3 Exercises for Pelvic Pain To Make Intercourse Less Painful

About 10–20% of people with vaginas in the US experience painful intercourse throughout their lives, per a March 2018 review published in the journal Cureus. This includes superficial pain of the vulva or vaginal entrance and deep pain inside the vagina or lower pelvis.

I'm a pelvic floor physical therapist who treats pelvic pain every day. Many of the people I treat end up in my office after seeing many healthcare providers and trying other treatment approaches, and some have been dealing with painful sex for decades. The people I see are a diverse group of different ages, backgrounds, and fitness levels. But the one thing they almost all have in common is feeling alone in their experience.

If you've also had intercourse that hurts in some way, I'm here to tell you that you aren't alone, and pelvic floor physical therapy can help. Several emotional and physical stressors and medical conditions such as urinary tract infections (UTIs) can cause or contribute to pelvic pain. However, in many cases, exercises done at home can manage discomfort and help you return to pain-free, enjoyable sex.

These exercises are not meant to replace proper medical care. Painful sex can have serious causes, and it's important to see your gynecologist or primary care provider for testing and diagnostics. Conditions like endometriosis, infections, vaginismus, vulvodynia, and interstitial cystitis can all cause pelvic pain.

Let's break these down:

• Endometriosis is when uterus-like tissue grows outside the uterus, per the National Library of Medicine MedlinePlus resource.
• Vaginismus is a rare condition that causes a muscle spasm around the vagina, causing it to narrow, per MedlinePlus.
• Vulvodynia is a pain disorder that causes severe burning, pain, and stinging of the vulva, per MedlinePlus.
• Interstitial cystitis, also known as bladder pain syndrome, causes bladder discomfort and frequent urination, per MedlinePlus.

These diagnoses may require medical care, yet sometimes people receive treatment and continue to experience symptoms. What then?

A few other factors may also contribute to painful intercourse. One of the most significant factors is your pelvic floor.

The pelvic floor is a large, bowl-shaped muscle group stretching from your pubic bone to your tailbone. Your pelvic floor controls your bladder and bowel. It's also what relaxes to allow for penetration and contracts rhythmically and involuntarily during orgasm.

Like all other skeletal muscles in the body, this muscle group can be weak or tight. While weakness and tightness pose potential concerns for pelvic floor functioning, vaginal tightness can lead to painful sex, which is medically known as dyspareunia, per the American Academy of Family Physicians.

The following three exercises are in no way meant to encourage forgoing visits with healthcare providers and physical therapists. But they are the ones I frequently advise patients to do at home to relax their pelvic floors and work toward pain-free intercourse. They can be done before sex to make penetration less painful, and they can be done after sex to help relax the body following an orgasm. It all depends on when you experience pain.

Diaphragmatic Breathing

The diaphragm is a dome-shaped muscle that sits beneath your rib cage and is connected to your pelvic floor via muscles and fascia (fibrous tissue). As you take a breath into your belly, your diaphragm draws downward. At the same time, your pelvic floor drops into a more relaxed position, stretching your pelvic floor.

As you exhale, your diaphragm rises to its resting position, and your pelvic floor follows suit. Diaphragmatic breathing allows us to stretch the pelvic floor throughout the day and can even be performed during intercourse to decrease pain.

How does one diaphragmatically breathe correctly? Lie on your back, placing one hand on your chest and the other on your belly. Take in a slow breath. You want your belly hand to rise while your chest hand stays still. Pause, and let the air slowly escape your lungs. Your belly hand should fall while your chest hand remains still.

Go slow; breathe in for five seconds, then out for five seconds. Your rib cage and abdomen should slowly expand and return to rest. This exercise cannot be overdone and can be practiced in any position. The more, the better.

Child's Pose

Child's pose is a common yoga pose and an excellent pelvic floor stretch. In a kneeling position, bring your knees out wide while keeping your toes together. You can roll up a towel or blanket to kneel on if this hurts your knees.

Sit up straight, and then bring your head toward the floor. If this is too much for your knees, hips, or back, bring your forearms to the ground in front of you and rest your head on your arms. When comfortable in this position, start taking big, slow breaths.

As you breathe in, you may feel a gentle drop through your pelvic floor, and as you exhale, you may feel it gently rise. Breathe in this position for at least 30 seconds, up to a few minutes.

Happy Baby

For happy baby, another common yoga pose, lie on your back. Take a deep breath and exhale to bring your knees toward your underarms, keeping your feet and knees wide. Grab the outside of your feet if you can, but your shins and knees are a great alternative if you have trouble reaching them. If you are flexible enough, try to bring your feet over your knees, perpendicular to the ground. Start breathing slowly.

To intensify this stretch, you can gently rock your hips back and forth, bending and unbending your lower back against the ground until you find a comfortable position. As you breathe in, you may feel that same gentle drop through the pelvic floor. As you exhale, you may feel that same gentle rise. Just like for child's pose, breathe in this position for at least 30 seconds or longer if comfortable.

How often should you do these moves? I typically recommend five diaphragmatic breaths at least five times per day. For child's pose and happy baby, 30 seconds to a few minutes at least 2–3 times per day. But they also can't be overdone, so the more, the merrier. Everyone is different, but the great thing about stretching is it can't hurt you.