Pain during sex is an exceptionally common (and frankly disturbing) reality for most women. According to research from the women's health brand OhNut, nearly 75 percent of women experience painful sex at some point in their lives, with a large percentage experiencing ongoing or chronic pain.
Yet there is very little scientific research devoted to female pain during sex. As Lili Loofbourow pointed out in her blockbuster essay on female sexual pain, if you look on PubMed, there are 393 clinical trials on dyspareunia (recurring pain during intercourse), 10 on vaginismus (extreme pelvic floor muscle spasms, making penetration impossible), and 43 on vulvodynia (chronic pain in the vulva or vagina). Meanwhile, erectile dysfunction has 1,954 studies.
We simply have not devoted enough funds or time to the study of female sexual pain—and it's not shocking in the least. We didn't even know the full structure of the internal clitoris until the '90s, let alone the finer points of female sexual health, arousal, and overall comfort.
Pain during intercourse is not normal. It has simply become so inherently embedded in our cultural vernacular that women and people with vaginas have come to think pain during sex should simply be accepted as a fact of life. This is not OK, and through conversations about sexual health, better sex education for children and adults alike, and the cultivation of medically accurate information, we can move to change the conversation.
So here are five reasons sex may become suddenly (or chronically) painful and what to do about them:
1. Lack of lubrication
Lack of lubrication is one of the leading causes of pain during intercourse or penetration. When the vagina is properly aroused, it naturally expands and becomes wet, allowing for entry. When you're not properly primed for intercourse, penetration of the vagina can feel uncomfortable and even painful. Vaginal dryness can also lead to tearing, abrasions, and even vaginal infections. This is not good!
It's important that your vagina is ready for penetration before it's attempted. According to the American College of Obstetricians and Gynecologists, it can help to use a water-based lubricant and engage in non-intercourse play such as masturbation or oral sex before intercourse. Make time for sexual play so you don't feel rushed.
2. Damage to the pudendal nerve
The pudendal nerve is the main nerve that connects the perineum to the outer genitals, urethral sphincter, and anal sphincter. It has many responsibilities, one of which is to communicate brain signals to the vaginal-clitoral network and vice versa. Damage to this nerve can cause pain during sex, vaginal or vulvar numbness, and pain in the perineum or anus. While research is still fledgling, Naomi Wolf points out in her book Vagina: A New Biography that damage to the pudendal nerve often goes unnoticed and undiagnosed.
Reasons for damage include vaginal trauma, traumatic birth, improper form during exercise or yoga, prolonged sitting, and episiotomy (when the perineum is cut during vaginal childbirth).
3. An undiagnosed STI
While 80% of people with a sexually transmitted infection will be asymptomatic, if you're experiencing a sudden onset of pain during sex, bleeding, burning, abnormal discharge, or a combination of these symptoms, you could be dealing with an undiagnosed STI. STIs such as HPV, chlamydia, and gonorrhea can present with pain during intercourse. If you're having persistent pain during sex, you should be screened for STIs immediately.
While most health care professionals will suggest being screened every six months to a year, I recommend being tested every eight weeks if you're not in a monogamous relationship with knowledge of your partner's current status. Never take your health for granted.
4. Cervical sensitivity or growths
The cervix is the gatekeeper or barrier between the vaginal canal and the uterus. The opening of the cervix, called the os, can be prone to sensitivity. For some people with vaginas, deep penetrative or rough sex can cause bleeding and discomfort in the cervix. While this is pretty common, there is also a possibility for underlying cervical issues. If you're worried, you should make an appointment with your OB-GYN to rule out an HPV infection, cervical inflammation, or cervical polyps.
5. Chronic pain disorders
If you're experiencing sudden, ongoing pain, it could be possible that you have a chronic pain-causing disorder such as endometriosis, chronic vulvodynia, or pelvic floor spasms—to name only a few of the possibilities.
It's hard to totally draw a distinct line between sudden pain and chronic pain, as the two are so often interlinked. You may suddenly experience conditions like vulvodynia, vaginismus, and/or dysperunia in what seems like a sudden manner. The reasons for this are varied: Pain could be due to a past trauma that has become manifestly physical, or it could be connected to depression or environmental stress.
Moreover, sudden pain can become chronic pain. And once seemingly "cured" chronic pain can resurface. Even with chronic illnesses like endometriosis, you may have terribly painful sex and then experience a respite from symptoms.
6. Psychological factors
Vaginal pain and psychological factors can be deeply interconnected. Many vaginal conditions (such as vaginismus and vulvodynia) are based both in the psychological sphere as well as the physical body. This is why these conditions are often found in women who don't seem to have any physical issue with their vulvas or vaginas.
We can store trauma or pain within our vagina (and bodies), giving it room to manifest in a physical way seemingly out of nowhere. The physical pain response has to do with the autonomic nervous system, which sends signals of sexual feeling to the brain and from the brain to the vaginal-vulgar network. That same autonomic nervous system also controls the fight-or-flight response. Basically, as trauma specialist Beser van der Kolk puts it, "The body keeps the score." The brain says, "I'm in pain," even though the vagina is physically healthy. The reasons for this can vary, including experiences of sexual assault, sexual shame, and poor body image.
There are different treatment options for different types of vulvar and/or vaginal pain. If your pain is bothering you enough to disrupt your everyday life and cause harm to your sex life or overall well-being, it warrants being addressed with a health professional. Make an appointment with your OB-GYN to rule out any medical conditions.
You may also benefit from working with a pelvic floor specialist. These highly trained professionals help to rehabilitate the pelvic floor muscles through strengthening, stretching, or working to calm spasms. If there are any psychological or emotional factors involved, work with a therapist may also be helpful in relieving some of the physical pain.
With all of this in mind, let us reiterate: Pain during sex is not normal. It should be taken seriously and addressed immediately. You deserve to have comfortable, pain-free, pleasurable sexual experiences that leave you feeling great and satisfied.
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