Sex is supposed to be fun and intensely pleasurable. However, most of us have experienced pain during sexual intercourse at one time or another and often it is the very first time that we have relations. But for some women, it can become a chronic problem. In fact, one of the most common gynecologic complaints among women during their reproductive years is pain during sex. It accounts for 8-22% of visits to gynecologists. The good news is that there is often an easy solution, from treating a simple case of vaginitis or encouraging more foreplay for better lubrication or even taking hormone treatment for the more annoying diseases like endometriosis. Pain during sex can begin with initial penetration, with thrusting, or a combination of the two. In this discussion, we are going to touch upon how male and female anatomy can affect pleasure during sex and how technique and position can be changed to make sex rock. Other conditions such as hormonal changes, underlying infections or diseases, and emotional factors can all impact a woman’s ability to enjoy sexual intercourse. There is no more need for suffering, read on.
Anatomy Affects Pain During Sex
The length of a woman’s vagina and the direction that the uterus is tipped (forward or backwards) can be one reason for pain during sex. Shorter vaginas and a uterus that is tipped back towards the rectum are common factors that can cause pain. One of the easiest ways to classify the different reasons for painful sexual intercourse is to divide the pain into ‘initial penetration’ pain and ‘deeper penetration’ pain.
For instance, women who have pelvic organ prolapse such as a dropped bladder or uterus (which is uncommon unless the woman has had multiple pregnancies) can cause both initial and deeper pain during sex. If a woman has a short vagina, the man needs to adjust his depth of thrusting or in the case of a backward tipped uterus, he would need to aim more towards the anterior part of the vagina towards the bladder and not towards the rectum. There are areas around the cervix that cause less pain and hitting the cervix directly can be very painful especially if the woman has had surgery to the cervix or a history of cervicitis. Cervicitis is an inflammation or infection due to vaginitis or sometimes sexually transmited diseases such as pelvic inflammatory disease (PID).
Easy adjustments in positions and technique can alleviate most of these issues. The hard part is asking your guy to do something different. No worries though. No loving guy wants his partner to be in pain. Usually, a guy can sense if a woman is in pain and will make the necessary changes to help. After all, the only way to a frequent and happy sex life is for both partners to experience pleasure, EVERY time. “The times they are a changing”….gone are the days when wincing is acceptable during sex.
Hormonal Causes of Painful Sex
During certain days of a woman’s cycle like the time right before menstruation, the vaginal tissue may be drierdue to the rise of the hormone known as progesterone. The blood vessels around the uterus can swell in during this period and produce a throbbing sensation known as ‘pelvic congestion syndrome’ that can make sex painful. Certain medications such as birth control pills and nursing can change the lubrication levels in the vagina which can make sex painful or less enjoyable. The reason for this is that nursing lowers the estrogen levels, the hormone that causes the necessary arousal juices. An autoimmune condition known as Sjogren’s Syndrome results in oral, vaginal, and eye dryness and sometimes the first symptom is vaginal dryness. Water-based lubricants are helpful but do not last very long. Silicone lubricants are longer lasting and have less risk of causing sensitivity. Sliquid brand has an organic line as well as silicone based versions. Check out this article describing all sorts of facts about lubricants and lists organic lubricants.
Diseases That Cause Pain During Sex
There are diseases of the female reproductive tract that can cause pain such as:
- Pelvic inflammatory disease (PID) – an STD that scars fallopian tubes
- Ovarian cysts – benign growths on the ovaries
- Endometriosis – lining of the uterus that spreads to other areas
- Adenomyosis – lining of the uterus that buries into the muscle of the uterus
- Skin rashes of the vulva – lichen sclerosis and others
- Bladder diseases – interstitual cystitis
- Autoimmune diseases – Sjogren’s Syndrome
- Gastrointestinal conditions – Inflammatory bowel conditions
- Childbirth lacerations
- Diabetes – frequent yeast vaginitis
Endometriosis is one of the worst diseases of the female pelvis. It is penetrating disease where the lining of the uterus travels or grows on other structures in the pelvis, vagina, bladder, and elsewhere. It is stimulated by the ovarian hormone, estrogen, and there is only one positive thing to say about this awful disease; it can be treated with medications and surgery and usually disappears with menopause. That is why it is important to get a medical diagnosis so that early treatment can stop the pain before it becomes chronic or affects your sex life.
Vaginismus are painful spasms of the muscles that control the opening to the vagina, part of the kegel muscles. Kegel muscles support the vagina, bladder, and other organs of the pelvis (read more about Kegel exercises here). They are important for sexual enjoyment and orgasm strength, but when they will not relax, they prevent penile penetration. Vaginismus can be overcome by using vaginal dilators. They work by gradually enlarging and relaxing the vaginal opening. Biofeedback and physical therapy can be useful also.
Besides dilators and lubrication, topical steroids and oral medications can be useful for women with pain during sex. Estrogen therapy during the menopausal years both orally and topically can improve the vaginal elasticity and blood supply which is crucial for the production of natural lubrication. Sometimes, anti-anxiety and anti-depressant medications are used to reduce muscle spasms and fear of penetration. The role of cannabis has not been formally evaluated but has shown usefulness in other chronic pain syndromes or as a pre-sex behavior.
Pain During Sex: Emotional and Psychological Aspects
If you are experiencing pain with sex, it may be related to emotional, psychological, or relationship issues. Sometimes, changing the sexual positions can allow for a pain-free intimate session. One such position is the cross-wise position whereby the man is lying diagonally over the woman. While a history of sexual abuse has not been linked to future sexual pain syndromes, parental shaming of the sex act and labeling it as indecent has been linked to a variety of sexual conditions, including vaginismus. Talk to your sexologist or gynecologist. They will help you through therapy so that you can enjoy a lifetime of pain-free sex.
Concluding Remarks and Resources
The thing about sex, according to gynecologists, is, “If you don’t use it, you lose it” meaning that the more sex you have, the healthier your vagina remains, free of problems, with stronger and more intense orgasms. It is not easy to discuss sexual problems, but it’s time for women to open up the dialogue with their doctors and counselors. With the online community of support, help is out there. Below is a list of books for more in-depth reading while you are practicing your kegels, the key to a healthy vagina, bladder, and sex life:
When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain by Andrew Goldstein, Caroline Pukall and Irwin Goldstein
Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain by Deborah Coady and Nancy Fish.