When sex hurts…
When assessing low libido, it is important to ask folks about pelvic pain. If there is any discomfort, it is natural driver of low libido and I’m sure that this makes sense; if sex hurts, you won’t feel compelled to partake in it. Conditions such as endometriosis, vulvodynia, vaginismus, an overly tight (hypertonic) pelvic floor, interstitial cystitis, and vaginal dryness or tissue changes around postpartum and menopause can all make penetration or even arousal uncomfortable. Many women are told the pain is "normal," "just stress," or something to push through, so they keep having sex that hurts and quietly decide the problem is their low libido. Often the low desire isn't the root problem at all. It's actually a reasonable response to an experience your body has learned to expect will be painful; your body is trying to protect you.
This happens through a protective loop between your brain and your body. When sex has been painful before, your nervous system starts to anticipate pain before touch even begins. Your pelvic floor muscles tighten to guard, lubrication and arousal drop, and you begin to watch for discomfort instead of noticing pleasure. That tension and dryness make pain more likely, which confirms the brain's prediction and strengthens the loop. Over time, desire can fade as a form of self-protection. Anxiety, avoidance, and guilt about letting a partner down can pile on top of this, adding emotional weight to an issue that's physical at its core.
The hopeful part is that pelvic pain is treatable, and desire often comes back once sex stops hurting. I usually recommend a team to support folks through this experience including myself, a pelvic floor physiotherapist and a family doctor or OBGYN if required. As we work to break the loop, it can help to take penetration off the table for a while and widen what "sex" means to you, focusing on touch, outercourse, and whatever feels good with no pain involved. That gives your nervous system a chance to relearn that intimacy can be safe and pleasurable.
You deserve care that takes both your pain and your pleasure seriously. I’m here to provide it.
