This is the clearest boundary on this site. Pain during sex isn’t a psychological problem to be worked through. It’s a symptom, it has causes, and those causes are diagnosable.
A great many people are told for years that they’re tense, anxious, or not sufficiently aroused, while a treatable physical condition goes unaddressed. The average delay to diagnosis for several of these conditions is measured in years, and the delay is largely caused by this framing.
The common causes
Not a diagnostic list — a list to take to a doctor.
Pelvic floor dysfunction. Muscles that are chronically over-tight rather than weak. Extremely common, frequently missed, and highly treatable with pelvic floor physical therapy.
Vulvodynia and vestibulodynia. Persistent vulval pain, sometimes provoked by touch. A recognised condition with recognised treatments.
Vaginismus. Involuntary muscular contraction preventing penetration. Involuntary is the operative word — it isn’t a decision and it isn’t resistance.
Endometriosis. Deep pain with intercourse is a classic and frequently overlooked symptom. The diagnostic delay here is notoriously long.
Hormonal. Thinning and dryness of tissue in perimenopause, menopause, postpartum and while breastfeeding, and with some hormonal contraceptives. Very common and very treatable.
Infections and skin conditions. Thrush, bacterial infections, lichen sclerosus, dermatitis.
Scarring from childbirth, surgery, or radiotherapy.
And for men, less discussed: prostatitis and chronic pelvic pain syndrome, phimosis, and pelvic floor dysfunction, which occurs in men too and is almost never mentioned.
Who to see, in what order
A doctor first — a gynaecologist, urologist, or a GP who will refer. Ask specifically for examination rather than reassurance, and mention pelvic floor assessment by name, because it’s the most commonly skipped step.
Then a pelvic floor physical therapist. This is the single most under-used and most effective referral in this whole area. It’s a genuine specialty with strong outcomes, and a great many people have never been told it exists.
Then, alongside, psychological support — because pain reliably produces a secondary layer that persists after the physical cause is resolved: anticipatory anxiety, guarding, avoidance, and a relationship that has reorganised around it.
The secondary layer, which is real
Once sex has hurt several times, the body anticipates. Muscles tighten before anything happens, which produces more pain, which confirms the anticipation. That loop can outlive the original cause entirely.
This part is treatable psychologically — and only alongside the medical treatment, not instead of it. A practitioner who works on the anxiety while the underlying condition goes undiagnosed is doing harm.
What not to do
Do not push through it. Repeated painful sex trains the anticipatory response and makes everything harder to treat.
Do not accept “it’s just anxiety” without an examination. Ask what has actually been ruled out.
Do not accept “this is normal after childbirth” or “normal at your age”. Common isn’t the same as untreatable.
Where this site stands
No coach should be treating this, and a competent one will refer immediately. This is the clearest case on the list, and if a practitioner offers to work on your pain rather than around it while you get proper care, leave.