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Pain during sex is common—but that doesn't mean it's normal.

By Kasandra Brabaw
March 22, 2021
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Sex is supposed to be enjoyable, full stop—but unfortunately, painful sex is an issue that many women and those who were assigned female at birth continue to deal with.

"Sex isn't supposed to be painful, yet painful sex is pretty common," June Gupta, WHNP, director of medical standards at Planned Parenthood Federation of America, tells Health. According to the American College of Obstetricians and Gynecologists, nearly 3 out of 4 women experience painful sex—technically called dyspareunia—at some point in their lives, and even that number may be off due to underreporting. "Painful sex is often not reported because I think a lot of women assume it's normal or are embarrassed to talk about it with their partner or their healthcare provider," Jaclyn Bonder, MD, a specialist in physical medicine and rehabilitation at Weill Cornell Medicine tells Health.

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Credit: Getty Images

But just because it's extremely common doesn't mean it isn't an issue that should be dealt with. Occasional pain happens for a lot of reasons, many of which might have more to do with how you were feeling emotionally during sex than anything physical. But there are many physical causes of painful sex, too.

If the pain you felt during sex was a one-time thing, or something that happens just when you're extra stressed or only when you're feeling bad about your body, you probably don't need to see a doctor. But if you consistently feel pain during sex, are afraid to have sex because you worry about pain, or always have pain in certain sexual positions or during your period, that may be a sign that something physical is going on and a doctor can help.

Doctors who specialize in women's health classify painful sex in two ways: pain on insertion or deep pelvic pain—and both can be due to a variety of reasons. Here's what you need to know, according to experts.

What to know if you feel pain on insertion

The umbrella medical term for pain on insertion is "vulvodynia" and it can have many different causes or no apparent cause at all, which doctors term "idiopathic vulvodynia."

Vaginal dryness

One reason you might feel pain as a partner puts their penis, fingers, or a sex toy into your vagina is because there's not enough natural or synthetic lubricant. Vaginas get dryer for several reasons, though one of the most common is menopause. "When someone goes through menopause the vaginal tissue gets thin and sensitive, their labia decrease in size, their vagina feels tighter and dryer," Nicole Bullock, DO, FACOG, an OB/GYN with Abilene Physician Group in Texas, tells Health. "Inserting anything vaginally is going to become an issue."

Other reasons someone might have dryness in their vagina is because they've started a new birth control that affects their estrogen levels, because they're breast feeding, or because of certain cancer treatments.

What can help: If you're dry because of menopause or breast feeding, try over-the-counter vaginal moisturizers ("yes, just like using facial moisturizers"), Mary Jane Minkin, MD, FACOG, Clinical Professor of Obstetrics at Yale University School of Medicine tells Health. If those don't work, try an internal vaginal moisturizer that includes some estrogen. Talk to your doctor about trying a new birth control if you think that's contributing. And, of course, lube is a vaginal dryness remedy that makes sex better at any age.

Infection

Yeast infections, bacterial vaginosis, urinary tract infections, and sexually transmitted infections are some of the most common causes of pain during sex, according to Dr. Gupta. Infections typically cause some swelling and inflammation in the vagina, which can make sex very uncomfortable. If you have a strange vaginal discharge; your vulva is itchy, swollen, or uncomfortable; or you have pain when you pee, check in with a doctor.

What can help: Vaginal infections can usually be treated with over-the-counter medicines or antibiotics prescribed by your doctor.

Vaginismus

Vaginismus is a little-known condition that causes vaginal muscles to clench and tighten, especially when someone tries to put anything inside — a penis, sex toy, or even a tampon. Sometimes, the muscles spasms characteristic of vaginismus can be related to past sexual abuse or trauma or emotions around sex like fear and shame, Dr. Minkin says. But other times vaginismus happens even without past trauma or after having worked through trauma in therapy.

What can help: A doctor will suggest someone with vaginismus use a set of vaginal dilators, which are like a set of dildos ranging in width from small (about the size of a finger) to large, to slowly stretch their vagina. Dr. Bullock would also suggest pelvic floor physical therapy. "All of my patients could benefit from pelvic floor physical therapy," she says. A pelvic floor therapist can help you realize when you're clenching your vaginal muscles and how to relax them.

What to know if you feel deep pelvic pain

Deep pelvic pain is the term women's health providers use when talking about pain people feel with penetration. A bit different than pain on insertion, this deep pelvic pain is felt further inside the vagina, closer to the cervix. Like with pain on insertion, deep pelvic pain can have many different causes.

Tilted uterus

If the pain you feel during sex seems to happen only in certain sexual positions, it's possible that you have a tilted uterus. Between 20 and 30 percent of people assigned female at birth have a uterus and cervix that tilt backward toward their spine rather than forward toward the belly like usual. Usually, a tilted uterus and cervix causes no problems and most people don't even know their uterus is tilted unless a gynecologist tells them so, according to Dr. Bullock. But sometimes certain sexual positions can be uncomfortable or painful for people who have a tilted uterus because the penis or sex toy hits their cervix.

What can help: If a titled uterus is causing pain during sex, you can find new, more comfortable sex positions. Talk to your sexual partner(s) and be detailed about what hurts so you can find pleasurable sex positions together. Products like the Ohnut can also help. The Ohnut uses three stretchy, donut-shaped rings to provide a bumper so that the penis or sex toy doesn't go as deeply.

Endometriosis

Endometriosis is a strange and complicated disease that causes tissue like that which lines the uterus to grow outside the uterus. That tissue can then swell and bleed each month just like the ones inside the uterus and can cause inflammation, lesions, and scar tissue inside the pelvic area. Some people who have endometriosis have chronic pain, some have pain only around their periods, and some have pain with sex or with bowel movements, Dr. Bullock says. Endometriosis causes painful sex if the endometrial-like tissue has grown onto the lower part of a person's uterus, near the cervix and vagina, Dr. Gupta says.

What can help: "While there is no cure for endometriosis, some symptoms can be treated through surgery or hormonal birth control, which can help cut down on the pain and bleeding you may experience during your period and sex," Dr. Gupta says. Typically, a doctor will suggest surgery to remove some of the endometrial-like tissue and the scar tissue it creates, and birth control can stop the invading tissue from swelling and bleeding.

Pelvic inflammatory disease

If the pain you feel is higher up in your pelvic area, that can be a sign of pelvic inflammatory disease (PID), Dr. Minkin says. PID is an infection in a woman or person assigned female at birth's reproductive organs. It's often a complication caused by a sexually transmitted infection (STI) like chlamydia or gonorrhea, that goes undiagnosed and untreated for too long, but other pelvic infections can cause PID as well. PID needs to be treated right away because it can lead to infertility if it goes untreated, Dr. Minkin says. Even women who have a history of PID who have been treated can have pain with sex from scarring related to the old infection.

What can help: If you suspect you might have PID, make an appointment with your doctor who will prescribe a course of antibiotics.

Vaginal septum

Young women and people assigned female at birth who feel a lot of pain when they start having sex might have a vertical or complete vaginal septum. The condition is also known as a "double vagina" because a wall of tissue runs vertically up the vaginal canal, separating the vagina into two categories and creating a barrier that fingers, sex toys, penises, and even tampons might not be able to pass through. Most people who have a vaginal septum won't know until they try to use a tampon or have sex for the first time, Dr. Bonder says.

What can help: If the vaginal septum is causing pain with using tampons or during sex, a surgeon can remove the tissue. Sometimes, the wall of tissue will be torn during sex, after which surgery won't be necessary.

Tight pelvic floor muscles

Pelvic floor dysfunction isn't always a result of vaginismus. Conditions that make people prone to tightening other muscles, like anxiety and temporomandibular joint syndrome (TMJ, which causes jaw clenching) can also cause clenching in the pelvic floor, Dr. Bonder says. "Pelvic floor muscles, which surround the vagina and control urination, defecation, and sexual function, should relax during intercourse," she says. Any tightening of those muscles during sex can cause pain.

What can help: Bonder suggests pelvic floor physical therapy. "Just like with a tight neck, you have to learn how to relax the muscles and stretch them out," she says. Vaginal dilators and muscle relaxers may also help.

Fibroids

Fibroids are growths in your uterus, Dr. Gupta says. They're very common and usually show up around ages 30-40, though they are more likely to grow earlier in Black women. Usually, fibroids aren't cancerous or dangerous in any other way, but they can cause pain during sex and affect a person's period or ability to get and stay pregnant.

What can help: A doctor will likely suggest pain medicines to manage the discomfort caused by fibroids or surgery to have them removed, Dr. Gupta says.

PCOS

Polycystic Ovarian Syndrome (PCOS) can cause painful sex if ovarian cysts leak, Dr. Gupta says. PCOS is a condition caused by an imbalance of androgen and insulin and has many symptoms that vary widely. A person with PCOS may also have severe acne and/or excess hair growth on their face, chest, belly, or upper thighs. "Symptoms of PCOS can impact a person's body image and confidence, resulting in discomfort during sex or diffculty getting and stayng aroused," Dr. Gupta says.

What can help: There's no cure for PCOS, but hormonal birth control, medicine to treat insulin resistance, and other medication or lifestyle changes can help manage the symptoms.

What to know if you feel pain only once in a while

Several of the issues that cause a pattern of painful sex can also explain the once-in-a-while painful sex most women and people assigned female at birth will experience. "Women tend to hold life tension in their pelvic floor, and those pelvic floor muscles need to relax during sex," Ava Leegant, MD, director of the pelvic floor institute at Montefiore Health System, tells Health.

Dr. Leegant points out that sex is a complicated process for most women and people assigned female at birth. "Women have less desire based on visual cues. We need to be relaxed emotionally."

If you're stressed about work, your kids, the house, your relationship, whether or not you're a good sexual partner, or anything else, you'll likely be less aroused and more likely to tense your pelvic floor muscles. If you're not relaxed, you can have the same issue with tight pelvic floor muscles as someone who's clenching their pelvic floor for another reason.

One key stressor that can greatly affect your sex life—and up your possibility of feeling pain while sex—is self-consciousness or feeling quite uncomfortable with how you look. "Going into sex feeling stressed or self-conscious about your body can lead to pain if you're not fully relaxed and present," Shannon Chavez, PsyD, licensed psychologist, sex therapist, and K-Y spokesperson tells Health.

Negative feelings about your body image can also cause you to try to suck your belly in or keep your partner from touching certain parts of your body, Dr. Chavez says, and that tension can restrict blood flow to your genitals, again leading to discomfort or even pain. "A lot of people aren't aware they're tightening," she says. "A big part of working with someone who has painful sex is helping them learn to relax and be more present in their body."

The #1 thing you can do to work through painful sex: talk about it

"Communication is the key for just about all of these issues," Dr. Minkin says. "There is a lot of research showing that if a woman is uncomfortable with sex, she will naturally want to have sex less (who would want to have sex if it hurts!)" It sounds obvious, but communication is important—communication with the people you have sex with, but also communication with your doctor.

"If you can communicate with your partner and seek appropriate medical help, you'll feel a lot better and have a much better relationship," Dr. Minkin says.

In communicating with your doctor and your partner, it's also important to normalize these moments of pain, instead of feeling shame or embarrassment when something in your sex life goes south. That way, you can learn from those moments, and focus on what makes your body feel good.

Dr. Chavez suggests using the concept of a "positive sandwich" when talking through something that hurts. "With the positive sandwich, you talk about what's going wrong and also what's working well, what you appreciate. The ego is fragile when it comes to sexuality." A positive sandwich keeps everything from being doom-and-gloom. "Be very direct," Dr. Chavez says. "Say 'I need more of this. This feels good.'"

Some products can also be helpful. Lube is great all the time, for everyone, even if you have plenty of natural lubrication. So, especially if you have pain sometimes because of dryness, get some lube. Something like an arousal gel can also intensify pleasure and help keep you grounded in your body.

If those first solutions don't seem to solve your problems, a doctor can help you figure out what might be going on, Dr. Bullock says. "Never be afraid to bring painful sex up to your doctor," she says. "It's up to them to be the expert."

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