When Sex Hurts: The Root Causes No One Talks About | #151

Painful sex is far more common than most women realize and far more complex than we’re ever taught.

In this episode, Dr. Leah shares her deeply personal 18-year journey with painful sex, low libido, and feeling dismissed by the medical system, alongside a comprehensive breakdown of the real root causes of pain during sex, from trauma and pelvic floor dysfunction to hormonal changes and lesser-known conditions like provoked vestibulodynia (PVD).

We talk honestly about why painful sex is not something you should “just push through,” why many conventional treatments miss the mark, and how healing often requires addressing multiple layers at once: physical, neurological, hormonal, and emotional.

If sex has ever felt painful, burning, tense, or emotionally complicated, or if you’ve been told everything “looks normal” but something still feels wrong, this conversation is for you.

Painful sex is not a personal failure, a relationship problem, or something you should tolerate. It’s often a signal, and when you understand the signal, healing becomes possible.

Content Note

This episode includes discussion of sexual trauma, medical trauma, and chronic pain. Please take care while listening and pause if needed.

What We Cover in This Episode

1. Why painful sex is common but not normal
2. How trauma (sexual, medical, or cultural) can create involuntary pelvic floor tension
3. The difference between deep pain vs. pain at the vaginal opening (and why that matters)
4. What vaginismus is and why dilators alone often aren’t enough
5. How pain and pleasure share the same neurological pathways
6. The role of vibration in interrupting pain signals
7. Why hormonal birth control can contribute to painful sex
8. What provoked vestibulodynia (PVD) is and why most women have never heard of it
9. How postpartum hormonal shifts can cause pain even when labs look “normal”
10. Why testosterone matters for vulvar tissue health
11. The connection between low libido and pain
12. How hypertonic (overly tight) pelvic floors contribute to pain, birth challenges, and postpartum issues
13. Why every woman should see a pelvic floor physical therapist at least once
14. How scars, tailbone injuries, infections, and nerve pain syndromes play a role
15. Why healing painful sex requires a root-cause, multi-layered approach
16. A message of hope: healing is possible, even after years of pain

00:00 Trailer + show intro

02:00 Why painful sex is more common than we think (and why women feel so isolated)

04:00 Dr. Leah’s personal story: living with painful sex from the very beginning

08:00 Being dismissed by doctors + why chronic pain is so confusing and isolating

12:30 Why treating symptoms doesn’t work

16:00 Endometriosis and deep pain during sex

25:30 Why pregnancy sometimes improves pain (and why it doesn’t always last)

32:45 Vaginismus explained

40:45 Pain, pleasure, and the nervous system

44:30 Trauma healing during pregnancy and how it changed postpartum pain

47:45 Provoked Vestibulodynia (PVD)

52:45 Birth control, testosterone, and why estrogen isn’t always the issue

56:45 What finally worked

59:45 Other overlooked causes of painful sex

1:04:30 Hypertonic pelvic floors

1:08:30 Final reflections, hope, and next steps

Resources Mentioned:

1. Dr. Leah's When Sex Hurts Immersion Course Waitlist
2. When Sex Hurts (book)
3. Womanhood Wellness Membership
4. Episode: Birth Preparation for Sexual Trauma Survivors