Have you ever experienced pain during sex? Perhaps discomfort during penetration or a burning or stinging sensation? If so, you’re not alone. According to the American College of Gynecologists and Obstetricians, 75 percent of women experience pain during sex at some point in their lifetimes. For some women, pain starts the first time they insert a tampon, finger or penis. Others notice it for the first time during a gynecological exam, at the beginning of a new relationship, after childbirth, or at the onset of menopause. Frustratingly, it seems pain in the vulva or vagina can take you by surprise at any time with no obvious cause.
Why is pain during sex so problematic?
Aside from the obvious, (who wants to be in pain when they should be enjoying sex?), pain during sex can cause secondary problems which can actually be harder to treat than the pain itself. Experiencing pain during sex makes many women avoid sex, and even relationships altogether and can eventually lead to relationship strain and breakdowns.
What’s more, even when women build up the courage to talk about it, they often receive unhelpful advice, or health care providers are unable to make a correct diagnosis. Because their condition isn’t understood, they may be told the pain is psychological, that it’s just all in their head.
So whilst most pelvic pain conditions are entirely treatable, yes, that’s right, let’s say it again:
Most pelvic pain conditions are entirely treatable
Many women live with vulvar or vaginal pain for years along with the associated feelings of shame, sadness, depression, and helplessness in the belief that they will never get better.
But the good news is that once you’ve got to the root of the problem, you can start your healing journey.
So, what are the causes of painful sex?
There are many common conditions that can cause pain in your vagina or vulva including:
- Dyspareunia - the medical term for painful intercourse
- Vaginismus - a very common condition where involuntary muscle spasms prevent or interfere with penetration
- Vulvodynia - chronic pain or discomfort in the vulva most commonly described as burning, stinging, irritation, and rawness.
Note that this is just a brief overview of some of the many pelvic pain conditions. But in all cases, they can often be traced back to these three main causes:
Hormonally, the vagina is ultra sensitive. That means that an absence or change of hormones in your body can have a significant effect on your vaginal health and cause pain. One of the main reasons for changing hormone levels is taking hormonal birth control. While it doesn’t cause problems for every woman, for some it can cause pain immediately after starting it, or months or years after. Other common causes of hormonally mediated pain include breastfeeding and the menopause.
Fortunately, pain caused by hormone imbalances can be addressed relatively easily by stopping or switching hormonal birth control methods, or increasing hormone levels with creams or ointments.
Just as some women hold their stress in their neck or shoulders, some women hold it in their vaginas, making the muscles tight and sore. Childbirth, injuries, aging and even sports like cycling or running can cause tight muscles. And of course, any sex-related fear or anxiety will also tense them up.
You might be surprised to learn that when muscles are clenched as a result of pain, stress or fear of pain, it can cause itching and burning of the vulva and vagina. Yes, what feels like skin sensitivity or irritation can actually be the result of tight muscles!
Tight muscles are often the most overlooked and underdiagnosed cause of pain. Fortunately they are very easily treatable with dilators, exercises, internal stretching and help from a physical therapist.
While not extremely common, nerve pain can develop from physical trauma or an allergic reaction to medication or as a secondary reaction to nerve damage in other parts of the body. Some women are also born with an excess of nerve endings in the vulva. When there are too many nerve endings in the area, the vulva can end up feeling too sensitive and reactive.
This is the most complicated factor involved in vulva and vaginal pain conditions and the most difficult for health care providers to identify. However, there are a number of medications to help treat this problem.
In the most serious cases and as a last resort, surgery might be necessary, but when carried out correctly it has a 98% success rate. This should give you encouragement that even the most complicated cases can be treated.
So once we know the causes, what can we do to treat pain during sex?
While far from being an exhaustive list, we hope these practical suggestions can serve as helpful first steps on your journey to healing.
See a doctor
If you haven't done so already, make an appointment with a healthcare practitioner. There are some very easy and obvious things that they can address straight away and some more serious conditions that it’s important for them to rule out such as infections, vaginitis or conditions like endometriosis, fibrosis, ovarian cysts and interstitial cystitis. Seeing a therapist can also be helpful for many women to overcome the pyschological distress caused by pain during sex.
Stop doing what’s hurting you
We cannot stress the importance of this enough. If penetration is hurting you, stop it. If touching your vulva is hurting, stop it. Today, right now. Pain during sex is not something you should grin and bear. You deserve better than that. Plus, by continuing sexual activities that hurt you, you create a connection between sex and pain, making it more likely that your muscles will tense, which just exacerbates the pain.
That’s why until you’ve identified the cause of your pain and have taken steps to prevent it, it’s vital that you show some love and respect for your body by stopping the painful activity. But that doesn’t mean you have to stop having sex all together…
Keep having sex
This might seem to contradict the previous point, but it’s important to build a postive relationship to sex whether you’re single or with a partner. Sex can have such positive impact on our wellbeing and relationships and there are many ways to enjoy it despite pelvic pain conditions. If penetration is painful for you right now, try oral sex. If it’s your vulva that’s hurting, focus on touching other erogenous zones for a while. These are just a few suggestions but we hope you get the point. Pelvic pain doesn’t have to mean the end of your sex life. You might just need to get creative, and that’s never a bad thing, right?
Vaginal and vulva pain is not well known in the medical world and there’s a lot of misinformation out there, even among gynecologists. The more you educate yourself, the better you can advocate to have your needs met and the better chance you have of helping medical practitioners help you. You can get started by listening to sex therapist Dr. Bat Sheva’s Pain During Sex collection created exclusively for Emjoy.
Review any hormonal birth control
Whether you’re taking birth control pills, patches, injections or have a vaginal ring fitted, this is a common cause of pain during sex for many women. If you suspect it's having any negative side effects on you, stop using it for a while to see how your body reacts. It may take weeks or even months, but you will heal from hormone-induced pain.
Stop using scented products
Stop using scented soaps, panty liners, and douches. These can be irritating for many women and are totally unnecessary. The vagina does a great job at cleaning itself! Instead, it’s best just to use warm water, wear 100% cotton underwear and only use pads when it’s absolutely necessary. Sleeping with nothing on your vagina or vulva also makes a huge difference for vaginal health.
We know, it’s easier said than done. But learning to physically relax your body and mind can go a long way to relaxing your pelvic floor muscles, which could significantly reduce your pain. It can also help you to face your pain more calmly. Some practical ways to add mind and body relaxation to your self-care routine include meditation, yoga, breath work and wellbeing apps like Emjoy.
Good luck on your healing journey
By being aware of some of the main causes of pain during sex and knowing some of the practical steps you can take to get better, we hope we’ve brought you one step closer on your healing journey. Remember, in nearly every case, pelvic pain is curable. It may take a while, you may need to see many professionals or even have surgery, but it will get better. And lastly, you are not alone and you are not broken. You have a right to not be in pain and you deserve to be happy. With some knowledge, courage and determination you can reclaim your sex life, pain-free.