Painful Sex: The Questions You’ve Always Wanted to Ask

Sex is supposed to feel good. But for some women, at certain times, sex is uncomfortable, perhaps even painful. You deserve to have pleasurable sex, and if sex is painful, something could be wrong. It’s important not to just “bear with it”. Be bold and empowered – speak up! Talk to your intimate partner and talk to your healthcare provider. At Diana Health, we care about your sexual health and are here to support you. 

To learn more about common reasons why women may feel discomfort during vaginal intercourse, as well as potential solutions, continue reading.

What causes painful sex?

Sexual activity can involve a variety of different acts between intimate partners. With this blog, we’re focusing on painful vaginal intercourse, also called dyspareunia. Painful intercourse can be caused by several conditions such as vaginal dryness, endometriosis, infection, or spasming of the pelvic floor muscles during vaginal penetration. 

What causes vaginal dryness or insufficient lubrication? 

Although many women think that vaginal dryness is only something experienced by women who have gone through menopause, vaginal dryness can happen for women at all ages, for several reasons. Estrogen helps to keep the vaginal tissue moist and lubricated. As a woman becomes several years out from the menopause transition, having very low levels of estrogen makes the vaginal tissue thinner, more fragile, and dryer. If a reproductive age woman’s hormones are not cycling regularly, which may happen while breastfeeding or while taking hormonal contraceptives, vaginal dryness may occur. Vaginal dryness or insufficient lubrication can also be caused by certain medications such as allergy medications, antidepressants, and sometimes even hormonal contraception.

What is endometriosis and how does it cause painful sex? 

Endometriosis is when cells that are usually found lining the inside of the uterus (endometrial cells), become located outside of the uterus. A common place for these endometrial cells to be found if they are outside of the uterus, is just behind the uterus in an area called the posterior cul-de-sac. During deep vaginal penetration for a woman who has endometriosis, these abnormally placed cells can result in pain. 

Can infections lead to painful intercourse?

Not all vaginal infections are the same. Some infections cause abnormal vaginal discharge while others can cause irritation and inflammation of the vaginal tissue. When this happens, anything rubbing on the vaginal wall, such as what happens during vaginal penetration, can cause pain. This may happen in women who have yeast vaginitis, bacterial vaginosis, or even more serious pelvic infections such as pelvic inflammatory disease. 

Can having a vagina that is too small for a male partner cause painful intercourse? 

The vaginal tissue is very elastic and can stretch. This is very evident during childbirth when the vagina stretches, allowing for the delivery of the baby. Sometimes the vaginal opening can feel too tight for comfortable vaginal penetration. This may be caused by vaginismus which is when the vaginal muscles involuntarily spasm, making it very hard or impossible for vaginal penetration. Sometimes skin conditions such as lichen sclerosis or eczema can impact the tissue around the opening to the vagina, leading to discomfort with intercourse. Some women develop vaginal stenosis, when the opening to the vagina becomes smaller and constricted, making vaginal intercourse difficult or impossible without the use of vaginal dilators or assistance. 

Could something be wrong with my female organs, making intercourse painful?

Sometimes uterine fibroids, ovarian cysts, a vaginal septum, or rare types of vaginal hymens can make intercourse uncomfortable or difficult. These are conditions that can benefit from consultation with a gynecologist as they are trained to do procedures to address these. 

Could stress be making intercourse painful?

When women are stressed, it is normal to feel more tense. Sometimes this causes tensing of the pelvic muscles, including the muscles surrounding the opening to the vagina, making intercourse uncomfortable. Women who have a history of sexual abuse may also experience emotional and/or physical pain during intercourse, even when it is desired and in a safe relationship. 

What can I do if sex is painful for me?

1. Stop and reach out!!! Book a visit with your Diana Health provider. We are experts in women’s health and are here to help you find the root cause of the discomfort and to engage in shared decision-making with you. Even if you try the suggestions below, it’s still important to connect with a healthcare professional to understand the underlying issue.
2. Communicate with your intimate partner: Honest and open communication is important for all intimate relationships, but especially if you’re struggling with painful intercourse. There are also couple’s therapists, sex therapists, and individual counselors who are available to help you work through the emotional impact of painful intercourse.
3. Use lubrication: Lubricants are over-the-counter products whose purpose is to make intercourse more comfortable by keeping everything – well, lubricated. Vaginal moisturizers are also often used regularly, where lubricants are specifically for intimate encounters.
4. Engage in relaxation and more foreplay before intercourse: Women typically take longer to become aroused than men. Foreplay is incredibly important to increasing genital blood flow and natural lubrication. As women age, it may take even longer to become aroused. Some women may benefit from the use of genital vibratory stimulation (a vibrator) to increase genital blood flow and arousal. There are reputable companies that you can connect with to get more information such as Intimate Rose.
5. Engage in healthy lifestyle behaviors: Eating the “Standard American Diet” (S.A.D.) that is rich in sugar-sweetened beverages, candy, cookies, pastries, and other junk food, increases the risk of sexual dysfunction. Similarly, being too sedentary, smoking tobacco, and excessive alcohol use can also lead to sexual dysfunction. If the cells lining the insides of your blood vessels are unhealthy (which happens with unhealthy lifestyle behaviors), you are more likely to have decreased blood flow, arousal, and lubrication. What you eat and how you move matters….even for your sexual wellbeing.
6. Ask about a referral to a pelvic floor physical therapist: Pelvic floor P.T.s have special training in helping women with issues such as painful intercourse. If you are struggling with painful sex, talk to your certified nurse midwife or doctor about whether or not seeing a pelvic floor P.T. may help. They can help women with strengthening or relaxing their pelvic muscles and support women who are dealing with other types of sexual dysfunction that can make sex painful. 

If sex is uncomfortable, you don’t have to suffer in silence. As women’s health experts, our team at Diana Health is here to help you figure out the underlying cause and address it. We are here to empower you! We are here to help you so that you can experience the pleasurable sex you deserve.