights why pelvic floor physical therapy for painful sex is a cornerstone of healing, as it helps release muscle tension, retrain the nervous system, and restore mobility. This isn't just about "fixing" a problem; it's about reclaiming your connection to your body and finding joy in intimacy again. If you've ever been dismissed or told "it's all in your head," this episode offers the validation, education, and hope you deserve.
Introduction
Dr. Kerry Winge: The first thing that you've done is walk in the door and take responsibility for your health. So that's a win right there. Someone's been dealing with this. They have this problem, whether it's a man or a woman, and they decide they want to get diagnosed. What does that process look like? I want to help people move through this beautiful, messy, sacred thing called life without the shame, silence, and unnecessary suffering.
Before we begin today's episode, I want to take a moment to acknowledge that this topic, pain with sex and pelvic pain, can be deeply sensitive. For some, it may stir up memories or emotions that are hard to process. If at any point you feel overwhelmed, please give yourself permission to pause or skip certain sections. This podcast is here to support your healing journey, and we'll meet you exactly where you are.
If you are ready to take the next step in your healing, know you're not alone. Every day at Pelvic Health Physical Therapy of Morgantown, my team and I treat people from all walks of life who are struggling with pelvic pain, intimacy issues, or painful intercourse. What you're about to hear are stories that reflect real patients, some of which may actually sound a lot like your own. And although we can't include every voice, the ones you'll hear today actually represent just the tip of the iceberg.
These are the voices we listen to daily in the clinic. And if there's one truth that continues to show up, it's that your healing is never linear. But it does happen. And with the right support, it's absolutely possible. So we are here to guide you, not to rush you. And every person's path looks different. There's no timeline, and there's no too late. This is a safe space to explore your story, reconnect with your body, and understand what healing actually might look like for you. So let's begin with a few patient experiences that you might recognize yourself in.
Voices of Pelvic Pain: Real Patient Stories
A 16-year-old girl, embarrassed and confused, she can't insert a Tampax. The pain feels sharp and wrong, but no one has explained why. She avoids talking about it because she doesn't want to seem dramatic.
Nathaniel: A 24-year-old woman raised in a deeply religious household waits until marriage to have sex, but on her wedding night, she experiences excruciating pain. She believes something is wrong with her body, or worse, her faith.
Dr. Kerry Winge: A 20-year-old college student avoids dating entirely. She knows that penetration causes pain, and she's terrified that if she actually connects with someone, the expectation of sex will destroy it.
Nathaniel: A 28-year-old man has severe pelvic pain and aching in his perineum after orgasm. He hasn't told his partner how much it affects him. He's afraid of what it means and afraid he won't be believed.
Dr. Kerry Winge: A 50-year-old woman notices pain creeping in during intimacy. She's perimenopausal, but no one warned her that hormonal changes could affect the vagina and the pelvic floor.
Nathaniel: A 75-year-old woman wants to rediscover pleasure in her body after decades of caregiving, but pelvic pain and dryness hold her back. "I finally have time for myself," she says, "but I can't enjoy it."
Dr. Kerry Winge: A new mom goes for her six-week checkup. Her OB says, "Everything looks fine." But when she and her partner tried to be intimate again, the pain made her cry. How can everything be normal if it hurts this much?
Nathaniel: A patient comes in after bladder sling surgery. Since the catheter was removed, she's had sharp urethral pain and pressure. Sex is out of the question. Even walking hurts.
Dr. Kerry Winge: And finally, a woman sits across from me with tears in her eyes. She was sexually abused in childhood and recently tried dating, but a simple kiss or intimate touch sends her body into panic. She doesn't feel safe, even in her own skin. So we talk about consent, not just with others, but with herself, because learning to feel safe again is the very first step.
These stories are painful, but they are also powerful because they remind us that pelvic pain is just not physical. It's emotional, spiritual, and relational. It touches everything: your identity, your safety, your voice, and your body. At Bottoms Up, our mission is to provide educational tools, therapies, and compassion, not just to fix pain, but actually to restore connection, to help people move through this beautiful, messy, and sacred thing called life with dignity, confidence, and joy.
What is Dyspareunia? Defining Painful Sex
Nathaniel: And if it isn't clear, what we're talking about today is dyspareunia. Now, question number one that people probably have, and I think it's obvious based on what we talked about, but let's just go over it. What exactly is dyspareunia?
Dr. Kerry Winge: It's a medical word that means pain during or after sex, and it might feel like burning at the entrance or a deep aching inside or sharp pain that actually lingers after intimacy. For some people, it's been there from the start. For others, it shows up after a UTI, childbirth, or menopause.
Nathaniel: And immediately the first question I have is, can this happen to men too, or is this usually something that we see only with women?
Dr. Kerry Winge: Yes, and it's rarely talked about. Men may feel aching in the perineum, pain during arousal, and also after ejaculation. It's real and it matters. Globally speaking, about 8-21% of women and up to 5% of men experience painful sex. In some areas, rates are much higher, but pain is often hidden. People feel embarrassed, dismissed, or unsure what is causing it.
Uncovering the Causes of Painful Intercourse
Nathaniel: So then what it sounds like to me is that this isn't super rare. 8-21% of women and 5% of men are experiencing this.
Dr. Kerry Winge: No, not at all. And if you've never told anyone you're not alone, it's common and it's treatable. Painful sex can be caused by a lot of things. Sometimes it's physical, like dryness, muscle tension, or a past infection. But sometimes it's emotional, like fear, trauma, or anxiety. But often we see a combination of both.
We break it into three different areas. Your body, you can have tight muscles, hormone shifts, scar tissue, infections, bladder or bowel issues. The second category is your brain with fear, nervous system sensitivity, and trauma. And then lastly, we talk about the relationship, stress, shame, and miscommunication. So it's just not in your head. Your body is actually trying to protect you.
Beyond the Physical: The Emotional Impact of Pelvic Pain
Nathaniel: So at the start of this episode, you and I talked about the experiences that you've heard at Pelvic Health Physical Therapy of Morgantown. And it sounds extremely emotional. So maybe walk us through how this affects people emotionally.
Dr. Kerry Winge: What I notice is that people start avoiding intimacy and they feel shame or guilt. They communicate that to me, but they also stop communicating to their partner. And that's why we say it's really important to start the conversation early. And patients will ask, "Well, what exactly do I say?" My recommendation is something along the lines of, "This isn't about you," to your partner. "This is about something that's happening in my body. I want to work on it with you," because every patient deserves intimacy that feels good and is not painful.
Getting Answers: The Diagnostic Process for Painful Sex
Nathaniel: So someone's been dealing with this. They have this problem, whether it's a man or a woman, and they decide they want to get diagnosed. What does that process look like?
Dr. Kerry Winge: Diagnosis starts between you and your practitioner with a kind, thorough conversation. So lots of history and then a gentle physical exam. Your practitioner may ask you questions like, "Where is the pain? What does it feel like? When did it start? What helps? What makes it worse? What makes it better?"
And as for the exam, they're going to have to look at all the muscles that may contribute to the pain. For a female, they may look at the vulva. You may experience a test called the Q-tip test where the practitioner takes a Q-tip and just gently goes over the pelvic muscles to see what is painful, what is not. But regardless of how the exam takes place at any point in time, you should always feel safe and in control. And communicate with your practitioner what you are ready for.
Nathaniel: So what I'm hearing is that this is very subjective in the sense that you have to be able to communicate what you are feeling. And so when you're going to this, you have to be very ready to communicate that with your practitioner because there's no blood test. They can't just draw your blood and say, "Well, you've got it. This is your problem."
Going with the Q-tip, you have to be able to communicate that it really hurts. So when you're going there, you just have to be mentally prepared for that. And I know that can sound like a lot, but what you're going through right now is worse than telling someone the pain you're feeling. Be ready to communicate. It's uncomfortable, but doctors can't read your mind. It's kind of like a relationship. You can't understand everyone's mind. You can't understand what's going on. You have to be able to communicate that. So I just wanted to stress that and that's really important.
Pathways to Healing: A Comprehensive Guide to Treatment Options
But let's say we've gone to the doctor and we got it diagnosed. What can I do now? What are the therapies? What do they look like? What are the treatments? Is there surgery? Is it just pelvic health PT? Walk us through what people can do to feel better.
Dr. Kerry Winge: Okay. So there's no one size fits all, but the first thing that you've done is walk in the door and take responsibility for your health. So that's a win right there. But many people start feeling better with some sort of combined approach with the following. So pelvic floor physical therapy is extremely important because it will help calm those tight muscles by releasing tension and restoring mobility for that natural slide and glide of the muscles in the pelvis so that they don't get caught or pinched or pulled during sexual or physical activity.
It's really hard for me to explain because it's something that people just can't see. So everybody thinks that the pelvis is an abyss. It's the dark hole down there. You can't really take a picture. You can't see what's going on. So you have to trust your practitioner that we are used to feeling these tight muscles all day. We can feel what's within the realm of normal. And we can feel when there's areas that are tight. And these muscles are also attaching to your hip and they're attaching to your lower back and they're attaching to your sacrum and your coccyx bone. Everything is connected. So that's why we are here to help.
We also work on retraining the body and the mind. So we're using many techniques that are working towards reprogramming a healthy connection that actually replaces pain with pleasure and fear with joy. This is a very simplistic explanation of a treatment for a complex problem. But trust me, it works. That's why you are going to an expert to help.
Steps 2, 3, and 4 are tools that we may suggest as needed, including, let's just say, if you're dry or you're peri- or postmenopausal or postpartum or maybe on birth control, you may say, "Okay, let's increase the lubricants." We're going to use a silicone or a glycerin-free water-based lube. That's not the only treatment. That is one of many.
Your provider may provide hormonal, or in our clinic, we may prescribe dilators or a wand, which is a self-trigger point release. We also have hormone-free products to balance the bacteria in the vagina, promote blood flow, and increase elasticity. And if trauma or anxiety is moderate or severe and we're not able to progress through your treatment, we're going to refer you to a psychologist or a sex therapist. And if we need help with pain management or further diagnostic testing, we're going to consult with your provider.
Some of the medical interventions with a provider may include things like lidocaine, which will numb the area, gabapentin to treat pain, Botox to relax the muscles, or in select cases, some surgery. But we usually use a combination of many tools in our toolbox based on your individual needs and what you need at each stage. But many people actually start seeing significant changes in just 6 to 12 weeks. But I've actually seen excellent changes sometimes just in one treatment.
Why Pelvic Floor Physical Therapy is a Key Part of Treatment
Nathaniel: So, Dr. Kerry, you're a pelvic health physical therapist. And so let's understand what makes pelvic PT unique to this specific condition.
Dr. Kerry Winge: Well, we are trained to work with your body in a respectful, trauma-aware way. We are trained to assess your muscles internally and externally. We guide you through breathing, stretching, and calming the nervous system.
And collaboration is key. So I take my expertise. We also talk with your doctor, your GYN, your urologist or your therapist. So even if we're not in the same building, we're on the same team. So collaboration happens all the time.
Nathaniel: Okay. And so how does pelvic PT tie into all of this?
Dr. Kerry Winge: Well, complex musculoskeletal dysfunction is our specialty and we deal with it all day, every day. So this is where you need to come.
Ask the Expert: Addressing Common Patient Scenarios
Nathaniel: We've covered a lot, but we're going to do a little ask the expert real patient questions type segment right now where I'm just going to ask you some questions that people have brought to you or that they talk about online. And we're going to get some expert opinions on that from Dr. Kerry herself. So case number one: after having my second baby, sex burns every time. My OB says it's just hormones. Is that true?
Dr. Kerry Winge: Hormones play a role, true, but so does scar tissue, dryness, and muscle guarding. So you may benefit from local estrogens, dilators, and pelvic physical therapy.
Nathaniel: Okay, case number two: I am a man with perineal aching during arousal. It's embarrassing.
Dr. Kerry Winge: You're not alone. Pelvic floor tension and nerve irritation can absolutely cause this. So go see your local pelvic PT. They can help retrain those muscles and calm your nerves.
Nathaniel: And case number three, last but not least: pain feels like a knife deep in my pelvis. I've been told it's endo, but I'm not sure.
Dr. Kerry Winge: Well, that's classic for endometriosis or pelvic floor trigger points. So it's very important that you have a full workup with a gynecologist and pelvic PT is key.
A Final Message of Hope and Healing
Nathaniel: All right. And I think that brings us to the end of the episode. So, Kerry, final thoughts that you can give everyone that's listening today?
Dr. Kerry Winge: At Bottoms Up, we make it our mission to provide more than just information. We offer education, tools, therapies, and compassionate support that addresses not only physical pain, but emotional and spiritual healing with the goal of restoring connection. I want to help people move through this beautiful, messy, sacred thing called life without the shame, silence, and unnecessary suffering, which is why I started this podcast to take my time to transfer the knowledge to help others.
Painful sex, it's not your fault. Whether your pain is physical, emotional, or both, it's valid. You deserve answers. You deserve relief. And pleasure is your right. Living without pelvic pain is absolutely possible.
Nathaniel: All right. And that brings us to the end of the episode. Thank you, everyone, for listening. Share this episode with someone you care about. Healing starts with understanding. And I think Dr. Kerry has done a great job helping us all understand. And stay tuned because we'll see you back for another episode of Bottoms Up.