Sex is supposed to be an enjoyable and exciting experience however, sometimes that isn’t always the reality. Painful sex is common, with one in ten women in the UK experiencing it, but that doesn’t mean it is normal (1).
There are lots of causes of painful sex and it’s important to ask yourself some questions:-
- What kind of pain are you experiencing? Is it a stabbing pain, burning sensation or a niggling pain?
- Where is the pain coming from? Does the pain feel like it’s deep inside your pelvis or is it in the vagina.
- When do you experience the pain? Does the pain come during penetration or is it associated with certain positions.
The most common cause? Dryness
Sex is always better when you’re wet! Nearly half of women who report pain during sex have also noticed vaginal dryness (1). If your vagina is as dry as the desert and you try to put something inside, you’ll likely experience discomfort or even feel like you’re getting a friction burn.
Vaginal dryness is usually associated with a drop in a hormone called oestrogen. This is why it is more common if you are postmenopausal or breastfeeding, when there is a natural drop in the levels of this hormone.
If you are experiencing vaginal dryness, it could be time to embrace the lube! Using a small amount of lubricant before sex can make the experience more pleasant and less painful. There are also hormonal treatments available such as medicated creams which can be prescribed and so, if the issue persists it is always worth booking in to see your GP.
Other causes of painful sex
Other than dryness, there are a number of reasons why sex can hurt during or after. You may experience pain inside your vagina, or deeper in your pelvis.
If your pain is in the vagina, it may be caused by:
- Sexually transmitted infection like chlamydia or genital herpes
- Thrush
- Skin conditions such as psoriasis and lichen sclerosis
- Vulvodynia where chronic pain affects your external sexual organs called the vulva and this has no known cause
- Irritation due to an allergy to things like latex condoms, soap products or spermicides
- Issues with your cervix, which can lead to pain when a penis penetrates to this depth
- Intercourse too soon after surgery or childbirth that involved an episiotomy or tear
Pain felt within the entire pelvis
This type of pain is often caused by conditions that affect your internal organs such as the uterus and bowel. Whilst these conditions cause pain during sex, you will also usually have other symptoms so it’s important to take note of anything else that seems abnormal.
If your pain during sex is coming from your pelvis, it may be caused by conditions such as:-
- Pelvic Inflammatory Disease (PID)
- Endometriosis
- Fibroids
- Irritable Bowel Syndrome (IBS)
- Constipation
Psychological Causes
Vaginismus is a mind-body response to the fear of vaginal penetration – the vaginal muscles tighten involuntarily, making penetration impossible or very painful.
This can prevent penetration during intercourse either completely or partially, and causes pain which can even feel sharp like razor-blades (2).
For some women with vaginismus, the debilitating symptoms may have begun as early as puberty with attempted use of tampons or painful first experiences of sex. This is primary vaginismus.
Vaginismus can, however, also occur after vaginal function has been normal for many years (secondary vaginismus). Vaginismus can occur intermittently – in certain contexts and circumstances only.
There are many reasons why this can happen including:-
🧠 Stress
🧠 Shame associated with sex
🧠 Issues surrounding body image
🧠 Medications with side effects that suppress your sexual desire
🧠 Medical problems that can affect libido: cancer, diabetes and thyroid problems
🧠 A history of trauma
What should you do about painful sex?
Sex should be an enjoyable experience that’s a really important part of your relationship; you shouldn’t have to suffer in pain through it.
If pain persists, it’s important to ring your GP or a healthcare professional at a sexual health clinic. They’ll be able to check you over and recommend any treatment options depending on your symptoms.
This could mean taking medication for an infection, using a special lubricant, stopping use of fragranced body care products, taking a form of oestrogen replacement or treatment for emotional issues at the root of the problem.
If your pain is coupled with bleeding, it’s important to book in with your GP or sexual health clinic as soon as you can to get checked out.
Top Tips for painful sex:
🏥 Rule out any underlying medical causes:
Book in with your GP or sexual health clinic. It can be embarrassing talking about sex but, it’s important to remember doctors and other health care professionals are used to dealing with problems like this
📅 Track your periods:
Do you experience pain during sex at a particular time in your cycle?
❤️ Switch up your sex life:
New positions, new lubes, new toys; explore new things to find better and wetter positions
😊 Be easy on yourself:
Sex is supposed to be fun and there can be a lot of pressure to pretend you’re ok. You can’t force yourself to have a good time and it’s important to be honest with your partner about what is going on.
- Communication is key, and knowing your partner is on the same page can help you to explore, at your own pace, what feels good and what isn’t working for you.
- Sometimes taking penetration off the table can allow you to enjoy an intimate experience with your partner without feeling stressed or pressurised. Communicating well, and gradually exploring your bodies without worrying about penetration as the end goal can allow you to enjoy the intimacy of sex in different forms.
Above all, remember it is NOT something you just have to accept! The sooner you open up the conversation the sooner you can get help, and get back to enjoying intimate moments rather than avoiding them!
Reference List
- Mitchell KR, Geary R, Graham CA, Datta J, Wellings K, Sonnenberg P, et al. Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey. BJOG An Int J Obstet Gynaecol. 2017;124(11).2
- Crowley T, Goldmeier D, Hiller J. Diagnosing and managing vaginismus. Vol. 339, BMJ (Online). 2009.