A client came to us after two years of avoiding a conversation she’d had with her OB-GYN, her physical therapist, and finally, hesitantly, with her coach. She’d been told her pain during intercourse — dyspareunia — was connected to an overactive pelvic floor, and that continuing to grind through heavy ab circuits and high-impact classes was likely making it worse, not better. She wasn’t looking for a cure from us. She was looking for a training plan that wouldn’t fight against the treatment she was already doing. That’s the conversation this article is built around, and it’s one we have more often at GForce than people might expect.
What Dyspareunia Is and Why Movement Is Part of the Picture
Dyspareunia is persistent or recurrent pain during or after intercourse, and it affects an estimated 10-20% of women in the U.S. at some point, according to the American College of Obstetricians and Gynecologists. Causes range widely — hormonal changes, dermatological conditions, infection, endometriosis, and musculoskeletal factors including pelvic floor muscle dysfunction.
The musculoskeletal piece is where movement-based training has something to offer. In many cases, the pelvic floor muscles are hypertonic — chronically tense rather than weak — often alongside tightness in the hip flexors, adductors, and deep external rotators. Mayo Clinic notes that pelvic floor muscle spasm is a recognized contributor to painful intercourse, distinct from purely gynecological causes.
This is important because it changes what “exercise” should look like. A tense muscle doesn’t need more contraction training. It needs to relearn how to lengthen, release, and coordinate with breath — which is a very different program from the core-strengthening routines most people associate with pelvic floor health. This is also why we treat this population differently than we treat clients working on general pelvic floor strengthening for fitness and injury prevention, where the goal is often the opposite — building contractile strength.
Where Personal Training Fits — and Where It Doesn’t
We’re direct with every client about scope of practice here: a personal trainer does not diagnose, does not perform internal assessment, and does not treat dyspareunia. That work belongs to a pelvic floor physical therapist and a physician, and we will not build a program for this condition without confirming the client is working with one or both.
What we do is build the surrounding movement environment — hip mobility, breath mechanics, core coordination, and graded loading — in a way that supports the manual therapy and medical treatment already underway, rather than working against it. In practice, that means we ask new clients for permission to communicate with their pelvic floor PT about movement restrictions, breath cues they’re already using, and any positions or loads to avoid.
This coordination matters more than people expect. We’ve had clients whose PT was actively working to downtrain pelvic floor tension while their previous gym program had them doing max-effort planks and heavy weighted sit-ups three times a week — directly undoing the manual therapy gains between sessions. Aligning the two is often the single biggest change we make.
For clients managing related pelvic floor conditions without pain, our approach looks more like what’s outlined in our piece on pelvic floor dysfunction training for core strengthening and mobility, but dyspareunia programming is more conservative and breath-led throughout.
The Assessment We Run Before Programming Anything
Before we write a single set or rep, we spend a full session — sometimes two — on assessment that has nothing to do with strength testing. We ask about breath patterns during exercise, current PT exercises and restrictions, positions or movements that currently increase pain or tension, and general activity tolerance day to day.
We also screen hip and lumbar mobility externally: hip internal and external rotation range, adductor length, and lumbo-pelvic control during basic movement like a bodyweight squat or step-up. We’re not diagnosing the pelvic floor itself — that’s outside our scope — but tight hip flexors and adductors are common co-contributors to pelvic tension, and they’re something we can directly address.
Breath assessment is a major piece. We watch whether a client naturally holds their breath during exertion (a Valsalva pattern), whether their ribcage expands 360 degrees on inhale or only in the chest, and whether exhale is a passive release or a held, guarded pattern. Roughly seven in ten new clients in this category show some form of breath-holding under even light load, which is a direct driver of increased intra-abdominal pressure against a tense pelvic floor.
From there we build a baseline: pain-free range of motion, comfortable load thresholds, and a short list of positions to avoid for the first two to three weeks while we build trust with lighter work.
Breath and Pelvic Floor Relaxation Work Comes First
Every program in this category starts with breath, not exercise. We teach 360-degree diaphragmatic breathing first: lying on the back, knees bent, one hand on the ribs and one on the belly, inhaling for a 4-count so the ribs expand sideways and the belly rises, then exhaling for a 6-count with a conscious release through the pelvic floor rather than a squeeze.
Once that pattern is consistent lying down, we progress to 90/90 hip breathing — feet elevated on a bench or box, knees and hips at 90 degrees, posterior pelvic tilt held gently while breathing the same 4-count in, 6-count out pattern for 5-8 breaths, 2-3 rounds. This position naturally lengthens the pelvic floor and teaches the muscle group to release under a light stretch rather than guard.
We spend two to three full weeks here before adding any real load, which surprises clients who expect a faster jump into “real” training. But rushing this stage is the most common mistake we see carried over from previous gym programs — moving to loaded core work before breath and release patterns are automatic just reinforces the guarding pattern we’re trying to undo.
By week three, most clients can maintain relaxed, coordinated breath through light movement — a bodyweight glute bridge, a supported hip hinge — without reverting to breath-holding, which is the signal we use to progress.
Hip Mobility and Core Coordination, Not Core Bracing
Once breath is stable, we shift to hip mobility and gentle core coordination work rather than traditional ab training. A sample sequence looks like: supine 90/90 hip switches (2 sets of 8 per side, slow and controlled), standing hip circles (2 sets of 6 per direction), and side-lying clamshells at a low range — 2 sets of 12, focused on control rather than burn.
Core work in this phase is coordination-based, not strength-based. Dead bugs with a focus on maintaining relaxed breath (2 sets of 6 per side, slow tempo), and bird dogs holding for 3-5 seconds per rep (2 sets of 8) teach the deep core and pelvic floor to work together without excess tension. We avoid weighted crunches, sit-ups, and hollow holds entirely in this phase — all three increase intra-abdominal pressure in a way that works against the release patterns we just spent three weeks building.
Adductor and hip flexor mobility gets dedicated time too — a 30-second couch stretch per side and a supported adductor rock-back, 2 rounds each, most sessions. Tight hip flexors pull on the pelvis in a way that can increase resting pelvic floor tension, so loosening them is directly relevant even though it’s not a “core” exercise in the traditional sense.
Progressive Loading Without Increasing Pelvic Floor Tension
Around week 6-8, once breath and coordination are consistent, we start adding light external load — but the progression looks different from a standard strength program. We avoid anything that requires a hard brace-and-hold pattern: no heavy back squats, no weighted planks, no max-effort deadlifts in this early phase.
Instead we use lighter, higher-control loading: goblet squats with a 15-20 lb kettlebell for 2-3 sets of 10, cued to exhale on the way up with a conscious release rather than a hard brace; supported single-leg RDLs with light dumbbells, 2 sets of 8 per side; and cable or band pull-aparts for upper body work that doesn’t involve the pelvic floor at all, which we intentionally include so clients still get a training effect and a sense of progress.
We track load progression the same way we would with any client — small, defined jumps of 2.5-5 lbs every one to two weeks — but the ceiling is different. We’re not chasing a 1-rep max here. We’re chasing consistent, pain-free movement at a moderate load, which for most clients tops out well below what they were lifting before symptoms started, at least in this phase of care.
Common Mistakes We See — and What to Do Instead
The most common mistake is defaulting to kegels as a first response. Kegels train contraction, and for a hypertonic pelvic floor, more contraction training often increases tension and worsens symptoms. If a client mentions they’ve been doing kegels on their own before working with us, that’s usually the first thing we pause.
The second mistake is pushing through pain during exercise, treating it like normal muscle soreness. Pelvic pain during or after training is a stop signal, not a “push through it” signal — we ask every client to report it immediately so we can adjust the movement, not the intensity.
The third mistake is jumping back into high-impact classes or heavy lifting too soon because a client feels “fine” on a good day. Symptoms in this category often fluctuate, and one pain-free week doesn’t mean the tissue is ready for a full return to prior training volume. We progress based on consistency across multiple weeks, not a single good session.
The fourth mistake is training in isolation from medical care. We’ve turned away programming requests when a client wasn’t working with a pelvic floor PT or physician, because building a plan without that diagnostic foundation is guesswork we’re not willing to do.
A Sample First Month at GForce
Week 1-2 focuses entirely on assessment and breath: two sessions a week of diaphragmatic breathing, 90/90 hip breathing, and gentle hip mobility — no loaded exercise, 20-25 minutes per session including plenty of coaching cues and check-ins on pain response.
Week 3-4 adds bodyweight coordination work: dead bugs, bird dogs, glute bridges (2 sets of 10, breath-led), and continued hip and adductor mobility, sessions extending to 35-40 minutes. We also start layering in general fitness elements that don’t touch the pelvic floor directly — seated rows, assisted pull-aparts, light upper body pressing — so clients feel like they’re training, not just doing rehab.
By week 5-6, if breath and coordination are solid and there’s been no pain flare in the previous two weeks, we introduce the light loaded work described above. This is also typically when we check back in with the client’s pelvic floor PT to compare notes and confirm the pace is appropriate.
Throughout, we keep sessions to two per week rather than three or four — this population generally does better with more recovery time between sessions early on, since the nervous system component of chronic pelvic pain benefits from consistency without overload.
Community, Confidence, and What Comes Next
A piece of this that doesn’t show up in a program spreadsheet is confidence. Many clients dealing with dyspareunia have spent months or years avoiding movement, worried that any exercise might make things worse. Rebuilding trust in their own body’s ability to move without pain is as much a part of the work as the physical programming itself.
We keep this work private and one-on-one — this isn’t a group class topic — but clients often tell us the broader GForce environment matters too. Training in a space where the coaching staff already understands chronic pain populations, rather than having to explain the situation from scratch, removes a layer of anxiety that a lot of gyms don’t account for. If anxiety and stress are part of what’s showing up alongside the physical symptoms, our approach to stress-relief-focused personal training often runs alongside this kind of programming.
Many of the clients we see in this category are also managing broader pelvic floor changes tied to hormonal shifts, which we address more specifically in our guide to pelvic floor health for women over 40 and our work on pelvic floor health, strength, and recovery for active women.
If you’re managing dyspareunia and already working with a pelvic floor physical therapist or OB-GYN, the next step is a conversation, not a workout. Book a free intro session at GForce, bring whatever notes or restrictions your care team has given you, and we’ll build a movement plan that works with that treatment instead of around it.