It can be devastating to feel pain when you were expecting to feel pleasure.
And yet, if you have ever experienced this, you should know you are not alone. The landmark "Sex in America" survey conducted in 1994 found that 1 in 5 women experience pain during sex, and this likelihood increases to 1 in 3 women when they are post-menopausal.
Dyspareunia is the medical term for any kind of pain experienced during sexual intercourse, and it encompasses any one or more of the following:
- Pain only at sexual entry (penetration)
- Pain with every penetration, including putting in a tampon
- Deep pain during thrusting
- Burning pain or aching pain
- Throbbing pain, lasting hours after intercourse
The reasons behind painful intercourse can be rooted in the physical or the emotional, or may be a blend of the two. A significant cause of painful sex is related to the dryness that can result from aging and/or a change in your hormones. Estrogen levels naturally fall as a result of menopause, breastfeeding, and may fluctuate as a result of birth control, hormone therapy, and more.
But it is important to consider that your mental state or personal traumas can equally impact your body's ability to open up to pleasure – perhaps following a difficult birth, intimate partner violence, miscarriage, etc. Even things seemingly unrelated to your sexual health, like everyday stress, anxiety and depression, can further aggravate pain.
Fortunately, much of this pain can be alleviated once you understand the cause(s).
We're going to explore the top six reasons why you might experience pain during sexual intercourse, then share our list of ways to start taking your pleasure back.
1. Vaginal atrophy
Peri-menopause is the phase prior to menopause that starts in a woman's 40s, but can start in her 30s or even earlier, and it is the first time many women experience pain with sex. This is caused by thinning, shrinkage and inflammation of the vaginal walls due to a decline in estrogen levels as women age.
A surprising number of women - over 50% of those who are post-menopausal - experience atrophy due to lower estrogen levels. The significant hormonal drop that accompanies menopause takes with it not just internal vaginal moisture and elasticity, but also much of the drive and internal signals that women associate with feeling aroused.
2. Vulvodynia and related conditions
Chronic pain on the outside of the vaginal opening, which is called the vulvar region of the vagina, is called vulvodynia. Symptoms include burning, itching, stinging, rawness, soreness and painful intercourse. For many women the first sign of symptoms comes with first experiences of intercourse, which is one of the reasons that many women don’t talk about it or go for help.
Some women who have struggled with reoccurring bacterial or yeast infections have a higher risk of vulvodynia, while others have a history of sexual abuse. However, most women with vulvodynia have no known factors that are associated with the condition.
A similar condition called vulvar vestibulitis may cause pain only when pressure is applied to the area surrounding the entrance to your vagina. Another related condition called vaginismus might also be considered if the muscles around and in the vagina tend to spasm. It is not an easy call, as vaginal pain can cause spasms and spasms can cause pain.
3. Pelvic floor disorders
Pelvic floor disorders typically refer to weakening of your pelvic floor muscles that result in issues with incontinence, constipation, or pelvic organ prolapse. According to the University of Chicago, pelvic floor disorders occur when the "sling" or "hammock" that supports the pelvic organs becomes weak or damaged. So, what does all of this mean for your sex life? The weakening of your muscles can cause you to relax or contract your vaginal muscles in a way that is out of line with what would make sex pleasurable, in addition to pain or discomfort in your pelvic region more generally (at times when you aren't engaging in sex). If you suspect this to be the cause of your pain, seeing a women's health specialist is the best place to start.
4. Arousal non-concordance and low sexual desire
Many of us have experienced an occasional mismatch between our physical and mental readiness for sex, referred to as arousal non-concordance. In these situations, we may be mentally aroused but are not experiencing signs of physical arousal. Or the opposite might happen – our body may become aroused at a time when we're not interested in sex. This can cause serious frustration when you're feeling ready to get down with your partner, but find your body just isn't there yet. This is a case when personal lubricant is your new best friend!
You may also experience a fluctuation in sexual desire as a result of your hormonal birth control. If you suspect this may be the case, talk with your gynecologist about trying to a different method of birth control. Even switching to a different type of hormone can have a significant impact on your mood and sex drive.
5. Postpartum recovery period
The hormonal changes a woman’s body undergoes during pregnancy can affect her sexual desire and response for a while after the baby is delivered. Feminine dryness, irritation, even pain with penetration are common in over 40% of new mothers. Lubricant can enhance your body’s natural lubrication response, which can be especially sluggish while a new mother is breastfeeding because estrogen levels are low.
If you've just given birth, your doctor may recommend a four to six week "waiting period" before beginning to have sex with your partner again. But once you are cleared to have sex again, this is a great example of when to use lube.
6. Chronic pain due to trauma
The kind of pain that results from an incidence or history of trauma is the most complex to treat because it means addressing uncomfortable and difficult experiences in our past.
According to RAINN, one in five women will be sexually assaulted in their lifetime. As a result of sexual assault, women may develop an increased sensitivity to pain (hyperalgesia) or physical coping mechanisms such as muscle tightening to combat thoughts of trauma they experienced. Seeking out a counselor or therapist you trust can help you talk through both the emotional and the physical symptoms you're experiencing. Check out this article from Psychology Today for ideas on how to find an effective treatment that works for you.
Ways to Make Sex Less Painful
- Seek the advice of your medical professional: If you have chronic or reoccurring genital pain, you should find a physician who can help you and rule out easily treatable causes of vulvar pain.
- Extend foreplay: Sex therapists recommend at least 30 minutes of kissing, cuddling, mutual whole-body massage, and oral sex before attempting intercourse. Take your time by exploring each other’s bodies and be patient. Read more about this in our blog post "Outercourse: The Cure for Painful Sex".
- Use a generous amount of lubricant: The only time you should reach for a lubricant is when you can't stand waiting anymore. Once you're feeling ready, try using and reapplying personal lubricant frequently to combat dryness. Lube helps remove friction, allows for greater sensitivity, and makes up the slack when your vulva is not keeping up with your brain.
- Exercise your pelvic floor: The practice of contracting your pelvic floor muscles regularly can improve blood flow to your vagina and pelvic floor, relax your vaginal muscles, make it easier for you to reach orgasm, and increase vaginal lubrication. Never tried kegel exercises? Click here for a thorough introduction. NOTE: In certain cases, kegel exercises can exacerbate pelvic floor disorder (PFD) symptoms, so be sure to talk with your doctor first if you suspect you may have PFD.
- Do your best to relax beforehand: Find whatever it is that brings you calm such as listening to soothing music or using aromatherapy. This will put your mind and body at ease before engaging in physical intimacy with a partner.
- Consider simple lifestyle changes: Sometimes switching to cotton underwear and giving up tight fitting clothes, or avoiding petrochemical irritants in douches, soaps, detergents and lubricants can make a big difference for some women. You may also want to avoid waxing the hair on the labia.
Make Love Revolution, "I Want to Tell You About Arousal Nonconcordance"
Memorial Sloan Kettering Cancer Center, "Pelvic Floor Muscle (Kegel) Exercises for Women to Improve Sexual Health"
The Journal of Pain, "Acute Severe Pain is a Common Consequence of Sexual Assault"
Healthline, "How to Enjoy Sex After a C-Section"
Insider, "Having sex after giving birth can be painful — here are 6 ways to help"
Psychology Today, "Does Intercourse Hurt? A Guide to Women's Sexual Pain"
Medium, For Women With Vaginismus, Trauma And Pain Go Hand In Hand