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Published in: JOURNAL, sexual wellness

Understanding Pain During Sex with Dr. Kristin Sapienza

Dr. Kristin Sapienza is a pelvic floor physical therapist in New York City. She uses her own experiences with painful sex and endometriosis to guide her empathetic approach to patient care.

Here, she shares some of  that personal experience and also provides background for reasons why people with vulvas might experience painful sex.

3 common reasons for painful sex:
Pelvic Floor Dysfunction ⟶
Childbirth ⟶
Menopause ⟶


I always suffered from pain with sex throughout my dating history.

I thought it was just me; something that I had to just deal with. Coming from a Catholic background where sex before marriage is seen as taboo and never talked about; it was hard for me to ever ask questions around painful intercourse.

I remember always looking forward to being intimate but counting down the seconds till it was all over.

I had suffered from poor body image throughout my teens and 20's, making me clench my pelvic floor worried about what men would think of my body naked.

In addition, from 15 years old, I suffered from stomach discomfort and what some doctors would just diagnose as Irritable Bowel Syndrome (IBS).

I was unaware of the toll that would have on my pelvic floor and contribute to pelvic floor dysfunction. Very close to my 30th birthday, I started having a period that never ended.

The pain was so unbearable that it made it hard to stand all day as a physical therapist. It almost felt as if my pubic bone and vulva was throbbing constantly. My job was to be someone else’s support system and I felt I could barely take care of myself.

* * * 

I went to many doctors before I was diagnosed with endometriosis following laparoscopic surgery. The pain then continued for another year after surgery before my cycle and central nervous system was regulated with acupuncture and pelvic floor physical therapy. However, I had to find my mojo again.

I felt dried up and asexual. I had to do the work with continued pelvic floor physical therapy and work on feeling sexy in my own skin again. For many women, they just think it’s their cross to bear and to focus on the pleasure of the partner.

We are lucky to have platforms to talk about these issues. We also have every right to experience pleasure.

This is just one account. 25% of women are currently suffering from painful sex, which is properly called “Dyspareunia” in medical terms.

Here are 3 instances in which women can suffer from painful intercourse in different phases of their lives:

Pelvic Floor Dysfunction

Pelvic Floor Dysfunction can occur for many reasons. The pelvic floor is essentially a bowl of muscles and the bottom of your core. The pelvic floor is responsible for support, digestion, stability, and pleasure.

Just like any muscle is your body, muscle can tighten and not function properly. The following issues can lead to pelvic floor dysfunction:

⟶ Chronic Constipation
⟶ Pelvic pain
⟶ Hip or Low Back Pain
⟶ A fall on your tailbone
⟶ Chronic UTI’s
⟶ Endometriosis or Adenomyosis
⟶ Medication Side Effects
⟶ General stress and anxiety

Pelvic floor physical therapists can help you break the pain cycle and relax the muscles that are chronically going into spasm. The pelvic floor then needs to properly contract and relax to find its balance.



The thought of having sex after a baby can be quite daunting. If you experienced tearing or an episiotomy during birth, you could experience some pain with intercourse.

There can be fear and anxiety around the thought of it. A majority of women experience some dryness because your hormone levels have dropped since giving birth.

The good news is that your estrogen will return to normal levels once you are done breastfeeding, and progesterone will return when you start ovulating again.

Pelvic floor physical therapists can help reduce the tension of the muscles that have suffered trauma from the birth and/or stress during pregnancy.


Menopause or Cancer Treatments

Menopause is accompanied with a drop of estrogen. This essentially changes how these muscles function.

They can become dry and sensitive and lose their vigor in providing strength and stability. Hence another opportunity for painful intercourse.

Cancer Treatments such as chemotherapy and radiation can also affect the tissues of your pelvic floor that can have similar effects to menopause depending on which type of cancer you may have suffered from.

Pelvic floor physical therapists will teach you how to manage this pain. They can find the driver to why this is happening and help you make the proper changes to your life so that you can experience pain free and pleasurable intercourse.

If you are looking for a pelvic floor physical therapist in your area, please refer to and enter in your zip code.


Keep Reading: 
Top Five Tips To Maintain A Healthy Cycle with Dr. Laura Meihofer ⟶
Treating Vulvodynia: What Didn’t Work ⟶
Read 7 Health-Related Reasons to Look at Your Vulva with a Mirror ⟶


Grab A Mirror & Make An Appointment with a Pelvic Floor Therapist
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If you are looking for a pelvic floor physical therapist in your area, please refer to and enter in your zip code. 

artwork: victor yrigoyen 

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