What can I do about painful sex?

Yes it feels good but it’s still painful. How confusing is sex! We would all agree that, despite how amazing sex is, it’s pretty weird. An intensely pleasurable workout involving strange gooey fluids and chemical reactions triggered by the tone of someone’s voice all leaving us in a strangely vulnerable position is just about as alien as it gets. So then, the last thing we need to make our heads spin further is to bring pain into the equation, but this is exactly the case for so many women. Accorinding to the American College of Obstetricians and Gynecologists, almost 75% of women contend with painful sex due to vaginal penetration at some point in their lives. Even the word ‘penetration’, as ridiculous as it sounds, brings an ode of pain for many women.

75% is such a towering number especially considering many women rarely complain or bring up their painful sexual experiences. For many women, painful sex is something they put up with long term because they just don’t know any other way. They think that pain and pleasure in this regard go hand in hand, but they don’t have to.

Firstly, let’s look at the reasons behind painful sex. The reality is there are dozens of causative factors of painful sex, that range from the physical to the pscychological so it is important to speak with your doctor to undercover the underlying condition or reason of why you might be suffering with pain during sex. We are not doctors and don’t pretend to be so online. In this article we will look at the most common causes of painful sex and potential treatments to alleviate the pain during sex.

The most common cause of painful sex and how to alleviate it

Endometriosis

Endometriosis, a condition characterized by the growth of tissue that usually grows inside the uterus (endometrium) growing on the outside in areas such as the ovaries or fallopian tubes or other pelvic areas can result in a heck of a lot of pain. Most endometriosis sufferers feel intense premenstrual or menstrual pain but they can also experience painful sexual experience. To combat this pain it is recommended to experiment to find what position/positions ring the most pleasure and least pain. For some women this may be doggy-style or side to side positions or even to keep sex shallow to avoid deep penetration. Keep a diary of when the pain during sex is worst is a good way of understanding at what point of the cycle does penetration hurt most so that sex can be avoided at those times.

Vaginal Skin Disorders

There are way too many skin conditions that can affect the vagina to go through them all here so we always recommend visiting your doctor or dermatologist for diagnosis and treatment options if you are concerned you might have skin condition related to your vagina. The fact is though that these vagina skin conditions can cause pain either directly or indirectly during sex and the best treatment will always depend on the condition itself. Depending on your condition your doctor may prescribe moisturizers, steroid creams or other creams and lotions. Additional lifestyle advice such as not wearing tight fitting fabrics and not using scented soapy products around the secret lady garden. Depending on your condition you may even be recommended to use a small vaginal dilator, to help widen the vulva entrance.

Hormonal Changes

Hormonal changes such as lowered estrogen levels during menopause can have a massive impact on a woman’s sex life. Lower estrogen levels do not just occur during menopause but estrogen levels can also drop during breastfeeding or when taking certain medications such as anti-estrogens. This lack of estrogen has a number of disruptive effects to the vagina and vaginal area including increasing vaginal dryness by decreasing those sexy secretions and also making the vulva skin and tissue thinner and more fragile. Your doctor may prescribe estrogen replacement therapy but there are other steps such as using a good lubrication during sex that can help with any pain you experience as a result of vaginal dryness.

Pelvic Floor Dysfunction
 

Pelvic floor dysfunction can be a result of either physical or psychological manifestations. Vaginismus is one such condition where the muscles on the vagina involuntarily contract and spasm causing a tightening of the vagina and pain or discomfort during sexual penetration. Working with a pelvic therapist and even mental health therapist can have a profound effect in alleviating these conditions.

After having a baby

After birthing the women’s vagina is in a process of healing. This recovery process, involving the healing of cuts and tears in the vulva and vaginal wall is often long and painful and sex in the days and weeks after birth can cause more pain. Our advice is to wait to get the all clear from the gynecologist before resuming penetrative sex.

Relationship issues 

Sometimes the physical pain women feel during sex is a result of poor relationship communication or just a plain old bad connection. A major part of sex is the lead up to the actual penetration, commonly known as foreplay. Painful sex is all too frequently caused by a lack of foreplay, which means the vagina does not have adequate time to secrete the protective fluids that naturally lubricate and protect against friciton, irritation and pain. Our advice is to speak with your partner about the do’s and don’ts, the things you like, love and dislike during those intimate times. It may be a good idea to see a sex therapist or relationship counsellor if you feel that a third party might be able to help you work through those kinky kinks in your relationship. Slow down, have fun and communicate as best you can.

Anxiety and depression

Anxiety and/or depression can be at the heavy heart of painful sex. Decreased libido can mean that despite the want for a healthy, happy sex life your body just doesn’t respond or responds in a paradoxical manner. A lack of natural secretions, causing vaginal dryness leading to dyspareunia or vaginismus, where the vagina muscles contract involuntarily can compound negative sexual experiences. As with all of these conditions, speaking with your doctor to realize the underlying reasons for the decreased libido and then taking steps to address this is so important. Speaking with a doctor specializing in women's health is usually the best first step to take. 

Another psychological issue that can have a powerful effect on sexual experiences is past sexual trauma or negative sexual experiences. Triggering a negative sexual memory can result in a physical reaction whereby the body responds as if it is reliving this negative experience. In this scenario the body may fail to prepare for sex and may instead respond in fear, shutting off or running away. Speaking with your doctor is a great first step towards addressing these issues and improving your sex life.