Burning Pain After Sex? Exploring Causes & How Pelvic Floor Therapy Can Help
Written by Dr. Karah Charette, PT, DPT, RYT
Are you experiencing burning pain after intercourse?
Do you have burning pain during penetration?
You are not alone, and there are answers and support.
Pelvic floor physical therapy can help.
Understanding the Sensation of Burning Pain After Intercourse
Burning pain after sex is common but that does not mean it is normal. There can be many different causes as to why someone can feel a burning pain during and/or after penetrative sex.
The pelvic floor has many layers and different anatomical structures that can be painful for different reasons. Sometimes burning can occur in more deep tissue, and oftentimes it can feel like it is more superficial. Sometimes the burning can happen right away and other times it can happen gradually, sometimes even having a delayed onset of up to a few hours after intercourse has occurred. All of these differences can be helpful in determining the exact cause of the burning sensation.
Within the context of the pelvic floor, pain and burning can have multiple causes. The only reason we perceive pain in the body is due to nerves and our nervous system. For that reason, usually there is nerve irritation. This does not mean nerve damage. Nerves thrive in healthy environments with good blood flow. So if muscles are tight and decreasing blood flow, nerves can get irritated. If there has been recurring infection in the area that is no longer present, nerves can still be sensitized from the history of real pathological infection. If there is a hormonal deficit in the tissues of the pelvic floor, this can also affect nerves and blood flow. Sometimes the cause of burning is not just one factor alone, but a combination of a few of these factors.
You can read more about the causes of sharp, stabbing pain in the vulva here.
Common Causes of Burning Pain After Sex
Pelvic Floor Muscle Tension & Poor Blood Flow
As stated above, tight muscles can limit circulation and that can cause distress on the nerves, sensitization, and burning sensations. Why the pelvic floor muscles get tight is a whole other exploration. There can be many reasons including stress, lack of coordination, trauma, hypermobility, GI dysfunction, history of concussion, poor posture, poor breathing mechanics, etc… It is the job of a skilled pelvic floor physical therapist to holistically assess your medical history and your overall presentation to help determine which factors are most likely contributing to your case.
You can read more about figuring out if your pelvic floor muscles are tight here.
Nerve Sensitization or Compression
Not only can pelvic floor muscles be tight, but also the connective tissue that surrounds the muscles and nerves which is called fascia. Fascia is highly sensitive (moreso than our skin) and connected to the nervous system. It will contract and tighten around real or perceived threat or danger to the body. Oftentimes this tissue gets tight and can also contribute to tension and compression of specific nerves that can contribute to pelvic pain. Some key nerves that can get irritated include the pudendal nerve, ilioinguinal, iliohypogastric, genitofemoral, and obturator nerves. Some of these nerves are even in the abdomen fascia and trunk, so it is important that areas above and below the pelvic floor are assessed and treated as well.
Hormonal Irritation and Tissue Sensitivity
Hormones play an important role in regulating the pelvic floor tissue as well. It has been shown that with lower levels of estrogen and/or testosterone the pelvic floor, and particularly the vestibule (which is directly at the opening), can become more sensitive. Hormones can be irregular due to contraceptives, perimenopause, and even stress and/or gut dysfunction. It is important that hormones are considered when dealing with burning pain after sex.
Psychophysiological Factors (Stress & The Nervous System)
The only reason we perceive pain in our body is because our central nervous system, particularly our cortex, has stories, beliefs, and ideas about what may or may not be a threat to our tissue. There is a difference between nociception (sensations of potentially noxious stimuli) and pain which is defined in the brain. This concept has been explored and studied by pain scientists Butler and Mosley. You can learn more about this concept of pain here.
This is an important aspect of pain management that cannot be ignored. This is not saying pain “is all in your head” but rather allowing for another avenue of healing when we acknowledge that stress, fear, and trauma all can affect pelvic floor tension patterns and the perceptions of pain in the body.
If you are someone who feels they have “tried every avenue” of healing but you have not examined your nervous system states and your beliefs around pain, there may be another path forward. This is why we value a somatic approach to pelvic floor physical therapy at Bodyful.
When Burning Becomes a Red Flag
If your burning pain after sex is persistent, intense, or accompanied with other symptoms such as urinary urgency, frequency, or incontinence, it is important you seek help from a skilled pelvic floor physical therapist.
Pelvic floor physical therapists are highly trained providers who know how to assess for both musculoskeletal causes of pain as well as infections or dermatological causes. Pelvic floor PTs do not treat infections or dermatology, however they are trained on how to appropriately refer out. It is also important to see a pelvic PT because even if the cause of the pain is an infection or dermatological issue, the pelvic floor muscles usually get tight and over-recruited in response. Working with a pelvic PT preventatively can help to ensure your muscles and nerves do not get overly sensitized in the future.
Effective Somatic Pelvic Floor Therapy Approaches
Manual Therapy & Fascial Mobilization
One of the primary ways we treat burning pain after sex at Bodyful is with skilled manual therapy techniques and fascial mobilization techniques. As nervous system informed practitioners, we use gentle yet specific and targeted techniques to reduce pain from trigger points and fascial holding patterns. This can help to immediately reduce pain and allow your nervous system to learn a new way of how to release muscular tension. This can also help promote more blood flow which helps to calm nerves and the overall pain experience.
Somatic Movement & Interoceptive Awareness
As pelvic floor physical therapists, we find that manual therapy alone is often not enough to create sustainable change. You can release a muscle, but if you do not change the organization patterns that muscle will often just get over-recruited again. At Bodyful, we also focus on practices such as efficient breathing patterns, nervous system regulation techniques, postural retraining, targeted strength training, and the relearning of mindful functional movement in order to decrease muscle guarding patterns and reestablish safety in the pelvis and pelvic floor.
Practices like breath‑based regulation, mindfulness, and movement to decrease muscle guarding and reestablish safety in the pelvis
You can learn more about our somatic approaches to healing here.
Self‑Care Practices For Burning Pain with Intercourse
Diaphragmatic breathing: Proper diaphragmatic breathing is key to pelvic floor regulation. When you breathe more into your ribcage and allow the diaphragm to expand, the pelvic floor will do the same thing. The key to a healthy pelvic floor is allowing it to be supple and have good range of motion.
Post-sex cool-down: It is important to allow your pelvic floor muscles to recover after intercourse. Just like you should stretch after a workout, the pelvic floor benefits from stretching and breath work after engagement during sex. Some great pelvic floor stretches to start with would be child’s pose, happy baby, and yogi squat. The key is to allow these stretches to be restorative and to do diaphragmatic breathing in order to get the pelvic floor to relax.
Posture: Pay attention to your posture throughout the day. If you sit for work, that can create compression and decrease circulation to the pelvic floor. Having an option to stand and change your ergonomics through the day can promote blood flow to the pelvic floor.
Holding patterns: Also try to notice if you are gripping or tensing your pelvic floor throughout the day. It is normal for this part of your body to recruit to help stabilize as it is part of your core, however without mindful awareness these muscles often stay tight and recruited. With curiosity, notice if you can allow for some gentle relaxation in this part of your body a few times a day.
What to Expect in Pelvic Floor Physical Therapy & Setting Goals
At Bodyful, you can expect a supportive and collaborative process when it comes to treatment. We meet you where you are and honor your beliefs, expectations, and goals.
We are trained to be skillful in all aspects of care- including the assessment, manual therapy, therapeutic exercise, somatic integration, nervous system resourcing, and therapeutic alliance.
Pelvic floor therapists are professionals in all of these aspects of care. We are able to perform special tests to rule in and out certain pathologies. We know how to triage care and provide appropriate referrals. At Bodyful, we are highly trained in skilled manual therapy including internal assessments when indicated as well as visceral fascial mobilization work. We are uniquely qualified in expert assessments of the core system and how to integrate that with the rest of the body. We are also uniquely qualified to hold the emotional complexities of pelvic pain as it relates to the body through our somatic lens.
At Bodyful, we highly emphasize agency and independence. You are not something to be “fixed” here. We focus on education and home programs so that you can learn to regulate your body and manage your symptoms on your own. We are here to support, guide, and witness.
