Female Sexual Dysfunction: Common Challenges and How Physical Therapy Can Help

Female sexual dysfunction is a broad term covering difficulties in sexual response, desire, pain, or satisfaction that can deeply affect quality of life. Problems like vaginismus, dyspareunia (painful intercourse), vulvodynia, anorgasmia, dysorgasmia, and low libido often leave women feeling frustrated, ashamed, or isolated. While many think these challenges are just “in their head,” they often have physical, neurological, hormonal, and psychological causes—or more often, a combination. Physical therapy, particularly specialized pelvic floor therapy, offers proven and non-surgical options for relief. At FeminaPT, our clinicians are experts in treating sexual pain syndromes and female sexual dysfunction with compassion, experience, and a whole-body approach. In the rest of this page, we’ll explain what female sexual dysfunction encompasses, the common types and causes, symptoms to look out for, and how pelvic floor physical therapy can help you reclaim sexual comfort and pleasure.

What is Female Sexual Dysfunction

Female sexual dysfunction refers to persistent problems during any phase of the sexual response cycle—desire, arousal, orgasm, or resolution—that cause distress or interpersonal difficulty. It is not a single condition but a spectrum that may include painful intercourse, difficulty achieving orgasm, or low sexual interest, with many women experiencing overlapping issues that often share roots. Dysfunction is considered clinically significant when symptoms persist for months, affect sexual satisfaction, or create emotional, relational, or physical consequences. At Femina Physical Therapy, sexual dysfunction is often linked with pelvic floor dysfunction, where muscles may be overly tight, poorly coordinated, or contain trigger points, as seen in conditions like vaginismus or vulvodynia. Hormonal, connective tissue, nerve, or scar-related factors can also play a role, while psychological elements such as anxiety, trauma, shame, or negative sexual beliefs may perpetuate a cycle of pain and tension. Hormonal shifts (menopause, postpartum, contraceptives), inflammation, scar tissue, or comorbid conditions like interstitial cystitis and endometriosis can further contribute. Recognizing the complex interaction of physical, emotional, and medical factors, Femina PT provides tailored treatment plans to address each woman’s unique needs.

Types of Female Sexual Dysfunction

Here are several of the more common types of female sexual dysfunction that Femina PT treats. Note that many women experience overlapping types.

1. Vaginismus/Genito-Pelvic Penetration Disorder—Involuntary spasms or guarding of pelvic floor muscles that make vaginal penetration difficult or impossible. Can be lifelong (primary) or acquired later (secondary). Often includes fear or anxiety around penetration.
2. Dyspareunia (Painful Intercourse)—Pain during or following sexual intercourse. Can be “entry” pain (near vaginal opening) or “deep” pain (pelvic organs, cervix). Often associated with other conditions, such as vulvodynia or scar tissue. 
3. Vulvodynia/Vestibulodynia—Localized or generalized pain in the vulva or vulvar vestibule. Burning, stinging, irritation—even with light touch, pressure, or sex. Vestibulodynia refers to pain in the vestibule
4. Anorgasmia / Dysorgasmia—Difficulty achieving orgasm (Anorgasmia), or having orgasms that are unsatisfying, painful, inconsistent, or otherwise dysregulated (Dysorgasmia).
5. Low Libido / Low Sexual Desire in Women—Reduced interest in sexual activity, diminished desire, or libido. This may coexist with other dysfunctions or occur on its own. Can be influenced by physical, hormonal, psychological, or relational factors

Causes of Female Sexual Dysfunction

Multiple, often interrelated causes contribute to female sexual dysfunction. Understanding these can help address root causes rather than only treating symptoms.

1. Pelvic Floor Muscle Dysfunction—Many sexual pain and penetration issues stem from pelvic floor muscles being too tense, not relaxing properly, having trigger points, or poor coordination. For example, in vaginismus and dyspareunia, muscle spasm or guarding obstructs penetration or causes sharp pain. 
   
2. Anatomical/Tissue Changes—Scar tissue from surgery or childbirth, hormonal changes (menopause or postpartum), inflammation, or thinning of tissues can lead to discomfort, lack of elasticity, or increased sensitivity. Vulvodynia is often aggravated by irritation or tissue sensitivity. 
   
3. Neurological/Sensory Changes—Nerve irritation, hypersensitivity, or altered pain perception can amplify or distort signals, causing even light touch or minimal pressure to feel painful. Conditions like vulvodynia or coexisting bladder pain syndromes may share this cause. 
   
4. Hormonal Influence—Fluctuations in estrogen, progesterone, or other hormones (e.g., during menopause, postpartum, contraceptive use) can dry or thin vaginal tissues, reduce lubrication, and weaken support structures, leading to more pain and dysfunction.
   
5. Psychological & Emotional Factors—Anxiety, fear of pain, past sexual trauma, negative sexual beliefs, shame, or relationship distress can all contribute. These often maintain the cycle of pain and avoidance. 
   
6. Lifestyle & Biomechanical Contributors—Activities that strain the pelvic floor (heavy lifting, prolonged sitting), poor posture, obesity, frequent straining with bowel movements, or urinary issues may contribute to or worsen dysfunction. 
   
7. Medical / Co-existing Conditions—Endometriosis, interstitial cystitis, bladder pain syndromes, hormonal disorders, infection, or chronic inflammation often co-occur with female sexual dysfunction. 
   

Symptoms of Female Sexual Dysfunction

Symptoms can vary greatly depending on the type and severity. Some women have mild discomfort; others have intense pain, significant distress, or avoidance of sexual activity. Common symptoms include:

• Pain during intercourse (dyspareunia), especially with entry or deep penetration
  
• Sensation of tightness, spasm, or involuntary muscle contraction during attempts at penetration (vaginismus)
  
• Burning, stinging, rawness, or irritation of the vulva or vestibule (vulvodynia/vestibulodynia)
  
• Difficulty achieving orgasm, or orgasms that are less intense or satisfying (anorgasmia, dysorgasmia)
  
• Low libido or decreased sexual desire
  
• Fear or anxiety around penetration or sexual activity
  
• Vaginal dryness, discomfort during or after sex
  
• Physical symptoms like soreness, pain with tampon insertion, and gynecological exams
  
• Psychological or relational impact: stress, shame, guilt, avoidance of intimacy, lowered self-esteem
  

How Pelvic Floor Physical Therapy Can Help in Treating Female Sexual Dysfunction

Pelvic floor physical therapy is a specialized treatment that addresses various pelvic health issues, including female sexual dysfunction. At Femina PT, this approach is tailored to help women achieve a fulfilling and pain-free sexual life.

How pelvic floor physical therapy can help in treating female sexual dysfunction:

1. Relieves Painful Intercourse: Conditions like vaginismus, vulvodynia, and dyspareunia can cause discomfort during sex. Pelvic floor therapy helps alleviate these symptoms by addressing muscle tightness and trigger points. 
   
2. Enhances Sexual Function: By improving pelvic floor muscle strength and coordination, therapy can increase sexual desire, performance, and the ability to achieve orgasm. 
   
3. Addresses Underlying Conditions: Pelvic floor therapists can help manage symptoms of endometriosis, interstitial cystitis, and other chronic pain syndromes that impact sexual health. 
   
4. Improves Bladder and Bowel Function: Pelvic floor therapy can reduce urinary urgency, frequency, and incontinence, which are often associated with sexual dysfunction. 
   
5. Supports Postpartum Recovery: After childbirth, pelvic floor therapy aids in restoring muscle tone and function, promoting better sexual health and overall well-being. 
   
6. Offers Non-Surgical Treatment: Pelvic floor physical therapy provides a non-invasive alternative to surgery, focusing on muscle rehabilitation and functional restoration. 
   

Treatment Options at Femina Physical Therapy

Female sexual dysfunction is rarely “fixed” by one thing alone. At FeminaPT, physical therapy is part of a multifaceted approach that addresses physical, emotional, relational, and lifestyle factors. Our evaluation looks at pelvic floor muscle tone, trigger points, tissue sensitivity, posture/movement, emotional context, and more. We then tailor treatment options to your situation. 

Here are many of the modalities we use, often in combination, to support recovery:

1. Internal Manual Therapy & Trigger Point Release—Licensed physical therapists use gentle internal techniques to release tight pelvic floor muscles and trigger points, soften scar tissue, and reduce muscle guarding. This helps reduce pain with penetration and improve muscle flexibility. 
   
2. Vaginal/Genital Dilator Therapy—In cases of vaginismus or when penetration is painful even with relaxed musculature, gently using dilators helps stretch tissues gradually, desensitize, and build tolerance in a controlled, safe manner. 
   
3. Biofeedback & Muscle Awareness Training—Using sensors or biofeedback tools to show you how your pelvic floor muscles are behaving helps with learning to relax rather than just contract. This is especially helpful in differentiating tension from relaxation and retraining coordination.
   
4. Manual Soft Tissue/Myofascial Release—Techniques to release connective tissue, fascia, scars, or other restrictions around the genitals, pelvis, hip, or abdomen that may be contributing to pain or restricted movement.  
   
5. Therapeutic Exercise & Stretching—Exercises to both gently stretch tight muscles and strengthen weak support muscles, often targeting the hip, core, and pelvic floor. This may also include posture and breathing work to reduce unnecessary strain.  
   
6. Desensitization & Sensory Re-education—Gradual exposure to touch, massage, pressure, or insertion (with dilators or otherwise) to help reduce hypersensitivity, retrain the nervous system, and restore comfort. (inferred from FeminaPT’s practice in treating vestibulodynia and vaginismus).
   
7. Pain Management Techniques—Modalities such as relaxation training, breathing training, TENS, heat/ice where appropriate, nerve glide, or neural mobilization may be used to reduce pain or reduce the sensitization of nerves.
   
8. Education & Psychological / Relational Support—Understanding the anatomy, what’s going on physically, addressing fear or anxiety, normalization of symptoms, communication with partner, and sexual education—these are all part of the process. 
   
9. Holistic & Supportive Strategies—Lifestyle adjustments: improving lubrication, hormonal support (if relevant), optimizing sleep, stress management, body posture, and activity pacing. Also, home programs and self-care tools (relaxation, gentle stretching, and massage) are essential. 
   

These treatment options are typically combined over weeks to months, with regular follow-ups. Many patients see a reduction in pain, improvement in orgasm, increased sexual comfort, and gradual return to sexual activities that used to be painful, undesirable, or avoided.

Frequently Asked Questions

Here are some common questions people have about female sexual dysfunction, including Vaginismus, Dyspareunia, Vulvodynia, Anorgasmia, and low libido in women.

1. Is painful intercourse (dyspareunia) always caused by Vaginismus?
   – Not always. Dyspareunia refers broadly to pain during intercourse and can have many causes—tissue sensitivity, hormonal changes, scar tissue, pelvic floor overactivity, endometriosis, or inflammatory conditions. Vaginismus specifically involves involuntary muscle spasm or guarding that makes penetration difficult or impossible. At Femina Physical Therapy, evaluation helps determine which is present or if both are involved.
   
2. Can I overcome vaginismus/genito-pelvic penetration disorder?
   – Yes. Many women with vaginismus benefit significantly from a combination of physical therapy (including dilators, manual therapy, and education), biofeedback, and psychological support. FeminaPT has seen many successful outcomes. Progress rates vary based on severity, consistency, and how soon intervention begins.
   
3. What is the difference between anorgasmia and dysorgasmia?
   – Anorgasmia refers to the inability to achieve orgasm; dysorgasmia refers to orgasms that are painful, delayed, diminished, or otherwise dissatisfying. Both are forms of female sexual dysfunction and are often treated by addressing physical, emotional, relational, and neurological factors.
   
4. How long until I see improvement?
   – It depends on individual factors: how long the dysfunction has been present, underlying causes, consistency with therapy, and whether multiple modalities are used. Many patients notice some pain relief or increased comfort within a few weeks; more significant improvement usually occurs over a few months. Some deeper issues or long-standing cases may take longer.
   
5. Will therapy be painful?
   – At FeminaPT, the goal is to reduce pain and discomfort. Initial sessions may involve discomfort, especially if tissues are very guarded, but therapists work gradually with you, often using gentle techniques first. Communication is key; therapy is adjusted to your comfort level.
   
6. Can therapy help with low libido or lack of desire?
   – Yes, especially if low libido is connected to physical pain, discomfort, fear of pain, or hormonal or psychological causes. By reducing pain (with conditions like dyspareunia or vulvodynia), improving comfort, and addressing emotional and relational issues, libido often improves. Additional counseling or medical input may be useful if hormonal or medical conditions are involved.
   

Do I need surgery for female sexual dysfunction?
– Most of the time, surgery is not the first option. FeminaPT focuses on nonsurgical (conservative) treatments first. Surgery may be considered only for specific structural issues or when conservative therapies are not sufficient. Even then, physical therapy is often part of pre- and post-surgical care.