3 Expert Tips to Boost Pleasure When Sex Hurts

Pelvic health physiotherapists play an essential role in helping people achieve and maintain strong, healthy, and well-coordinated pelvic floor muscles. These muscles support pelvic stability and hold up the pelvic organs—but my passion has always been their role in sexual function and how that impacts a person’s emotional wellbeing, identity, and relationships.

I often notice that clients are comfortable discussing bladder or bowel concerns early on, yet only later—after deeper conversation—share that they also experience sexual dysfunction. These issues frequently coexist, but sexual concerns are still minimized or hidden because sex and intimacy remain taboo in many cultures and communities. When we begin to understand that sex and intimacy are basic activities of daily living, it becomes clear that sexual function is a key component of overall quality of life.

It’s important to acknowledge that arousal and pleasure look different for everyone, regardless of anatomy. Each person moves through the sexual response cycle (desire/libido → arousal/excitement → orgasm → resolution) in their own unique way. Some stages may feel muted, skipped, or show up in a different order—and that’s completely normal.

With that in mind, here are several practical tips and strategies to help increase pleasure and sexual satisfaction, even if penetrative sex is currently painful.

1. Be the expert of your own body

Before you get into some intimate times with another human, it’s very important to explore and become comfortable with your own body. By doing this, you can understand what parts of your body are sensitive to touch – whether it be arousal or a painful sensation. Then, you can openly communicate with your partner where they need to move their attention to ramp up your pleasure level.

For partners who feel shy or unsure, try using open-ended questions like,“What parts of your body can I touch that excite you?” or “How do you like to be touched?” These invite deeper sharing and create a safer space than a simple “What do you like?”

Remember that arousal and pleasure aren’t just about physical touch—every sense can play a role. Smell, visuals, sound, and even sexy talk can all enhance the experience. Adjust the environment in supportive ways: dim the lights, add calming or sensual scents, play music that soothes or excites, and create a space that helps “downtrain” the nervous system so intimacy feels safer and more enjoyable.

It’s all about connection, comfort and care!

2. Bring home pelvic health physiotherapy techniques into the bedroom

During a physical assessment, your pelvic health physiotherapist may evaluate your pelvic floor skin health, muscle mass, and muscle tone. Some people experience dryness, itchiness, or tightness in and around the pelvic floor. In these cases, your physiotherapist may collaborate with your medical team to help you access moisturizers or prescribed topical medications (such as lidocaine, estrogen, or baclofen) to improve comfort and support healthier pelvic floor function. Always follow your healthcare provider’s guidance—these topical supports can make a meaningful difference in long-term comfort and pleasure.

If penetration is painful, this is an ideal time to use techniques based on “non-nociceptive input”—which simply means applying non-painful sensory stimulation to help calm a hypersensitive, overactive nervous system. While the more advanced methods your physiotherapist uses in-session can be difficult to replicate on your own, simpler, accessible strategies can still be very effective. These include deep breathing into the lower rib cage, body scanning or mapping, mindfulness, distraction or gentle stretching of tissues around the painful area, experimenting with leg or hip positioning, and gradual exposure to touch.

Example: Start by touching the area over multiple layers of clothing. Over time—every week or so—reduce one layer until you can comfortably tolerate direct skin contact.

The most important rule when dealing with pain during sex is this: don’t push through it. If you continue despite the discomfort, your body may tense up defensively and your brain may begin to associate sexual intimacy with danger. Over time, this can create persistent sensitization—meaning the nervous system becomes increasingly reactive, and the painful experience keeps repeating itself. We definitely want to avoid that cycle.

Pain or oversensitivity can also stem from poorly healed scars, muscles that are too tight (internally or externally), or pelvic floor muscles that aren’t coordinating well. The good news is that these issues are highly treatable. Your pelvic health physiotherapist can teach you how to manage muscle tightness, work on scar desensitization, and improve pelvic floor coordination at home before intimate moments—skills that can make a meaningful difference in comfort and pleasure.

In cases of reduced sensitivity, the cause may be simple and treatable. For example,  clitoral phimosis—when the clitoral hood is adhered to the clitoris—can prevent adequate stimulation; a pelvic health physiotherapist can gently release the connective tissue. Reduced sensation can also occur after a recent scar where nerves were cut (on the penis or vulva), and those nerves need time and support to regenerate. Your physiotherapist can guide you through scar management techniques to gradually improve sensitivity.

If you have a healthy, responsive pelvic floor, gentle rhythmical Kegels during arousal can help increase the blood flow to the vagina or penis. The key is performing them correctly—most people don’t—so make sure to have your pelvic health physiotherapist assess whether Kegels are right for you and teach you proper technique.

3. Don’t be afraid of sex products

Think of them as teammates, not adversaries. For example, the OHNUT is a bunch of stretchy rings that fit snug onto the base of a penis or any object that goes into the vagina. It acts like a bumper for the penis/object to prevent deep thrusting pain. 

Lubrication is the hype friend you absolutely want in your corner! Ensure you are using a high quality lubricant and truly go to town with it! For instance, if you are having penis-vagina sex, apply lubricant generously to the vulva, inside the vaginal canal, on the length of the entire penis as well as the testicles. All areas of possible friction should be covered so that your mind is settled and present, and you feel comfort and safety throughout the experience.

 

                                                         

Michiko Caringal (she/her) holds a Master’s of Science in Physical Therapy as well as a Master’s of Health Science in Bioethics from the University of Toronto. She is a Registered Pelvic health Physiotherapist in Vancouver, BC, with over 16 years of experience in clinical, research, education, and leadership roles in rehabilitation, health care and fitness. She is the founder of Happy Down There Physiotherapy, works part-time at the University of British Columbia Bladder Care Centre and leads as Educator/Mentor at Trans Care BC. Her personal accounts and professional work have been published in medical journals such as The Journal of Ethics in Mental Health, and she is regularly interviewed for her professional insight in popular magazines and podcasts. In the clinical setting, Michiko believes that combining the clients’ expertise on their own body with her expertise in pelvic health, helps to achieve client goals and a better quality of life.