If sex hurts, you won’t want to do it. For most of us, pain stops desire cold. It’s estimated that about 20 percent of women suffer vaginal pain with foreplay or intercourse. Pain can be intermittent or chronic and can stem from a wide variety of causes, like infections, yeast, STDs, allergies, drug reactions, nerve damage, and chronic disorders. Unfortunately, many women complaining of pain during sex are dismissed as being inhibited, having psychiatric problems, or merely exaggerating the problem when, in fact, their symptoms are related to legitimate medical issues.
Here are just a few common causes of sexual pain:
1. Poor arousal. When a woman becomes aroused, the labia, clitoris, and vagina swell and natural lubrication is produced inside the vagina—all of which help protect a woman from pain during intercourse. Without these natural protective mechanisms, the vaginal tissue might be dry and fragile, causing uncomfortable friction or even tearing. Unfortunately, women with existing pain problems often grit their teeth and move forward with intercourse, telling their partner to “just get it over with." This just exacerbates the pain cycle.
If you experience this: Seek the advice of a gynecologist to diagnose causes of sexual pain. Use lubrication during foreplay and intercourse to increase pleasure and comfort. Spend at least 30 minutes in foreplay before attempting intercourse.
2. Vaginal clenching. If you’re about to do something that has repeatedly caused you pain in the past, you are going to flinch. When sex hurts, women unconsciously squeeze their vaginal muscles contracting the space available for the penis to enter, causing intercourse to hurt more.
If you experience this: A specialty called “woman’s health physical therapy” treats sexual pain problems. Making an appointment sooner rather than later can keep sexual pain problems from becoming chronic.
3. He has a large penis. While men may worry a great deal about being too small, women complain to me about 20 times as often about him being too big. Sex can hurt if he is well-endowed either by length or girth.
If you experience this: Seek help from a sex therapist and to discover how to adjust both sexual positions and rhythms for greater comfort. A physical therapist may also be an important referral.
4. Menopause. As the hormone estrogen diminishes, a woman’s vulvar and vaginal tissue becomes thinner and less lubricated. To add to the problem, during midlife, couples often stop having sex as often due to either his or her waning desire. Unfortunately, infrequent sexual intercourse can cause vaginal atrophy.
If you experience this: Ask your doctor about your eligibility for hormone replacement or vaginal estrogen cream. Once sex no longer hurts, try to continue with regular love-making to keep your vagina in good shape.
5. Vestibulitis. This pain, often described as burning, occurs just at the entrance or “vestibule” of the vagina—most frequently around the lower crescent of the vagina (in clock terms, from 4 o’clock to 7 o‘clock). With vestibulitis, the vagina usually has a red area surrounding the vaginal opening. Without this red demarcation, however, the diagnosis is sometimes missed at a regular gynecological exam.
If you experience this: See your gynecologist for diagnosis. If the condition persists, seek the counsel of a pelvic pain specialist.
6. Vaginismus. This is an inability to be penetrated. Anxiety is at the root of a woman’s pain when her vagina contracts and will not allow any form of penetration. Women with vaginismus often have had trouble using tampons, painful gynecological exams, and fear of painful intercourse.
If you experience this: Sex therapy can uncover the root cause of the fear and design steps to systematically allow pain-free penetration.