The Gut–Pelvic Floor Connection No One Explains

"Your tests are normal." For many people experiencing pain during sex, these words are both reassuring and incredibly frustrating. On one hand, it's good news that there isn't an infection, tear, or serious medical condition. But on the other hand, you're still left wondering: "If everything is normal... why does it hurt so much?" The reality is that pain during sex is common, but it's not something you should simply put up with. And importantly, normal test results don't mean your pain isn't real. In many cases, pain during sex is related to how the muscles, nerves, and tissues are functioning—not just how they look. Is it normal for sex to hurt? No. While temporary discomfort can happen from time to time, pain that is ongoing, recurrent, or causes you to avoid intimacy is not considered normal . Pain during sex can affect people of all ages and may occur: at the entrance of the vagina with deeper penetration during certain positions after intercourse or even for hours afterwards. No matter where or when it occurs, persistent pain deserves assessment. Why can everything look "normal" but still hurt? Many conditions that cause pain don't show up on scans, blood tests, or routine examinations. Think about a tension headache. Your brain scan would usually be normal—but that doesn't make the pain any less real. The same can happen with the pelvic floor. Your muscles may be: overly tight difficult to relax sensitive to touch uncoordinated protecting the area after previous pain, injury, childbirth, or surgery. These changes are about function , not necessarily structure. The pelvic floor's role in painful sex Your pelvic floor muscles form a supportive sling at the base of your pelvis. For comfortable penetration, these muscles need to: relax lengthen coordinate with breathing respond appropriately to movement. If they remain tense or become protective, penetration may feel: sharp burning stretching like "hitting a wall" or simply impossible. This doesn't mean the muscles are weak—it often means they're working too hard. Stress can affect your pelvic floor Stress doesn't just affect your mind—it affects your body. When we're stressed or anxious, we often unconsciously: clench our jaw tense our shoulders hold our breath tighten our abdominal muscles brace our pelvic floor. Over time, this constant muscle guarding can contribute to persistent pelvic tension and discomfort. That doesn't mean the pain is psychological. It means your nervous system and muscles are closely connected. Other factors that may contribute Pain during sex is often influenced by more than one factor. These may include: previous painful experiences childbirth pelvic surgery hormonal changes endometriosis bladder pain bowel dysfunction constipation menopause skin conditions nerve sensitivity persistent muscle tension. A thorough assessment considers all of these—not just one possible cause. "It's all in your head"—a harmful myth One of the most upsetting things people hear is that because their tests are normal, the pain must be psychological. That's simply not true. Pain is always real. Even when scans or examinations don't identify a structural problem, your nervous system, muscles, connective tissues, and movement patterns can all contribute to ongoing symptoms. Understanding what's driving your pain is the first step towards improving it. How can a pelvic floor physiotherapist help? A pelvic floor physiotherapist doesn't just look for weakness. They assess how your pelvic floor muscles: relax contract coordinate respond during breathing and movement contribute to your symptoms. Depending on your individual needs, treatment may include: education about pelvic pain breathing and relaxation strategies pelvic floor muscle down-training gentle manual therapy where appropriate movement and stretching exercises bladder and bowel advice strategies to reduce muscle guarding. If another condition is suspected, your physiotherapist may also work alongside your GP, gynaecologist, or other healthcare providers to ensure you receive comprehensive care. Frequently Asked Questions Can tight pelvic floor muscles cause pain during sex? Yes. An overactive or tight pelvic floor can make it difficult for the muscles to relax during penetration, contributing to pain or discomfort. A pelvic floor assessment can determine whether muscle tension is playing a role. Why do my scans keep coming back normal? Many causes of painful sex relate to how muscles and nerves function rather than changes that appear on imaging. Normal scans are reassuring, but they don't rule out pelvic floor dysfunction or other functional causes of pain. Should I keep having sex if it hurts? Persistent pain during sex shouldn't be ignored. Continuing to push through pain can sometimes reinforce muscle guarding and fear of pain. It's important to seek assessment so the underlying cause can be identified and managed appropriately. The Bottom Line Pain during sex is common—but it isn't something you have to accept as "normal." If you've been told that everything looks fine but intimacy is still painful, know that your experience is valid. Many causes of painful sex involve the way your muscles, nerves, and tissues are functioning, and these issues often won't show up on routine tests. A pelvic floor physiotherapist can help identify the factors contributing to your symptoms and work with you to develop a personalised treatment plan, so you can move towards comfortable, confident intimacy again. You deserve answers—not just reassurance that your tests are normal. If pain during sex is affecting your quality of life or relationships, book an assessment with one of our pelvic health physiotherapists to take the first step towards understanding and treating the cause.

You're halfway through a workout. Maybe it's a box jump, a heavy lift, a sprint, or even just a big laugh during your fitness class. Then it happens. A small leak of urine. Many people brush it off as "normal after having kids" or assume it's simply the price of staying active. Others stop running, avoid jumping, or give up the sports they love altogether. Here's the truth: Leaking during exercise is common—but it isn't normal, and it isn't something you should have to accept. More importantly, it doesn't always mean you have a weak pelvic floor. Why do I leak urine when I exercise? Exercise places extra pressure on your bladder and pelvic floor. Every time you jump, run, cough, lift, or land, the pressure inside your abdomen increases. Your pelvic floor needs to respond at exactly the right time to help support your bladder and keep you dry. If that system isn't working efficiently, urine leakage can occur. This is known as stress urinary incontinence—the leakage of urine during activities that increase pressure on the bladder. Does leaking mean my pelvic floor is weak? Not always. This is one of the biggest misconceptions we see. While reduced pelvic floor strength can contribute to bladder leakage, it's only one piece of the puzzle. Your pelvic floor may also be: lacking coordination or timing unable to relax properly between contractions working too hard and becoming fatigued struggling to manage pressure during exercise affected by previous pregnancy, childbirth, surgery or hormonal changes. Think of it like your calf muscles. Even if they're strong, they won't help you run efficiently if they don't contract at the right time or coordinate with the rest of your body. The pelvic floor works the same way. Why does it only happen during certain exercises? You might notice leakage when you: run jump skip lift heavy weights do burpees sneeze during a workout play netball, basketball or tennis trampoline with your kids. These activities create higher forces through your body, meaning your pelvic floor needs to react more quickly and effectively. Leaking during high-impact exercise doesn't necessarily mean you'll leak during everyday activities. I only leak a little—is that okay? Even a few drops matter. Small leaks are often dismissed because they're manageable, but they can be an early sign that your pelvic floor or pressure management system isn't functioning as efficiently as it could. Addressing symptoms early is often easier than waiting until they become more frequent or start affecting your lifestyle. What if I've never had children? You don't need to have been pregnant to experience bladder leakage. We also see leakage in: runners gym-goers dancers gymnasts CrossFit athletes women going through perimenopause or menopause men after prostate surgery people with chronic coughs or constipation. Pelvic floor dysfunction can affect anyone. Should I stop exercising? In most cases, no. Exercise is incredibly important for your physical and mental health, and the goal isn't to avoid movement—it's to understand why you're leaking and address the underlying cause. Sometimes small changes to technique, breathing, exercise selection or training load can make a significant difference while you're working on improving pelvic floor function. How can a pelvic floor physiotherapist help? A pelvic floor assessment looks far beyond whether you can do a Kegel. Your physiotherapist may assess: pelvic floor muscle strength muscle relaxation and coordination breathing patterns pressure management movement during exercise lifting technique bowel and bladder habits lifestyle factors contributing to symptoms. Treatment is tailored to your body and goals and may include: pelvic floor muscle training (when appropriate) learning how to coordinate your pelvic floor with movement breathing and pressure management strategies progressive return to impact activities exercise modifications while symptoms improve education to help you train with confidence. The aim isn't simply to stop the leaking—it's to help you return to the activities you enjoy without fear or embarrassment. When should you seek help? It's worth booking an assessment if you: leak during running, jumping or lifting wear a pad to exercise "just in case" avoid certain workouts because of leakage notice your symptoms are becoming more frequent feel pressure or heaviness during exercise have tried Kegels without improvement. You don't have to wait until the problem becomes severe. Frequently Asked Questions Is it normal to leak urine when exercising? No. Although it's common, leaking urine during exercise isn't considered a normal part of ageing, childbirth or fitness. It's a sign that your bladder and pelvic floor would benefit from assessment. Can pelvic floor exercises stop bladder leakage? For many people, pelvic floor muscle training is an effective treatment. However, not everyone with bladder leakage needs strengthening exercises. Some people require training to improve coordination, relaxation or pressure management instead. Can I keep exercising if I leak? In most cases, yes. Staying active is important. A pelvic floor physiotherapist can help identify why you're leaking and guide you on how to continue exercising safely while addressing the underlying issue. The Bottom Line Leaking during exercise isn't something you should ignore—or simply accept because you've had children or are getting older. Whether it's a few drops during a jog or enough to make you avoid your favourite workout, there's usually a reason it's happening, and effective treatment is available. The first step is understanding why you're leaking. From there, a personalised assessment can help you build the strength, coordination and confidence to move freely again. You shouldn't have to choose between staying active and staying dry. If bladder leakage is holding you back, book an assessment with one of our pelvic health physiotherapists and let us help you get back to exercising with confidence.

Hormone therapy can bring many positive changes, but it can also influence how your body feels and functions, including your pelvic health. Changes to bladder, bowel, sexual health and pelvic pain can occur as your body adapts to different hormone levels. For people taking testosterone, lower oestrogen levels can affect the tissues of the vagina and vulva, sometimes causing dryness, irritation, discomfort with penetration or changes in bladder function. Some people may also experience increased pelvic floor muscle tension, which can contribute to pelvic pain, bowel or bladder concerns, or discomfort during intimacy. For people taking oestrogen, changes in sexual function can occur as the body adjusts to treatment. This may include changes in libido, arousal, erections or ejaculation. After gender affirming surgery, pelvic health physiotherapy can also support recovery by helping with pelvic floor function, bladder and bowel health, scar management and vaginal dilation where appropriate. These changes do not happen to everyone, but if something feels different, uncomfortable or is affecting your daily life, it is worth paying attention to. Pelvic health physiotherapy can help you understand what may be contributing to your symptoms and provide practical strategies to improve comfort and function. Your body is constantly changing, and hormone therapy is one part of that picture. Understanding those changes can help you feel more informed and confident in looking after your pelvic health.