How Pornography Can Cause Pelvic Pain: A Pelvic Health Physiotherapist’s Perspective

During a Q+A session following a presentation on adolescent pelvic health and sexual wellbeing, I was asked to explain the link between pornography and pelvic pain. Initially, I stalled as I wanted to give this answer justice in the small amount of time we had. I have thought about it more since then, and decided to write a blog as there was so much I wanted to say, and am so grateful that this question prompted me to write this blog.

Pornography is widely accessible, more so in recent years with easy access to the internet on various screens and devices. The average age of first exposure to pornography is reported to be around 11 years old, with some studies indicating children as young as 8 years old encountering explicit material – mostly unintentionally. Research has shown that up to 93% of males and 62% of females have seen pornographic videos online before the age of 18 years. As a consequence, unfortunately it is serving as a primary source of sexual education, especially for adolescents. Mainstream pornography is typically skewed toward unrealistic and gender-biased portrayals of sex, which can have significant implications for pelvic health, particularly in females. As an advanced pelvic health physiotherapist, I aim to shed light on how exposure to violent, male-centric pornography can contribute to pelvic pain, including dyspareunia (painful intercourse) and persistent pelvic pain, on the background of chronic pelvic floor muscle tension.
 

The problem with mainstream pornography: a skewed view of sex

Mainstream pornography often depicts sex in a way that is far removed from healthy, mutually pleasurable sexual experiences. The portrayal is frequently biased towards male pleasure, with female pleasure receiving little to no emphasis. Moreover, rough, aggressive, or even violent sexual acts are common, creating a distorted view of what “normal” sex looks like.

When young people turn to pornography as a source of sexual education, they may come to accept these depictions as standard or expected in real-life sexual encounters. This normalisation can contribute to misconceptions about sex, including unrealistic expectations of what arousal and pleasure should look like for both partners. If girls are viewing pornography, they may also view sex being predominantly portrayed as a performance, focused on male gratification, which can negatively impact their sexual experiences. In addition, models used in pornography often display a vulva that looks a “certain way,” leading to young women believing that their anatomy is not normal.

 

The impact on female sexual arousal and pelvic floor muscle tension

The absence of an emphasis on female arousal and pleasure in pornography can lead to a lack of sexual enjoyment and comfort in women. Mainstream pornography often jumps into penetrative acts without showing adequate arousal, foreplay, or attention to the female partner’s needs. For most women, arousal involves a gradual buildup that allows the body to become fully prepared for intercourse. When sex occurs without sufficient arousal, the pelvic floor muscles may remain tense and protective, leading to discomfort or pain. This is because the pelvic floor naturally tightens in response to perceived threats or discomfort, and if sexual activity is experienced as rushed or rough, the muscles may not be able to relax. This engagement of the pelvic floor muscles can lead to overactive muscles. This can then lead to painful intercourse (dyspareunia). When muscles stay in a tightened state, this can also lead to pain outside of intercourse, with no apparent triggers.

The portrayal of sex in pornography often emphasises visual stimulation rather than a holistic, embodied experience. This can lead to a disconnect between mental arousal and the body’s physical response. When arousal is driven purely by mental or visual factors, without a corresponding physical response (such as increased lubrication, engorgement of clitoral erectile tissue, softening of the vaginal canal, and relaxation of the pelvic floor muscles), penetration may be painful. No-one ever tells us that women need an erection just as much as men, to achieve comfortable, pleasurable intercourse. Repeated experiences of painful intercourse can further condition the pelvic floor to remain tense, even in anticipation of sex, reinforcing a cycle of pain.

Lastly, pornography’s focus on male climax as the primary goal, with little or no depiction of female pleasure, can condition women to deprioritise their own sexual satisfaction. This mindset can lead to internalised pressure to engage in sexual activities they may not fully enjoy or feel ready for, resulting in physical responses including involuntary tightening of the pelvic muscles. Over time, this can manifest as persistent pelvic pain, pelvic floor muscle tightness (which can affect bladder and bowel function) and reduced sexual pleasure.

 

The need for adequate sexual education

As a pelvic health physiotherapist, I am disheartened by the amount of young people who still are not getting the correct sexual education that is needed, as I hear of countless examples of early sexual encounters are uninformed, non-pleasurable and often painful (at least for the female in a heterosexual experience).

Key factors for good sexual education include:

• Consent & respect
• How to communicate with sexual partners
• Anatomy & physiology
• Normal changes in puberty
• Contraception options
• STIs – promoting safe practices
• Healthy relationships
• Discovering body & pleasure (without shame or embarrassment)

Sexual education needs to be age-appropriate, culturally and gender sensitive, and must foster open communication. Parental and community involvement is paramount for adequate sexual education for our next generation.  If a parent is uncomfortable having conversations with their young adult (and/or vice versa), having some good resources to provide is important.

I also believe that it is important to educate young people on safe online behaviour, and to help them understand that not everything they see online reflects reality. By staying cyber-aware and engaging in open, honest conversations, parents can mitigate the potential negative effects that exposure to pornography (intentional or unintentional) can have, and to develop a healthy understanding of relationships and sexuality.

Some of my favourite sexual education resources are:

• “Welcome to Sex” by Yumi Stynes & Dr Melissa Kang
• www.OMGYES.com
• “Come As You Are” – Dr Emily Nagoski
• Sex Education – Netflix (no, really - this is an amazing resource for older teens - and very entertaining) 

 

Final Thoughts

Understanding the link between pornography, pelvic pain, and sexual function allows us to take meaningful steps towards empowering the next generation with positive sexual health.

While pornography may seem like a convenient way to learn about sex, mainstream content often promotes unrealistic, male-centric, and even harmful views of sexual activity. For women, the lack of focus on arousal and female pleasure, combined with portrayals of violent or aggressive acts, can contribute to the development of pelvic pain. Recognising the potential impact of pornography on pelvic health is the first step toward addressing its effects. By embracing a holistic approach to sexual education and pelvic floor awareness, women can break the cycle of pain and reclaim their sexual health.

If you (or someone you know) are struggling with pelvic pain, consulting a pelvic health physiotherapist can be a valuable step toward finding relief and improving your overall wellbeing. Pelvic pain doesn’t have to be a part of your sexual experience. Learning how to connect to and control your pelvic floor muscles, and discover pleasure within your body are paramount to positive sexual experiences. Healing is possible, and you deserve to enjoy a healthy and fulfilling sex life.