When sex is painful, many people experience it as confusing, distressing, or even deeply isolating. It is very common to feel internal pressure to “push through,” relax more, or somehow endure it—often accompanied by the hope that things will eventually improve on their own.

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However, when pain keeps recurring, simply enduring it usually does not help. In many cases, it can even increase stress and tension over time.

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From a sex therapy perspective, pain is an important signal from the body. It deserves attention and respect—without judgment and without the expectation that you should just “be able to get through it.”

Penetration is not a requirement for sexuality. Together, we can explore what your body needs right now, what feels comfortable, and what may still be too much at this moment.

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How Pain During Sex Can Show Up

 

Pain during sex (dyspareunia) can present in very different ways.

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Some people experience discomfort during penetration or with certain types of touch. Others describe burning, stinging, or irritation at the vaginal opening. Some feel deeper pressure or pain during or after sexual activity.

People with a penis can also experience pain—for example during erection, due to foreskin or skin-related conditions, or discomfort in the pelvic region.

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There is no “normal level” of enduring pain. If something hurts, it is completely valid to pause or stop. This also applies to anal sex—pain is not something you are expected to push through, but a signal that something needs attention or adjustment.

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Possible Causes of Pain During Sex

 

Pain during sex is often not caused by a single factor, but by a combination of physical, psychological, and relational influences.

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Physical factors

Possible medical or physical causes include:

• irritation or inflammation in the genital area

• skin conditions or mucosal sensitivity

• hormonal changes (e.g., cycle, breastfeeding, contraception, menopause)

• endometriosis or other gynecological conditions

• pelvic floor muscle tension

• chronic pain conditions such as vulvodynia or vestibulodynia

For people with a penis, urological or physical factors may play a role as well, such as foreskin tightness, pain during erection, or pelvic discomfort.

This list is not exhaustive—it is meant to show that there are many possible medical explanations. A medical evaluation can therefore be an important and relieving step.

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Tension, stress, and body memory

When pain occurs repeatedly or is anticipated, the body often responds with early muscle tension. This is not “in your head,” but a protective response of the nervous system.

Over time, the body can learn to anticipate discomfort and stay guarded. Stress, performance pressure, shame, or past difficult experiences can intensify this response.

Many people describe a cycle: the more they want intimacy to “finally work,” the harder it becomes for the body to relax.

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Relationships, communication, and emotional dynamics

The relational context often plays an important role as well.

When sexuality is not openly discussed or uncertainty is present, misunderstandings can easily develop. Withdrawal, adaptation, or unspoken pressure can make pain not only a physical experience, but also an emotional burden.

In these situations, pain can start to feel like something “between two people” rather than a shared experience that can be understood and worked through together.

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Therapeutic Perspective

 

Pain during sex is often understandable and, in many cases, treatable—or at least significantly reducible.

Sex therapy is not about optimizing sexuality. It is about helping you better understand your body, reducing pressure, and opening up new ways of experiencing intimacy. Penetration is never a requirement for sexuality or closeness.

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Terms You May Encounter

 

In medical or therapeutic contexts, you may come across terms that help describe sexual or genital pain. You do not need to know or “assign” these terms to your experience. Often, simply being familiar with them can already bring some relief and clarity.

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Dyspareunia

A clinical term for recurrent or persistent pain associated with sexual activity.

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Vulvodynia

Chronic pain in the vulvar area (external genital region) lasting at least three months, without a clearly identifiable cause.

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Provoked vestibulodynia

Pain at the vaginal entrance, often triggered by touch, pressure, or penetration.

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Genito-pelvic pain/penetration disorder (GPPPD)

A clinical category that includes different aspects such as pain during penetration, fear or anticipation of pain, and involuntary or habitual pelvic floor tension.

These terms do not automatically mean that a diagnosis applies to you. They are primarily tools for understanding and describing experiences. What matters most is always your individual experience—not a label.

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How I Can Support You

 

Psychological counseling and sex therapy for pain during sex do not replace medical treatment. However, they can be very helpful when pain begins to affect your sexuality, body image, relationship, or daily life.

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The focus is not on “eliminating symptoms,” but on better understanding what is happening in your body and sexual experience—and reducing the pressure connected to it.

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What We Can Work on Together

 

A central part of the work is developing a shared understanding:
When does the pain occur? In which situations does it increase or decrease? Are there moments when it feels even slightly more manageable?

From there, we often focus on noticing early bodily signals and responding to tension in a different way—not through control or fighting the body, but through small, realistic steps that create more safety.

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Another key area is boundaries and communication. Many people experience relief when they begin to express needs, pauses, or limits more clearly—without having to justify themselves.

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Expanding sexuality beyond penetration can also be an important part of the process. Intimacy, pleasure, and closeness are not limited to one specific form and can be expressed in many different ways.

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If you wish, your partner can be included in this process to support mutual understanding, reduce pressure, and develop practical ways of navigating intimacy together.

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Depending on your situation, collaboration with medical providers or specialized pelvic floor physiotherapy may also be helpful. I can support you in coordinating this if needed.

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My approach is trauma-informed and integrates sex therapy with body-oriented perspectives. I draw on systemic, emotionally focused, mindfulness-based, and cognitive-behavioral methods.

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How It Works

 

Free initial consultation (20 minutes): Briefly clarify your concerns and whether my approach is a good fit
Sessions: primarily online; in-person sessions in Berlin are possible by arrangement
Duration: 50 minutes
Frequency: weekly or biweekly, depending on your needs
Confidentiality & data protection: fully confidential, in line with professional standards and GDPR-compliant practices

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Next Step

 

If you would like, we can start small—with a free initial consultation. No pressure, no expectations. Just a space to understand what you need right now.

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Safety Note in Case of Crisis

 

If you are in acute distress, feeling overwhelmed, or experiencing suicidal thoughts, please seek immediate support (for example, through a local crisis service such as the Berlin Crisis Service or a national helpline). In a medical emergency, call 112.

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References​

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American College of Obstetricians and Gynecologists. (2016). Committee Opinion No. 673: Persistent vulvar pain. Obstetrics & Gynecology, 128(3), e78–e84. https://doi.org/10.1097/AOG.0000000000001645 (PMID: 27548558)

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Bergeron, S., Khalifé, S., Dupuis, M.-J., & McDuff, P. (2021). Cognitive-behavioral couple therapy versus lidocaine for provoked vestibulodynia: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 89(4), 288–299. https://doi.org/10.1037/ccp0000631 (PMID: 34014693)

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Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., et al. (2016). 2015 ISSVD/ISSWSH/IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. Obstetrics & Gynecology, 127(4), 745–751. https://doi.org/10.1097/AOG.0000000000001359 (PMID: 27008217)

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Brotto, L. A., Bergeron, S., Zdaniuk, B., & Basson, R. (2020). Mindfulness and cognitive behavior therapy for provoked vestibulodynia: Mediators of treatment outcome and long-term effects. Journal of Consulting and Clinical Psychology, 88(1), 48–64. https://doi.org/10.1037/ccp0000473 (PMID: 31841023)

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Dewitte, M., Borg, C., & Lowenstein, L. (2018). A psychosocial approach to female genital pain. Nature Reviews Urology, 15(1), 25–41. https://doi.org/10.1038/nrurol.2017.187 (PMID: 29182603)

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Hazan, C., & Shaver, P. R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. https://doi.org/10.1037/0022-3514.52.3.511

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Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). Brunner-Routledge.

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Nehra, A., Alterowitz, R., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J. J., et al. (2015). Peyronie’s Disease: AUA Guideline. The Journal of Urology, 194(3), 745–753. https://doi.org/10.1016/j.juro.2015.05.098

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Ter Kuile, M. M., Melles, R., de Groot, H. E., Tuijnman-Raasveld, C. C., & van Lankveld, J. J. D. M. (2013). Therapist-aided exposure for women with lifelong vaginismus: A randomized waiting-list control trial. Journal of Consulting and Clinical Psychology, 81(6), 1127–1136. https://doi.org/10.1037/a0034292

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Zarski, A.-C., et al. (2021). Efficacy of internet-based treatment for genito-pelvic pain/penetration disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology. https://doi.org/10.1037/ccp0000665

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FAQ​

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Do I just have to accept pain during sex?

No. Pain during sex is not something you need to accept or tolerate as a normal state. It is an important signal from your body that deserves attention.

A medical evaluation is often a helpful first step to rule out physical causes. At the same time, pain can also affect your sense of safety, your sexuality, and your relationship with your body.

Therapeutic support is not about “thinking pain away,” but about understanding what helps you feel more safe, grounded, and self-directed in intimate situations.

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Why do I have pain during sex even though nothing medical was found?

This is a very common and often confusing experience.

Even when no clear medical cause is identified, pain in conditions such as vulvodynia or vestibulodynia is real and distressing. Pain is processed by the entire nervous system, not only at the site where it is felt.

Stress, fear of pain, and ongoing tension can contribute to the persistence or intensification of symptoms. This does not mean the pain is imagined.

In therapy, we look at both physical and psychological factors in a non-judgmental and balanced way.

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Can fear of pain during sex get worse over time?

Yes, this could happen. When intimacy is repeatedly linked with pain, the body often develops protective responses. Some people notice increased pelvic floor tension, others experience reduced sexual interest or avoidance.

This is not a weakness, but a natural protective mechanism.

Together, we can work on gently interrupting this cycle.

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Can therapy help with vulvodynia or pain during penetration?

Yes, many people find psychological support a helpful complement to medical care.

Therapy can help you:

• understand the interaction between pain and the nervous system

• recognize early signs of tension

• reduce shame or self-blame

• communicate boundaries more clearly

• rebuild safety and confidence in intimate situations

The goal is not performance, but a more compassionate and supportive relationship with yourself.

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How does pain during sex affect relationships?

Pain rarely affects only one person. It often influences intimacy, communication, and shared sexual experiences.

Many couples become caught in cycles of uncertainty, avoidance, frustration, or guilt. Talking about it can feel difficult.

Therapy provides a space to address these dynamics. If desired, partners can be included to support understanding and develop new ways of relating to intimacy.

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What can I do if sex or penetration is painful?

The most important step is to take your boundaries seriously.

You do not need to endure pain to meet expectations. Often, reducing pressure, slowing down, or exploring non-penetrative forms of intimacy can already make a difference.

If symptoms persist or feel distressing, a medical evaluation is recommended. You do not have to navigate this alone.

In an initial consultation, we can explore together what next steps make sense for your situation.