Pain With Intercourse Is Not Normal — and It Is Not Inevitable
Dyspareunia — pain with intercourse — is one of the most common and most undertreated pelvic floor conditions affecting adults. Despite its prevalence, it is surrounded by a level of stigma and clinical dismissiveness that leaves many patients suffering for years without a clear diagnosis or effective treatment. Patients are told their pain is psychological, that they need to relax, that it will improve with time, or that this is simply something they will need to work through.
In the majority of cases, dyspareunia has an identifiable musculoskeletal cause. The pelvic floor — the group of muscles, ligaments, and connective tissues that form the base of the pelvis — is the primary driver of pain with intercourse in most patients. And when the pelvic floor contribution is properly evaluated and treated, outcomes are significantly better than with any approach that doesn't address the musculoskeletal system directly.
At Bray Chiropractic & Wellness in Glastonbury, dyspareunia is treated as a clinical problem with a clear musculoskeletal explanation — not as a psychological issue, a relationship problem, or something that simply has to be managed.
What Is Dyspareunia?
Dyspareunia is defined as persistent or recurrent pain during or after intercourse. It can affect both men and women, though it is significantly more common in women. The pain can be superficial — occurring at the vaginal entrance — or deep — occurring with deeper penetration and involving the pelvic floor, cervix, or surrounding structures.
Dyspareunia is classified as primary when it has been present since the onset of sexual activity, and secondary when it develops after a period of pain-free intercourse. Secondary dyspareunia is more common and is frequently associated with identifiable clinical events — childbirth, surgery, infection, hormonal changes, or the gradual development of pelvic floor hypertonicity.
What Causes Dyspareunia?
Dyspareunia can have multiple contributing factors — and accurate assessment requires distinguishing between them:
Pelvic floor hypertonicity
Excessive tension in the pelvic floor muscles is the single most common musculoskeletal driver of dyspareunia. A hypertonic pelvic floor cannot relax appropriately during intercourse — producing pain through muscular resistance, trigger point irritation, and tissue sensitivity. The pain is real, it is physical, and it is addressable through pelvic floor rehabilitation. Learn more about Pelvic Floor Dysfunction.
Vaginismus
A condition in which the pelvic floor muscles contract involuntarily in anticipation of or in response to penetration — making intercourse painful or impossible. Vaginismus is closely related to pelvic floor hypertonicity and is treated through a combination of pelvic floor manual therapy, neuromuscular retraining, and progressive desensitization.
Vulvodynia and vestibulodynia
Chronic vulvar pain — including burning, stinging, and sensitivity at the vaginal entrance — that frequently has a pelvic floor and central sensitization component alongside the localized tissue sensitivity. Addressing the pelvic floor contributors to vulvodynia is an important component of comprehensive treatment.
Postpartum dyspareunia
Pain with intercourse following childbirth is extremely common — and extremely undertreated. Perineal tearing and repair, hormonal changes, pelvic floor hypertonicity, and scar tissue from episiotomy or laceration all contribute to postpartum dyspareunia. Learn more about Postpartum Pelvic Floor Care.
Hormonal changes
Decreased estrogen — associated with menopause, breastfeeding, and certain medications — produces vaginal tissue changes that contribute to dyspareunia. While hormonal management is outside the scope of chiropractic care, the pelvic floor and musculoskeletal contributors to dyspareunia that co-occur with hormonal changes are addressable through manual therapy and rehabilitation.
Scar tissue and fascial restrictions
Scar tissue from perineal repair, episiotomy, cesarean section, or pelvic surgery can produce fascial restrictions and tissue sensitivity that contribute directly to dyspareunia. Manual therapy for scar tissue and fascial restriction is an important component of treatment for patients with a surgical or obstetric history.
Deep dyspareunia and pelvic organ involvement
Deep pain with intercourse — occurring with deeper penetration — can involve the pelvic floor, bladder, bowel, or surrounding structures. Deep dyspareunia requires careful assessment to identify the specific structures involved and any contributing visceral pathology that requires medical management alongside musculoskeletal care.
Dyspareunia in Men
While dyspareunia is most commonly discussed in the context of women, men can also experience pain with intercourse — typically driven by pelvic floor hypertonicity, pudendal nerve irritation, or myofascial tension in the perineal and pelvic floor musculature. Male dyspareunia is significantly underdiagnosed and undertreated, and it is assessed and treated at this practice with the same clinical thoroughness as any other presentation. Learn more about Pelvic Floor Care for Men.
A Note on Clinical Approach
Many patients who seek care for dyspareunia have never been able to discuss their symptoms openly with a provider — or have felt dismissed, minimized, or uncomfortable when they did. That will not happen at this practice.
Dr. Bray approaches dyspareunia with the same clinical directness, thoroughness, and respect he brings to every presentation. Every aspect of the assessment and treatment is explained clearly before it happens, performed with full informed consent, and conducted in a professional clinical environment where patient comfort is always the priority. If you have questions or concerns before your first visit, reach out directly — there is no obligation and no pressure.
How Dyspareunia Is Evaluated at This Practice
Assessment of dyspareunia at Bray Chiropractic & Wellness includes:
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Detailed health history — onset, character, location, associated symptoms, obstetric and surgical history, prior medical and musculoskeletal evaluation, and treatment history
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Full lumbopelvic musculoskeletal assessment — lumbar spine, sacroiliac joints, and hips
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External pelvic floor assessment — evaluating tone, tenderness, trigger point activity, and tissue sensitivity
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Internal pelvic floor assessment when clinically appropriate and with full informed consent
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Neurological screening — assessing pudendal nerve and lumbar nerve root contributions
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Scar tissue assessment when obstetric or surgical history is relevant
How Dyspareunia Is Treated at This Practice
Treatment for dyspareunia at Bray Chiropractic & Wellness is individualized based on assessment findings and may include:
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Pelvic floor manual therapy — external and internal soft tissue treatment targeting hypertonicity, trigger points, and tissue restrictions
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Scar tissue mobilization for perineal, episiotomy, and cesarean section scars
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Chiropractic manipulation and mobilization of the lumbar spine, sacroiliac joints, and hips
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Dry needling for pelvic floor and surrounding musculature trigger points
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Neuromuscular retraining — pelvic floor relaxation, desensitization, and progressive loading strategies
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Rehabilitative exercise targeting pelvic floor coordination and deep core function
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Clinical nutrition guidance when systemic inflammation or hormonal factors are contributing
Learn more about Pelvic Floor Therapy, Chiropractic Care, and Rehabilitative Exercise at this practice.
Painful Intercourse Treatment in Glastonbury, CT
Patients with dyspareunia and painful intercourse in Glastonbury, South Glastonbury, Hebron, Marlborough, East Hartford, Manchester, and the surrounding Hartford County area will find a thorough, musculoskeletal-focused, and clinically respectful approach to dyspareunia care at Bray Chiropractic & Wellness.
No referral is required. New patients can schedule directly online or by calling or texting (203) 303-4760. Bray Chiropractic & Wellness is in-network with Aetna, Anthem BCBS, Cigna (ASH), and CT Medicaid (Husky). Self-pay and HSA/FSA options are also available.