Tools for Painful Sex: Kiwi, Ohnut & Position Changes for More Comfortable Penetration
by Dr. Brittany Schroeder, PT, DPT, PWCS, NCPT
Pain with sex—also called dyspareunia—is common, but that doesn't mean it's something you should simply learn to tolerate.
And, as with most pelvic health problems, the internet has plenty of products promising to help.
Some of them can be genuinely useful. But before spending money on another pelvic health gadget, we need to ask a much more important question:
What are we actually trying to change?
Does penetration hurt right at the vaginal opening? Only when it gets deeper? Does one particular angle hurt while another feels completely fine? Do your pelvic floor muscles seem to tense before penetration even begins? Does sex start comfortably and become painful as friction increases? Or is it actually your back, hip, knee, shoulder, or abdomen that makes certain positions uncomfortable?
Those aren't the same problem.
So, in this installment of our Pelvic Health Tools series, we're looking at two products designed to address different types of pain with penetration—the Kiwi and Ohnut—along with several tools you already own: your body position, pillows, lubrication, and the ability to change the depth, angle, and mechanics of penetration.
As always, remember:
The tool isn't the treatment.
A good tool changes a specific variable that is contributing to your symptoms while you work on understanding and addressing why the pain is happening in the first place.
Before You Buy Anything: Where Does It Hurt?
"Sex hurts" gives us surprisingly little information in terms of finding a solution.
One of the first things we want to know is where it hurts and when during penetration the pain occurs.
Pain at the vaginal opening
Superficial or entry pain may feel like burning, stinging, tearing, stretching, or simply like your body doesn't want to allow something in.
Potential contributors can include pelvic floor muscle overactivity, vulvar or vestibular pain, hormonal or tissue changes, inadequate lubrication or arousal, scar sensitivity, dermatologic conditions, infections, and other causes.
If the painful part happens at the entrance, limiting how deeply penetration occurs probably isn't going to solve the problem.
Instead, we might experiment with changing friction, pressure, muscle activity, arousal, tissue mobility, sensory input, or the angle at which penetration begins.
Deep vaginal or pelvic pain
Other people tolerate initial penetration perfectly well but develop pain once penetration reaches a certain depth.
This may feel like pressure, aching, cramping, or a sharp sensation when something gets "hit."
Endometriosis is one possible contributor to deep dyspareunia, but cervical sensitivity, pelvic floor muscle tenderness, visceral factors, scar tissue, musculoskeletal factors, and other pelvic conditions can contribute as well.
Here, depth and angle become especially interesting variables.
Pain in one particular spot
Sometimes we hear:
"It's fine except when they hit this one spot."
That's useful information.
If changing your hip position or the direction of penetration changes the symptom, angle may matter more than depth.
Pain somewhere else entirely
And sometimes "painful sex" isn't primarily vaginal pain.
Your hip may hurt in a position requiring a lot of hip flexion or rotation. Your knees may not tolerate kneeling. Your shoulder may hurt while supporting your upper body. Your low back may prefer one spinal position over another.
That doesn't make it any less relevant.
Sex is physical activity. The rest of your musculoskeletal system gets a vote too.
What Is It?
Kiwi is a small pelvic health tool designed primarily for external and shallow internal use around the vaginal opening.
Unlike a vaginal dilator, which generally progresses farther into the vaginal canal, Kiwi is designed to work primarily around the vulva, vaginal entrance, and superficial pelvic floor. It can provide pressure and optional vibration.
That distinction matters because Kiwi and a dilator aren't necessarily trying to accomplish the same thing.
What Are We Actually Trying to Accomplish?
If penetration hurts immediately at the vaginal opening, the goal isn't necessarily to make the vagina capable of accommodating something progressively larger.
Instead, we may need to work on things like:
identifying sensitive areas around the vaginal opening,
improving the ability of the pelvic floor muscles to relax and lengthen,
decreasing an automatic guarding response,
exploring pressure or touch without immediately progressing to penetration,
improving sensory tolerance,
or practicing coordination between breathing, pelvic floor relaxation, and touch.
This is where a tool like Kiwi may make sense.
How Might Kiwi Help?
Kiwi gives you a way to apply controlled pressure and vibration around the vaginal opening without immediately introducing deeper penetration. It can assist with desensitizing tissues that are painful with superficial penetration.
For someone whose pelvic floor reflexively tightens in anticipation of penetration, that may provide an opportunity to practice experiencing touch while intentionally changing the muscular response.
Pressure can also be directed toward specific superficial pelvic floor muscles or sensitive areas rather than simply inserting something farther into the vaginal canal.
Vibration adds another form of sensory input and may feel relaxing or less threatening for some people.
But none of those things mean that every painful vaginal opening needs to be massaged.
Pain does not automatically mean "tight muscle."
Burning, tearing, itching, bleeding, tissue irritation, hormonal tissue changes, dermatologic conditions, infection, vestibular pain, and other conditions can all cause pain around the vaginal opening.
Repeatedly pushing on an irritated tissue because someone told you your pelvic floor is "tight" isn't necessarily going to help.
We need to know what we're treating.
What Does the Research Say?
Here's where we separate reasonable clinical theory from evidence for a specific product.
There is evidence supporting pelvic floor physical therapy as part of treatment for some people with dyspareunia. A 2023 systematic review and meta-analysis included 19 studies examining interventions including multimodal physical therapy, manual therapy, pelvic floor training, and electrotherapy and found evidence for improvement in pain and quality of life with physical therapy interventions.
That does not mean research has established that Kiwi itself treats painful sex.
At this point, direct clinical evidence for this specific device is limited. So while its design gives us several clinically reasonable ways to use it, we shouldn't confuse that with evidence that everyone with entry dyspareunia needs one.
Who Might Benefit?
Kiwi may be worth considering when:
pain is primarily at or near the vaginal opening,
superficial pelvic floor muscle tenderness contributes to symptoms,
penetration triggers an automatic muscular guarding response,
gentle pressure or vibration feels helpful,
you're working on graded exposure to touch or penetration,
or your pelvic floor therapist has identified a specific reason to incorporate it into treatment.
Who Might Not Want to Start Here?
Kiwi probably isn't the first tool I'd reach for when:
pain occurs only with deep penetration,
the primary issue is friction or inadequate lubrication,
there is unexplained bleeding, itching, tearing, or visible tissue irritation,
touch consistently causes significant symptom flares,
or we haven't figured out why the vaginal opening hurts in the first place.
How Do You Use It?
More pressure, more time, and more pain do not earn you extra credit.
Start with tolerable contact. You might simply explore the tissues externally before using any internal pressure.
If you find an area that feels sensitive or causes your muscles to tighten, the goal isn't necessarily to press on it until it submits. Less is more.
Try breathing. Let your abdomen soften. Allow your body to get heavy into the surface you are resting on. Notice whether your pelvic floor can release around the sensation. Change the pressure, location, or vibration and see whether the response changes.
The goal is information and coordination, not using brute force to make a tissue change. Gentle, patient, and passive.
Do You Actually Need One?
No.
Your hands, breathing, positioning, and other tools may accomplish many of the same goals.
Kiwi may simply make some of those strategies easier or more accessible.
That's what makes something a tool rather than a treatment.
Our Clinical Verdict on Kiwi
Potentially useful for the right problem, but not a universal solution for painful sex.
It's a cleverly designed tool and we do recommend it to certain patients... but we tend to trial the device in clinic first to observe how each patient responds before giving general advice to go buy and try.
If your symptoms are primarily superficial and there's a muscular or sensory component, Kiwi may give you a convenient way to work with those tissues.
If your pain is coming from something entirely different, it's just another object in your nightstand.
What Is It?
Ohnut is a set of soft, interlocking rings worn around the base of a penis or penetrative object.
Adding rings decreases the amount of available penetration depth.
Simple.
And that's actually what we like about it.
It isn't claiming to retrain your pelvic floor or remodel tissue.
It changes one mechanical variable: depth.
There is an optional vibrating ring that can be purchased in combination with the original nonvibrating rings for additional sensation, either to enhance pleasure or minimize discomfort.
What Are We Actually Trying to Accomplish?
Imagine penetration feels completely comfortable for the first several inches.
Then—ouch.
Something about deeper penetration reproduces your pain.
You could spend the entire sexual encounter monitoring every movement and reminding your partner not to go too deep.
Or you can put a physical bumper in the way.
That's essentially what Ohnut does.
How Might It Help?
Deep dyspareunia can occur when deeper penetration contacts or places tension on sensitive pelvic structures.
Reducing penetration depth may allow someone to participate in penetrative sex while staying within a range that feels good.
It can also decrease the amount of vigilance required during sex.
Instead of constantly wondering whether the next thrust is going to hurt, there's a physical limit in place.
And sometimes creating a little more predictability is useful when pain has made penetration feel unpredictable.
What Does the Research Say?
This one actually has direct product-specific evidence now.
A 2024 pilot randomized controlled trial studied Ohnut in people with surgically confirmed endometriosis and deep dyspareunia.
Thirty-one couples were randomized, although only 17 completed the full study. After accounting for baseline pain, average deep-dyspareunia scores during the intervention period were 2.46/10 in the Ohnut group compared with 4.69/10 in the control group. Both patients and partners also reported good acceptability.
That's promising.
It's also a small pilot study with considerable attrition and narrow eligibility criteria, so we're not going to turn it into proof that Ohnut treats every type of deep dyspareunia.
What it gives us is preliminary evidence supporting something mechanically logical:
If deeper penetration causes pain, physically limiting depth may reduce that pain.
Who Might Benefit?
Ohnut makes the most sense when:
entry is comfortable but deeper penetration hurts,
symptoms consistently occur beyond a particular depth,
cervical or deep pelvic contact is uncomfortable,
endometriosis contributes to deep dyspareunia,
or you want a physical depth limit rather than having to consciously control penetration throughout sex.
Who Might Not Benefit?
If pain happens as soon as penetration begins, Ohnut probably isn't addressing the relevant variable.
It also isn't treating endometriosis, pelvic floor dysfunction, cervical sensitivity, or whatever else may be contributing to deep pain.
It simply allows you to modify penetration while those other issues are addressed.
How Do You Use It?
The rings are stackable, which means you can experiment with how much depth feels comfortable.
You don't necessarily need to eliminate deep penetration entirely.
Think of it as finding your current working range.
Maybe three rings feel great today. Maybe eventually two do. Maybe you always prefer a particular depth.
There isn't a graduation ceremony where you're required to stop using it.
Comfortable sex is the goal.
Do You Actually Need One?
Also no.
You can decrease penetration depth without buying anything.
Certain sexual positions naturally limit depth, the receptive partner can control movement, and partners can simply use shallower thrusts.
The advantage of Ohnut is that it creates a consistent physical boundary without requiring either person to actively maintain it.
Our Clinical Verdict on Ohnut
For deep dyspareunia, this is one of the more mechanically straightforward pelvic health tools.
It has a clear job, doesn't pretend to fix the underlying condition, and now has preliminary direct clinical evidence supporting its use for endometriosis-associated deep dyspareunia.
Your Body Position Is a Tool Too
This may be the most underutilized—and cheapest—tool in this entire article.
Instead of asking:
"What is the best sex position for painful sex?"
Ask:
"What needs to change about this position to make my symptoms better?"
Depth?
Angle?
Friction?
Hip position?
Spinal position?
Muscular effort?
Who controls the movement?
Change one variable and see what happens.
Our original clinical positioning project approached sexual positions exactly this way: recommendations differed depending on whether symptoms were superficial, deep, anterior, abdominal, or musculoskeletal.
If Deep Penetration Hurts
Start by making penetration shallower.
Try spooning or sidelying.
Spooning naturally tends to decrease penetration depth. Face-to-face sidelying can do the same while allowing both partners to remain supported. You can also simply use shallower thrusts.
You don't always need a completely different position when two fewer inches solves the problem.
If You Need More Control
Put the receptive partner in a position where they can control the movement.
Try receptive partner on top.
Being on top allows the receptive partner to control depth, pace, and intensity.
This can be particularly useful when there's a small window between that feels great and absolutely not.
Try sitting face-to-face.
This can also give the receptive partner greater control while providing close contact and support.
One consideration: sitting may require more active pelvic floor contribution, so it isn't automatically the best choice for someone whose symptoms increase with muscular effort.
If One Particular Spot Hurts
Experiment with angle.
Your vagina isn't simply a straight tube, and changing pelvic or hip position changes the direction in which penetration occurs.
Try changing your pelvis.
Place a pillow or wedge underneath the pelvis.
Move it higher.
Move it lower.
Change how much the hips are flexed.
Bring the legs closer together or farther apart.
Small changes can substantially change where pressure occurs.
We also recommend using wedges, bolsters, or pillows specifically to elevate the hips and alter the angle of penetration.
If anterior penetration (near the urethra) is uncomfortable
Changing the angle more posteriorly may help.
One option is reverse receptive-partner-on-top, which changes the direction of penetration while still allowing the receptive partner to control movement. Our original positioning project included this specifically as an option for anterior vaginal/urethral irritation.
Again, this isn't a magic position.
It's an experiment:
If we change the angle, does the symptom change?
If Entry Hurts
We may want the opposite strategy: make initial penetration as easy and controlled as possible.
A supine position with the hips slightly elevated may improve the angle of entry for some people. Adequate lubrication can simultaneously decrease friction. Our original project included this combination for superficial vaginal pain.
You can also slow everything down.
Allow plenty of time for arousal before penetration.
Let the receptive partner guide initial insertion.
And remember that a position that gives the receptive partner control may be more useful than one that theoretically creates the "perfect" angle.
If Your Hip Hurts
Avoid forcing the hip into a position it doesn't tolerate just because that's what you think sex is supposed to look like.
Options include missionary with the receptive partner's legs inside the penetrating partner's legs and supported quadruped.
Pillows and bolsters can also support the legs so the hip muscles aren't doing all the work.
If Your Knees Hurt
Get off your knees.
Seriously.
Sidelying or lying on your back with the legs extended can decrease the amount of knee flexion or weight-bearing required.
If Your Shoulder Hurts
Choose a position where you aren't holding yourself up through your arms.
Options can include lying prone, lying supine, sitting with support, spooning, or sidelying.
If you have painful Abdominal Pressure
Supported standing may be worth experimenting with because it changes the pressure and positioning through the abdomen and pelvis. This was included in our original clinical guide particularly for people whose abdominal symptoms limited other positions.
The important word is supported.
A wall, countertop, sturdy piece of furniture, or partner can take some of the muscular work out of the position.
A Few Other Tools Worth Mentioning
You don't need specialized "pelvic health" branding for everything.
Pillows, wedges, and bolsters
These can change angle, depth, joint position, and how hard your muscles have to work.
Your normal bed pillows may work just fine.
Lubricant
If friction contributes to pain, address the friction.
Lubricant decreases tissue drag, but remember that needing more lubrication and having inadequate arousal aren't necessarily the same thing.
Silicone-based lubricant like Uberlube can be a specifically good strategy for decreasing friction-related tissue irritation. However, you do not want to use this is combination with silicone-based tools like dilators or the Kiwi, as the lubricant can degrade the material of the product.
Water-based lubricant like Good Clean Love is also a great option.
External vibration
Vibration can also be used for pleasure and arousal—not just pelvic floor "treatment."
The Kiwi is a tool that can bridge the gap between clinic and bedroom, which gives it a nice versatility; however, if you already have a vibrator you enjoy, there is no reason to purchase the Kiwi specifically for the purpose of arousal and pleasure.
Clitoral vibration can be a nice way to facilitate arousal and lubrication.
Sometimes the most helpful pelvic health advice is simply:
Make sure sex actually feels good before adding penetration.
Penetration Is Optional
This one deserves to be said explicitly.
Sex does not require penetration.
If penetration hurts, you can take it off the table. Maybe not forever, but for a time to discover and enjoy other aspects of intimacy that do not continue to support a negative association between sex and pain.
Oral sex, manual stimulation, external toys, mutual masturbation, and other forms of sexual activity can provide intimacy and pleasure without penetration at all—something we intentionally included in the original clinical resource.
This can be particularly valuable when someone is actively working through a painful condition.
Repeatedly "checking" to see whether penetration still hurts can turn sex into a test.
Sometimes removing penetration temporarily removes the anticipation surrounding it and gives you room to experience sexual activity that actually feels good again.
The Long and Short of It
Painful sex isn't one problem.
So there isn't one tool—or one sex position—that fixes it.
Before buying something, identify the variable you're trying to change.
Pain at the opening? Think about friction, tissue sensitivity, muscle response, arousal, entry angle, and control.
Pain with deeper penetration? Experiment with depth.
Pain in one particular spot? Experiment with angle.
Pain only in certain positions? Look at the hips, spine, knees, abdomen, muscular demand, and who is controlling the movement.
Everything hurts? That's probably not the moment to order five different pelvic health gadgets. That's the moment to figure out why.
And remember that persistent dyspareunia isn't always a problem that can—or should—be solved through self-treatment alone. Pelvic floor rehabilitation has evidence supporting its role for some people with dyspareunia, but treatment needs to match the contributing factors.
Kiwi may be useful when pain is superficial and you're specifically working with the sensory or muscular response around the vaginal opening. Direct evidence for the product itself remains limited.
Ohnut limits penetration depth and may be particularly useful for deep dyspareunia. A small randomized pilot trial now provides preliminary evidence supporting its use for endometriosis-associated deep dyspareunia.
Position modification may be the most useful tool of all.
Change the depth.
Change the angle.
Change your hip or spinal position.
Change who controls the movement.
Add support.
Decrease friction.
Or take penetration out of the equation entirely.
The goal isn't to find a way to tolerate painful sex.
The goal is to understand what makes your body feel better—and build from there.
References
Fernández-Pérez P, Leirós-Rodríguez R, Marqués-Sánchez MP, Martínez-Fernández MC, Oliveira de Carvalho F, Maciel LYS. Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis. BMC Women's Health. 2023;23:387. doi:10.1186/s12905-023-02532-8.
Wahl K, Orr NL, Parmar G, et al. Ohnut vs waitlist control for the self-management of endometriosis-associated deep dyspareunia: a pilot randomized controlled trial. Sex Med. 2024;12(4):qfae049. doi:10.1093/sexmed/qfae049.
Schvartzman R, Schvartzman L, Ferreira CF, Vettorazzi J, Bertotto A, Wender MCO. Physical therapy intervention for women with dyspareunia: a randomized clinical trial. J Sex Marital Ther. 2019;45(5):378-394. doi:10.1080/0092623X.2018.1549631.
Ghaderi F, Bastani P, Hajebrahimi S, et al. Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. Int Urogynecol J. 2019;30:1849-1855. doi:10.1007/s00192-019-04019-3.
Sidorkewicz N, McGill SM. Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient. Eur Spine J. 2015;24(3):513-520. doi:10.1007/s00586-014-3626-y.
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