Understanding Pelvic and Vaginal Pain: What’s Really Going On

Hi friends, Dr. Amanda here 👋. Today we’re diving into a topic that so many women deal with but often feel nervous to bring up: pelvic and vaginal pain.

This might look like:

• Pain during sex

• Pain inserting a tampon

• Pain at a gynecological exam

  
  

Now—let’s be clear—a gynecological exam isn't supposed to feel amazing. A speculum isn’t exactly comfortable. But you should never experience unbearable or sharp pain. If you do, that’s a sign your body is asking for help.

Pelvic and vaginal pain can come from a lot of different factors. Let’s unpack the most common ones together.

1. Sleep Quality

Sleep affects everything in the body—including pain. Poor or fragmented sleep increases inflammation and makes our nervous system more sensitive, which can make pelvic or vaginal pain feel worse.

👉 Especially for new moms (where sleep quantity is limited), improving quality can make a huge difference. Small adjustments in sleep hygiene add up—check out the Sleep Hygiene post to learn more!

2. Estrogen Levels

Low estrogen often leads to vaginal dryness, which makes sex or tampon use uncomfortable.

Common times this happens:

• Menopause

• Long-term breastfeeding

Simple strategies:

• Use lubricant during intimacy

• Take more time with foreplay to encourage natural lubrication

  
  

3. Pelvic Floor Muscle Tension

Sometimes the pelvic floor is too tight or guarded. This can happen if you’re:

• An athlete with a super strong pelvic floor (think horseback riding, gymnastics, CrossFit)

• Someone who constantly performs kegels without working on relaxing the pelvic floor too

• Someone who is chronically stressed. If you're noticing tension through your shoulders, pelvic floor will probably be tense as well.

When muscles stay in “guard mode,” they can cause pain with penetration, exams, or daily activity. Learning both how to relax and engage the pelvic floor is key.

4. Trauma and Guarding

After trauma (whether sexual trauma, childbirth trauma, or even an injury like an ankle sprain), the body often responds by tensing muscles to protect itself. Sometimes, those muscles never fully “turn off” again.

This guarding can continue for months—or years—causing a cycle of pain ➡️ fear ➡️ more tension ➡️ more pain.

Breaking the cycle might include:

• Relaxation techniques

• Breathing and nervous system work

• Support from a trauma-informed counselor or therapist

💡 Here in Spokane, I love recommending Angela Pham Coaching. Angela is trained in women’s health, trauma, abuse recovery, and even nutrition—she’s an incredible resource for the emotional side of pelvic pain.

5. Psychological State & Libido

Headspace matters. If you’re stressed, distracted, or not in the mood, sex can feel painful or dry.

Some ways to support intimacy:

• Talk openly with your partner

• Use lube + longer foreplay

• Stay connected throughout the day (texts, little gestures)

• Schedule intimate time—yes, really! It helps take some pressure off

  
  

6. Sensitization (Chronic Pain Response)

When pain has been around for a while, the nervous system can become extra sensitive—sending pain signals even when something isn’t harmful.

Think of your nervous system like a bucket: normally it takes a lot to “overflow” into pain. With chronic pain, that bucket starts half full, so even small triggers set it off.

The good news? The brain and nerves can be retrained. With the right strategies, we can teach your body that movement and intimacy are safe again.

Allie Ward discusses pain neuroscience with Dr. Rachel Zoffness on her podcast Ologies in an easy to understand way! Check out that episode here:

7. Pelvic Girdle Pain

Pelvic girdle pain (PGP) is common in pregnancy—sometimes affecting up to 70% of women in late pregnancy.

It can show up as:

• Pain in the front of the pelvis (pubic symphysis)

• Pain in the back of the pelvis (SI joint, tailbone)

• One-sided or both-sided pain

  
  

Often people blame the hormone relaxin, but really it’s about muscles being asked to support more load than they’re ready for. Strengthening is the best prevention and treatment.

Helpful strategies:

• Support belts for stability

• Manual therapy for tight back, hip, and pelvic floor muscles

• Targeted strength training for the core, glutes, hips, and back

  
  

Treatment Strategies We Use at Ascend Pelvic Health

There isn’t a one-size-fits-all solution—but here are some of the tools we use:

• Manual therapy (external or internal, if you’re comfortable) to release tight pelvic floor muscles

• Pelvic floor relaxation training → focusing on deep belly breathing, not endless Kegels

• Nervous system calming → breathing techniques that help your body shift from fight-or-flight into rest-and-digest

• Strength training & coordination → building resilience in the muscles that support the pelvis and spine, and learning when to engage the pelvic floor

  
  

Every plan is individualized—because every woman’s body and story is unique.

The Takeaway

Pelvic and vaginal pain is complex—there’s rarely just one cause. But here’s the good news: there are solutions. With the right evaluation, we can uncover the root factors, break the cycle of pain, and help you feel like yourself again.

👉 At Ascend Pelvic Health, I work with women every day who thought pain was just something they had to “deal with.” It’s not. Let’s figure out your story and start the path toward healing.

✨ Ready to get answers? Schedule a Free Discovery Call today!

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