When Lube Isn't Enough: Healing Painful Sex with Pelvic Floor Therapy & Dilators

You did everything right. You talked to your doctor. You started vaginal estrogen. You bought the expensive silicone lubricant.

But when you tried to be intimate, it still felt like hitting a brick wall. Or maybe it felt like a deep, aching cramp that lasted for hours afterward.

If this sounds familiar, the problem likely isn't your skin anymore—it’s your muscles.

Medical professionals call this Dyspareunia (painful intercourse). In menopause, it often evolves into a condition called Vaginismus or a "Hypertonic Pelvic Floor." Essentially, your body is remembering past pain and physically bracing against it.

The good news? Muscles can be retrained. Here is the guide to the therapies that actually work: Pelvic Floor PT and Dilators.

To understand why you need therapy, you have to understand the Pain-Anticipation Loop.

1. The Trigger: Initially, sex hurt because of thinning tissue (GSM).

2. The Reaction: Your brain registered "Sex = Pain."

3. The Guarding: Now, the moment you are touched (or even think about sex), your pelvic floor muscles subconsciously slam shut to protect you. It’s a reflex, like flinching when something flies at your face.

4. The Result: Trying to penetrate clenched muscles causes more pain, which reinforces the brain's belief that sex is dangerous.

You cannot "relax your way out of it" with a glass of wine. You have to physically retrain the muscles to let go.

If you have a knee injury, you go to a physical therapist. If you have a pelvic injury, you go to a Pelvic Floor PT.

"Wait, isn't that just Kegels?" NO. In fact, if you have painful sex, Kegels are the worst thing you can do. Kegels tighten the muscles. You likely have a "Hypertonic" (too tight) floor. You need to learn to lengthen and relax (down-train) those muscles.

What happens in a session? It can be intimidating, but it is highly professional.

• External Work: The therapist may work on your hips, back, and abdomen (which often pull on the pelvis).

• Internal Work: With your consent, they use a gloved finger to identify "trigger points" (knots) inside the vagina and gently release them.

• Biofeedback: Some use sensors to show you on a screen when your muscles are clenching vs. relaxing, so you can learn what "letting go" actually feels like.

The word "dilator" sounds scary (and a bit medical), but think of them as "Desensitization Trainers."

They are a set of graduated silicone tubes, ranging from the size of a pinky finger to the size of a partner.

How to Use Them (The Protocol): You do not use these during sex. You use them solo, in a quiet room, for 10–15 minutes a day.

1. Start Small: Use plenty of lube and insert the smallest size.

2. Breathe: Do not move it in and out. Just hold it there. Focus on "belly breathing" to relax the pelvic floor around it.

3. The Goal: You are teaching your brain: "See? There is something inside me, and it doesn't hurt."

4. Level Up: Once you can insert a size with zero pain and zero anxiety, you move to the next size up.

Note: This process takes months, not days. Be patient.

Sometimes the pain is deep—a specific knot in the muscle that feels like a charley horse.

• The Tool: A Therawand or pelvic wand is a curved tool (often S-shaped) designed to reach deep internal muscles that a straight dilator can't.

• How it works: You use it to gently apply pressure to the sore spot (trigger point) until the muscle releases. It puts the control in your hands.

In this type of therapy, the motto "No Pain, No Gain" does not apply.

If you feel pain (anything above a 3/10 discomfort), STOP. If you push through the pain, you are just re-confirming to your brain that penetration hurts, and the muscles will clench harder next time.

You are building trust with your body. Do not violate that trust by forcing it.

Using dilators or going to PT might feel unsexy. It might feel like "work."

But consider this: You are taking active steps to heal a part of your body that has been hurting. You are breaking the cycle of pain.

Start by Googling "Pelvic Floor PT near me" (look for the initials WCS or PRPC). It is the single most effective investment you can make for your sexual future.

• Need to fix the tissue quality first? Read GSM: It’s Not Just Dryness.

Struggling with desire? Read Where Did My Libido Go?.