When Sex Is Painful

It’s not easy talking about sex being uncomfortable, but it’s more common than you think. According to the American College of Obstetricians and Gynecologists, nearly 75% of women report experiencing painful intercourse at some point.

Whether sex has always been painful or is occurring because you just had a baby or are going through menopause, having pain-free sex is a practice that can take time. It involves training your body, mind, and nervous system to experience pleasure. It may require help from a team of providers across gynecology, physical therapy, psychology or counseling, pain management, and complementary therapies like acupuncture.

Causes of Painful Sex

Many different issues can cause sex to hurt. It’s usually due to a combination of such factors as:

Vulvodynia (chronic pain around the opening of the vagina without an identifiable cause)
Muscle-related conditions (vaginismus, tight pelvic floor muscles)
Medical conditions (such as endometriosis, organ prolapse, pelvic inflammatory disease)
Hormone issues (low estrogen, vaginal dryness)
Infections and allergic conditions (sexually transmitted, vaginal infections, semen allergy)
Congenital issues (imperforate hymen, vaginal septum)
Cancer (including treatments like chemotherapy, radiation, and surgery)
Mental health issues (stress, anxiety, depression)
Trauma (physical or emotional)

It’s important to see your provider to rule out possible causes like sexually transmitted diseases (STDs) or other treatable conditions that can lead to painful sex.

What Does ‘Pain’ Really Mean?

Pain during sex can occur with penetration, pressure, or touch. Common sensations include:

Deep aching
Burning or itching
Rawness like sandpaper or rug burn
A prickly feeling like sitting on a cactus
Zapping or shooting pain

Pain may be linked with urinary symptoms such as burning, frequency, and urgency (like a UTI). These symptoms often go together because the same nerves run through the urinary tract and vagina.

The Cycle of Painful Sex

It’s helpful to temporarily pause vaginal intercourse until there is some improvement. Continuing to have painful sex can turn the act into a “negative reinforcer.” Your nervous system will start to associate sex with danger, and will be more likely to trigger pain in future encounters.

The Road to Returning to Sex

This can be a great time to reconnect with yourself and focus on your sexual needs.

Stay intimate, avoid penetration: If penetrative sex is painful, avoid penetration until your tissues and nervous system are more relaxed. You can be intimate without penetration.

Practice self-pleasure: Explore what feels comfortable for you to learn how to better communicate with your partner.

Activate your senses: Try dance and music, rub lotion or massage oil over your body, use candles or mood lighting, do yoga and belly breathing, or practice mindful eating.

Open communication: It’s important to communicate with your partner. Consider working with a professional to help you navigate these conversations.

Seek support: This will depend on the factors influencing your pain. It’s often helpful to work with a team for a combination of psychosexual, pharmacologic, and rehabilitative treatment. We also highly recommend establishing care with a gynecologist you trust. Your Hinge Health physical therapist and coach can also be part of your support team as you work on exercise therapy and lifestyle changes to improve your symptoms.

When You’re Ready to Return to Sex

Continue open communication. It can feel uncomfortable to discuss your sexual needs and comfort levels. Generally, the hardest part is initiating conversation. Once you do, couples are often pleasantly surprised with the ease of conversation or the outcome.

Warm up for sex like you’d warm up for a workout. Try exercises that open the hips and promote relaxation of the pelvic floor, such as deep belly breathing, child’s pose, and squats.

Modify positions to make them more comfortable.

Missionary: Lie on your back with feet together, knees splayed apart with pillows under each knee or with your legs straight and a pillow under your knees.
Doggy style: Lie on your stomach with a pillow under your chest and pelvis.
Spooning: Side lying is generally a more comfortable position. You can use your buttocks to control depth and pace while using your hand as a buffer between you and your partner to help keep the depth to your comfort zone.

Tools for Returning to Pain-Free Sex

Discuss these with your provider, as some will be more or less appropriate for your condition.

Dilators: A device that comes in many sizes and is designed to gradually stretch your pelvic floor muscles to reduce pain and anxiety around penetration.
Pelvic Wands: A curved device used for gentle internal pelvic massage that’s especially helpful to release trigger points and reduce pain.
Lube: Always use lubrication! Ask for our Safe Vaginal Lubricants resource to learn more.
Pillows: Use pillows or bolsters to support your back, hips, thighs, or pelvis during intercourse.
Penetration rings: They are placed on the penis before sex to limit depth of penetration.
Soak and seal: Sit in comfortable water (tub or sitz bath under the toilet seat) or use a peri bottle for five to 10 minutes after sex. Gently pat yourself dry, then seal in moisture with a layer of petroleum jelly (e.g. Vaseline or Aquaphor).
Vaginal estrogen: If you have a vagina, there is a good chance you will experience vaginal dryness at some point. The most common times are postpartum and menopause, but many women who experience pain with intercourse also experience vaginal dryness. Ask your doctor if vaginal estrogen is right for you.
Lidocaine: Whether an ointment, gel, or spray, this can help numb the area so sex is less painful. It’s often advised to be used 10-15 minutes before intercourse or procedures like a Pap smear. It may burn or sting for a few minutes before you feel the numbing effect.

Key Takeaways

Pain with sex is relatively common and can be caused by a lot of different factors, such as congenital issues, mental health issues, and more.
Pain with sex may occur with penetration, pressure, or touch, or without a stimulus.
Just because you have pain with sex now, doesn’t mean you will always have pain. There are many ways techniques and approaches that can help you gradually return to pain-free sex.

References

Dyspareunia (painful intercourse): Causes, diagnosis & treatment. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12325-dyspareunia-painful-intercourse
ISSWSH – Home. (n.d.). International Society for the Study of Women’s Sexual Health. https://www.isswsh.org
Painful intercourse (dyspareunia). Mayo Clinic. (2022, March 1). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/painful-intercourse/diagnosis-treatment/drc-20375973
Santos-Longhurst, A. (2022, March 14). The 20 best positions to try for all kinds of sex. Healthline. https://www.healthline.com/health/healthy-sex/comfortable-sex-positions
Vaginismus treatment solutions. (n.d.). Vaginismus. https://www.vaginismus.com/
When Sex Is Painful. (n.d.). American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/when-sex-is-painful