Women and Painful Sex

By Dr Brooke Van Zanden

Many people are surprised to learn that about 20% of Australian women experience painful sex (Richters et al. 2007). Despite the commonality of painful intercourse (also known as dyspareunia), many people feel very alone and often delay seeking support – sometimes for years.

Untreated dyspareunia can have significant impacts on the lives and relationships of women (or people with vaginas who don’t identify as women); but the issue receives very little attention and funding for research and clinical practice. As a result, the treatment of dyspareunia has not progressed in the same way that supports for men’s sexual health concerns have.

Sex in the perinatal period can be a particularly challenging time. Our bodies change rapidly with pregnancy and birth. Pregnancy, birth and lactation bring about significant changes in hormonal levels, which can impact libido and arousal. For instance, many breastfeeding mothers may notice a reduction in their natural lubrication which assists with penetrative sex. Some people find that reduction in lubrication can result in pain upon penetration. Others may be recovering from birth injuries (e.g., scar tissue or anatomical changes may cause discomfort), or the psychological impact of a traumatic birth which can change our relationship with how we see our body, and feelings of safety with intimacy. And often overlooked is the significant shift in intimate relationships that occur in this time. As a new child is welcomed into the home, parents are faced with the tremendously difficult task of looking after their baby (often with far less social supports than what humans were evolved to parent with). It is no wonder that when balancing all of these tasks, sleep deprivation, and post-natal recovery, many people find returning to intimacy a daunting (and often painful) prospect.

The good news is that painful intercourse and sexual health concerns can be overcome with the right supports. These supports will look different for each person – for most people this may involve an assessment from a GP to identify any physical causes contributing to the pain. Many people also benefit from seeing a physiotherapist who specialises in women's health. As a psychologist, I enjoy working with people to understand how relationship dynamics, stress and anxiety can contribute to, or worsen, painful sex.

Vaginismus is a common cause of painful sex and is often associated with anxiety. When people experience vaginismus, sex can be so painful that penetration feels impossible. Many people describe that their partners feel like they are hitting "a brick wall". In this situation, anxiety or stress during intimacy can trigger the pelvic floor muscles to contract making penetration difficult.

A psychologist can help identify factors leading to stress, anxiety and lowered arousal. This may involve exploring beliefs around intimacy and sex (e.g., having sex because you feel like you should out of duty; negative cultural or social messages around sex, and worries about intercourse (e.g., anticipation of pain, performance anxiety or worries about judgement, and previous trauma). Many people find that once they feel safe, relaxed, and free to say no to sex, their experiences with intimacy are greatly improved.

Brooke is one of the psychologists at Banksia Psychology & Supervision. You can follow or contact them at:

Instagram: @banksiapsych

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Website: www.banksiapsych.com