Effective Self-Help for Women’s Pain During Intercourse

According to the landmark “Sex In America” survey (1994), sexual pain afflicts around 20 percent of American women—15 percent before menopausal, 33 percent after. That’s such a shame. Except for consensual BDSM, sex should never hurt, not even the first time.

Many Possible Causes

Pain on intercourse has a myriad of possible causes, among them: vaginismus, rushed lovemaking, insufficient lubrication, relationship distress, birth control pills, vulvar irritation, vulvar vestibulitis, oxalate irritation, sexually transmitted infections, a history of sexual trauma, and the man inserting too quickly or deeply. For more on this, read my previous post on the subject.

Genital pain often requires professional care. But before consulting your gynecologist, I suggest obtaining a copy of Sex Without Pain by Encino, California physical therapist Heather Jeffcoat, DPT. Jeffcoat is one of a small number of health professionals who specializes in evaluating and treating women’s genital pain. Her supportive 75-page book debunks common myths (Just relax.), and provides a simple step-by-step program that has cured many women’s genital pain in just a few months.

The Sex Without Pain Self-Help Program

Jeffcoat’s program begins with a self-assessment questionnaire, Kegel exercises (check out my recent post on Kegels), a pelvic “clock” to locate your pain, and an exploration of trigger points in and around the vulva.

It proceeds to the “IRAS” method, pronounced “erase,” an acronym for Insert, Release, Adjust, and Stretch, which employs a set of graduated-diameter vaginal dilator rods that gently stretch the pelvic floor muscles, the ones around the vulva and vagina—with illustrated directions for their insertion, manipulation, and use in perineal massage. (Jeffcoat provides access information for the dilators she uses in her practice.)

Next she presents a set of exercises for transitioning from dilator work to intercourse with a lover.

Finally, Jeffcoat recommends several hip and hamstring stretches inspired by yoga and Pilates that help maintain pelvic floor flexibility (with illustrations).

What If Sex Without Pain Doesn’t Cure It?

Even if Jeffcoat’s program doesn’t eliminate your pain, her book is still valuable. It teaches basic pelvic anatomy and physiology, which helps women better describe their situations to health professionals. In addition, the book lists specialists around the country who use similar approaches to treating genital pain.

Chronic genital pain is maddening and may cause serious relationship distress. Why live with it? The self-help program in Sex Without Pain may well minimize your pain or cure it.

To obtain Sex Without Pain, search the title on Google.

If the book doesn’t produce sufficient relief, then I’d suggest contacting one of the experts Jeffcoat lists, or consulting a sex therapy. To find a sex therapist near you, visit the American Association of Sex Educators, Counselors, and Therapists, the Society for Sex Therapy and Research, or the American Board of Sexology.

P.S. I have no personal or financial relationship with Heather Jeffcoat.


Bergeron, S et al. “A Randomized Comparison of Group Cognitive-Behavioral Therapy, Biofeedback, and Vestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis,” Pain (2001) 91:297.

Binik, Y.M. et al. “Female Sexual Pain Disorders: Genital Pain or Sexual Dysfunction?” Archives of Sexual Behavior (2002) 31:425.

Graziottin, A. et al. “Vulvodynia: The Challenge of Unexplained Genital Pain,” Journal of Sex and Marital Therapy (2001) 27:503-512.

Graziottin, A and L.A. Brotto. “Vulvar Vestibulitis: A Clinical Approach,” Journal of Sex and Marital Therapy (2004) 30:125.

Lamont, John, et al. “Psychosexual and Social Profiles of Women with Vulvodynia,” Journal of Sex and Marital Therapy (2001) 27:551-555.

Laumann, EO et al. “Sexual Dysfunction in the United States,” Journal of the American Medical Association (1999) 281:537.

Reissing, E.D. et al. “Vaginal Spasm, Pain, and Behavior: An Empirical Investigation of the Diagnosis of Vaginismus,” Archives of Sexual Behavior (2004) 33:5.



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