Why Sex Still Hurts Even After Pelvic Floor Therapy
Many people arrive at pelvic floor physical therapy hopeful—and for good reason. Pelvic PT can be an essential part of treating painful sex, vaginismus, and pelvic floor dysfunction.
But for a surprising number of people, therapy ends and the pain remains.
If you’ve found yourself Googling “sex still hurts after pelvic floor therapy” or wondering whether pelvic floor therapy “didn’t work,” you’re not alone—and you’re not broken.
What you may be missing isn’t another physical intervention.
It’s the brain–body piece that pelvic floor therapy alone cannot address. That’s what I do in sex therapy! I’m Dr. Carli Blau, sex therapist and women’s health expert and I provide sex therapy to individuals and couples in New York, New Jersey and Florida.
Many of my patients come to me after they’ve seen many doctors and pelvic floor PT’s and specialists because they’re still feeling sexual pain despite multiple interventions.
Doctors and PT’s are not taught anything about sex. In all their training, most only have 1-2 classes max about sex and sexual functioning or arousal, so they’re not trained in the brain/vagina connection when it comes to sexual behavior, arousal, desire and performance.
But… I am! As a sex therapist, I help women explore their vagina from a sexual perspective, learning what they’re aroused by and how they can feel arousal despite also feeling pelvic discomfort or even pain.
When Pelvic Floor Therapy Helps—But Doesn’t Finish the Job
Pelvic floor physical therapy is excellent at addressing:
Muscle tension and guarding
Coordination of the pelvic floor
Tissue sensitivity
Mechanical contributors to pain
Many people make real progress:
They can tolerate exams
They can use dilators
Muscles feel “looser”
Pain decreases in non-sexual contexts
And yet…
Sex still hurts.
Penetration still feels impossible or anxiety-provoking.
Or the body freezes the moment intimacy becomes sexual.
This disconnect is deeply confusing—and often shame-inducing.
Why Pain With Penetration Can Persist After PT
Here’s the part that rarely gets explained clearly:
Pelvic floor therapy treats the muscles.
Sex happens in the nervous system.
If penetration has been painful, stressful, rushed, or pressured in the past, the brain learns to associate insertion with threat—even after the muscles are capable of relaxing.
So when sex begins, the body may respond with:
Automatic tightening
Numbing or dissociation
Anxiety or dread
A sudden loss of desire
Pain that feels “out of proportion” to touch
This is not because therapy failed.
It’s because your nervous system is still protecting you.
The Missing Link: Arousal, Safety, and the Brain
Penetration is not a neutral physical act.
For the body to allow it comfortably, the nervous system needs to be in a state of:
Safety
Choice
Arousal
Low pressure
Emotional presence
Pelvic floor therapy can improve capacity for penetration—but it does not automatically teach the brain that penetration is:
Wanted
Safe
Erotic
Optional
Without that relearning, pain often persists during sex even when exams or exercises are tolerable.
Why “Just Relax” or “Keep Practicing” Often Backfires
Many people are encouraged to:
Push through discomfort
Keep attempting penetration
Treat sex like another exercise
Unfortunately, this can reinforce the problem.
When penetration happens while someone is:
Anxious
Bracing
Focused on “getting through it”
Afraid of disappointing a partner
The nervous system learns:
“Sex requires endurance, not pleasure.”
Over time, desire may decrease—not because attraction is gone, but because the body is trying to avoid pain.
When Pelvic Pain Is No Longer Just Physical
If sex still hurts after pelvic floor therapy, it often means:
The muscles are no longer the primary driver
The nervous system is still responding to learned threat
The brain hasn’t associated penetration with arousal and safety yet
This is where sex therapy becomes essential—not as a replacement for PT, but as the missing integration.
How Sex Therapy Helps When Pelvic Floor Therapy Isn’t Enough
Sex therapy focuses on:
Rewiring the brain’s association with penetration
Reducing anticipatory anxiety
Reintroducing touch without pressure or performance
Separating intimacy from penetration
Restoring desire and choice
This work is slow by design—because safety cannot be rushed.
For many people, healing begins when penetration is no longer the goal.
A Reframe That Matters
If you’ve completed pelvic floor therapy and sex still hurts, it does not mean:
You failed
Your body is resistant
You didn’t try hard enough
It means your body is communicating something important.
Pain is not a flaw. Pain doesn’t mean there is something wrong with you. Pain is not constant, and it doesn’t mean that it will last forever. Pain is here and now and together we can make it part of your past.
Pain isn’t a forecast, it’s simply information.
And often, it’s asking for a different kind of support.
You’re Not Alone—and You’re Not Out of Options
Painful sex after pelvic floor therapy is one of the most common reasons people seek sex therapy.
It’s also one of the most treatable—when the brain, body, and emotional experience are addressed together.
At CarliBlau.com, this is a core focus of my work:
supporting people whose pain persists after medical treatment, and helping them rebuild safety, desire, and trust in their bodies again.
Looking for Support?
If pelvic floor therapy helped—but didn’t fully resolve your pain—sex therapy may be the missing piece.
You deserve sex that feels safe, chosen, and pleasurable.
Not something you have to push through.
To make an appointment for therapy call 917-227-0573
