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Let’s talk about when sex hurts and what you can do about it.
Sex can hurt for many reasons — both physiological and psychological — but here are some of the more common ones and how to deal with them.
Penetrative sex can be uncomfortable, but sometimes it really hurts... like I-am-doubled-over-in-pain hurts. The medical term for this is dyspareunia, which refers to recurring or persistent pain before, during, or after sex, according to the Mayo Clinic. The pain might only occur upon entry, penetration with anything (like a tampon), deep thrusting, or a combination of those — and the level of pain can range from mild to severe.
Pain is a complex and multifaceted issue, so there isn't always one single explanation or treatment. And it can be very frustrating when something that's supposed to be pleasurable causes pain and discomfort instead. So we spoke to two experts to find out what can cause painful sex and and which treatments are out there: Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine; and Dr. Shannon Chavez, licensed clinical psychologist and certified sex therapist in Los Angeles.
FYI, for the purposes of this article we are focusing on penetrative vaginal sex — so that means sex involving a penis or finger or dildo (or any other toy) going into the vagina.
An active vaginal infection.
"The first question we ask is, does she have an active infection of some sort which is causing or exacerbating her pain?" Minkin tells BuzzFeed Health. An outbreak of genital herpes, UTIs, yeast infections, chlamydia, and gonorrhea are all examples of vaginal infections that can make sex painful and uncomfortable, Minkin says. These infections can cause inflammation or irritation of the vulva and vaginal canal, which makes entry and penetration really hurt. Some infections can also affect the cervix and uterus, which may cause deeper pain with thrusting.
In addition to painful sex, you might also have other STI symptoms such as itching, abnormal discharge, or burning. But often times, STIs have no symptoms at all. So the best way to tell if an infection is causing the pain is to visit your OBYGN and to get tested.
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Injuries or irritation to the vulva and vagina.
The skin of the vulva and vaginal opening is very delicate and sensitive, Minkin says, so it's not uncommon for injuries to happen. These injuries could be caused by an accident, surgery, pelvic trauma, female circumcision, piercings gone wrong, or an incision made to widen the birth canal (episiotomy). They can cause tears and scarring that make sex very painful upon entry, especially if there's a wound that isn't fully healed.
So if you do have an injury on or around your genitals, it's important to take the time to heal properly and wait to have sex until your OBGYN gives you the green light. Additionally, certain skin conditions can cause irritation or lesions on the skin of your vulva that make sex painful. These include eczema, allergic reactions, or a condition called lichen planus. If you are concerned, talk to your OBGYN or dermatologist about pain during sex.
Vaginismus, which causes the vaginal muscles to tense up upon penetration.
"Vaginismus is a condition in which there's involuntary contraction of the vaginal and pelvic floor muscles and there can be so much tension that it doesn't even allow for entry," Chavez tells BuzzFeed Health. So in addition to making sex painful, vaginismus can cause the muscles to spasm and clench to the point where you can't insert anything in the vagina, even a tampon. Since the tightening of these muscles is involuntary, it can happen even when a person is aroused and wants to have sex, Chavez says — so the condition can be incredibly frustrating. Many women with vaginismus suffer in silence.
It can be caused by both physical and psychological factors, or a combination of both. "In treatment, we often tackle both sides," Chavez says. So a patient might need to see a therapist to deal with anxiety or stress about intercourse, but also see a pelvic floor therapist to learn how to relax and re-train their muscles.
Read one woman's search for the right treatment in I Got Botox In My Vagina And It Changed My Life.
A chronic pain condition like vulvodynia or vestibular vulvitis.
"The big thing that causes pain upon entry is vulvodynia or vestibular vulvitis, which causes chronic pain in the vulvar region," Minkin says. This can cause a lot of pain during penetration and also any other activity that puts pressure on the vulva, such as bike riding or even just sitting. "We don't know the exact medical cause, but we think it might be an inflammatory response in the nerves around the opening of the vagina and the vulva which causes hypersensitivity and pain," Minkin says.
There is no cure for vulvodynia, but you can treat the symptoms. If you have vulvodynia, do not feel alone. "It's not uncommon and studies have shown that as many as 9% of women have dealt with this at one point in their life," Minkin says.
Abnormal anatomy.
Some people are born with an anatomical defect that either changes the shape of the vagina or makes it so there is little or no opening. You've probably heard of the hymen, a membrane that partially covers the vaginal opening, and the myths about how it "breaks" during intercourse. When someone has an "imperforate hymen," Minkin says, it means that the membrane is abnormally thick or tight, which can make sex very painful or even impossible. "Sometimes there's no opening at all, so these women don't even bleed during their period and the blood can collect in the vagina," Minkin says.
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare sexual development disorder that can cause a person to be born without a vagina or incomplete reproductive organs. In these cases, attempting penetration can be super painful. Treating these disorders may involve surgery, Minkin says, or using vaginal dilators.
Marita Patrinos / Via buzzfeed.com
Conditions like endometriosis, pelvic inflammatory disease, or fibroids can cause deep pain.
"If the pain is deeper in the pelvis, the first thing we consider is endometriosis because it's fairly common and usually causes pain during sex," Minkin says. Endometriosis occurs when the tissue lining the uterus grows on other organs, and it's a common culprit when it comes to pain during sex. There's no cure, but treatment can include hormone therapy or surgery, Chavez says.
Other conditions that can cause chronic pelvic pain include scarring due to infections, uterine prolapse, pelvic inflammatory disease, fibroids, ovarian cysts, and more. "If the pain is deep in your pelvis, you should go to the doctor because may need to get the fibroids or cysts removed — vigorous sex could actually pop a cyst, which is extremely painful," Minkin says.
Vaginal dryness caused by hormones, medication, or stress.
When sex is painful during penetration, it could mean that you aren't sufficiently lubricated. Moisture is key and without it, penetrative sex can cause friction that leads to micro-tears and irritation. The vulvar tissue is already fragile, but vaginal dryness can cause a lot of pain during penetration. Vaginal dryness could be caused by a change or suppression of hormones, Chavez says, which can happen during pregnancy, menopause, or when someone goes on birth control. Stress can also change the body's chemistry, Chavez says, and result in a loss of moisture.
"Medications, such as antidepressants and antihistamines like Benadryl, can also cause vaginal dryness and affect libido," Minkin says. If you have vaginal dryness, you should talk to your OBGYN to find out what could be causing it and how you can treat the problem.
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Not enough lube.
Even if you don't have a problem with vaginal dryness, sometimes the vagina's own lubricant isn't enough to last throughout sex. And that can lead to discomfort, friction, and pain during penetration or deep thrusting. So lube should really be your best friend. You can use it during foreplay and penetration. Minkin suggests trying a good lube that'll actually keep the vagina moist, and trying out a few different kinds to see which one works best.
Some of the experts' vagina-friendly lube picks include Vagisil ProHydrate Internal Moisturizing Gel, Lelo Personal Lubricant, and Überlube. Check out this lube guide for more information and suggestions.
Maritsa Patrinos / Via buzzfeed.com
Lack of foreplay and stimulation.
"It's the equivalent to a male erection — the woman needs stimulation and foreplay or else sex is probably going to be uncomfortable or painful," Minkin says. The vagina is self-lubricating, but it takes a little work and dedication to get the liquids flowing. "It takes a woman’s body at least twenty minutes to become fully aroused, which includes engorgement of erectile tissue in the labia, clitoris, and vaginal canal," Chavez says.
The solution? Talk to your partner and ask for more stimulation and foreplay, Minkin says, and don't rush into penetrative sex. "There is no particular form of foreplay needed other than an activity that is pleasurable and stimulating to you," Chavez says. Slowing things down and being more mindful about foreplay and sexual arousal can really help.
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Certain positions.
In some positions, you might feel perfectly fine and good but other positions can really cause a lot of pain during penetration and deep thrusting. "You should try to find positions that are comfortable and that work with your partner — we can't change anatomy but we can find positions that work with your body," Chavez says.
A large penis or dildo (within a reasonable size range) can cause some discomfort and pain, Minkin says, but it's highly unlikely that a penis is "too big" for a vagina or it will injure the cervix. "The vagina can accommodate a baby's head that's 10 centimeters in diameter, and there's no penis as big as that," Minkin says. If you do feel like size is an issue, try loading up on lube and avoiding positions that cause pain.
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Lack of connection or relationship issues.
Pain and discomfort during sex can also be caused by a personal issue between two partners, Chavez says. Lack of attraction, relationship issues, and poor communication can all affect a person's mental state and result in a lack of arousal or decreased lubrication. It's important to communicate with your partner and let them know what you do and do not like, Minkin says — and remember, consent is key.
You can also check in with your partner about boundaries to make sure you are both on the same page during sex. Some couples may benefit from seeing a sex therapist, Chavez says, who can do exercises with couples to teach them how to enhance pleasure and avoid things that cause pain.
Psychological factors such as anxiety, fear, or self-esteem issues.
Fear and anxiety around penetration can create a mental barrier, Chavez says,
which can lead someone to unconsciously tense up their pelvic floor muscles during sex, which causes a physical barrier for penetration-based activity. "Maybe they had a negative sexual experience so they anticipate pain and discomfort, or they have experienced trauma such as sexual abuse, violation of boundaries, sexual assault," Chavez says. As a result, the mind can go into fight-or-flight mode, which can cause the body and pelvic floor muscles to clench up.
Poor self esteem and body image issues can also decrease arousal or cause someone to become tense or nervous during sex. "There is no one-size-fits-all treatment," Chavez says, so overcoming these psychological barriers will depend on the person and their experiences and needs.
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Ignoring the pain, which can make things worse. Listen to your body and see a doctor.
"Pain is a communication from the body, so I always tell clients to listen to what the pain is telling you — do not ignore it, because it's better to address it sooner than later and avoid further discomfort to the body," Chavez says. So if you have recurring pain during sex, you should see a doctor who can help pinpoint the cause and suggest treatment. Not to mention, you should speak up to your partner and communicate how and when sex hurts, so you can work together to make things more comfortable.
And finally, don't feel alone. "Pain during sex is actually so common, but it's also so isolating because a lot of women feel like everyone else in the world is having great sex so there must be something wrong with them," Chavez says. If you do have pain during sex, know that it's common and you have a lot of options and many different specialists out there who can help.
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