Let’s End This Debate. Pain with Sex: Common or Normal?

Let’s End This Debate. Pain with Sex: Common or Normal?

Three in four women* experience pain during sex at some point in their lives—that’s most of us, so you are not alone! There’s even a clinical umbrella term for this, dyspareunia, or frequent pain during intercourse, which involves feeling pain at any point just before, during, or after sex.

(Also, we’re using the term “sex” here to mean intimacy of any kind with another participant/s. Often "sex" is used synonymously with penetrative sex between a penis and vagina, but really has a much bigger definition and is not restricted to specific body parts, participants, or actions).

What can pain with sex feel like?

This can manifest as several different symptoms including burning, stinging, sharpness, or extreme tenderness. Pain may be located in the outer genitals (vulva), within the vagina, or deep in the pelvis. Some will feel pain only during penetration, while others may feel discomfort when using tampons—menstrual cups and discs could also cause discomfort. Pain may be experienced deeply with each thrust, or the pain may emerge slowly following sex. Some even feel continued throbbing or burning pain long after intercourse has ended.

What is causing this pain?

There are several reasons why you might feel pain during sex but one of the most common is vaginal dryness. Low estrogen levels can cause vaginal dryness, which is a primary concern for those going through menopause as levels naturally decrease at this time. Your estrogen levels also drop right before you menstruate, so sex might be less lubricated and therefore more painful during that time as well. Reduced sexual activity and antihistamines can be contributing factors here too.

Other causes to be aware of

If dryness isn’t your issue, consider the following:

  • Skin diseases in the genital area—eczema and psoriasis
  • Conditions like endometriosis, pelvic inflammatory disease, bladder prolapse and infections of the urinary tract, vagina, or reproductive organs
  • Certain cancer treatments
  • Injury to the pelvic area from childbirth
  • Reconstructive surgery
  • Damage to the pudendal nerve—this supplies sensation to the vaginal area as a major nerve in the pelvis
  • Musculoskeletal complaints like arthritis or tight hip or pelvic muscles

If you think you might have any of the above-mentioned conditions, talk to your doctor to see if you can get a definitive diagnosis and treatment plan.

Is there anything I can try myself?

Yes! There are a few lifestyle and self-care options you can try and see what works best for you. Below are our top three.

  1. Lubricant – Probably the most recommended by doctors and depending on the type you get, totally safe! Nonhormonal lubricants and moisturizers may help reduce friction and pain during intercourse. Water-based is always best and avoid fragrances, as this can be an irritant. If you’re looking for a more inexpensive option, or just want to use something you might already have on hand, you can try vegetable oil—coconut oil is fairly popular. *Note: oils and oil-based lubricants can weaken latex and should not be used with condoms.
  2. Change up your techniques – Extend foreplay to increase moisture in the vaginal tissues before intercourse. Stay here as long as you need—communicate with your partner about when you’re ready. Speak up about what does and doesn’t feel good. Our partners aren’t mind readers, so it’s best not to assume they automatically know what we want/need.
  3. Use it or lose it – Frequent sexual activity can help stretch and strengthen muscles and increase blood flow and lubrication to the area. Of course, if it’s still too painful, don’t force it. *Pro tip: your cervix secretes mucus around the time of ovulation, so you’ve got natural lubrication on your side then.

My pain isn’t responding to lifestyle changes and self-care techniques

Sometimes taking things into our own hands doesn’t pan out the way we hoped it would. That’s okay! That’s what your healthcare provider is there for. Based on their diagnosis they may recommend one of the following treatments:

  1. Pelvic floor physical therapy – Many women with vulvar pain have tight or weakened vaginal and pelvic floor muscles. The weakening can be a result of aging, childbirth, excess weight, hormonal changes, and certain physical strains. They can also tighten in response to genital pain. Physical therapy can help to reduce tightness and improve muscle function.
  2. Vaginal estrogen – Topical, low-dose estrogen helps most women with vaginal atrophy and is also recommended in some cases of vestibulodynia and vulvar skin issues. Application topically releases little estrogen into the bloodstream, so it carries less risk of side effects than systemic estrogen. *You can also add estrogen boosting foods to your diet!
  3. Lidocaine – Your doctor can prescribe this numbing agent that may help ease sexual discomfort when applied as an ointment to the vestibule before and after sex. *Note: application could affect your partner—chat with your doctor about how to avoid this.
  4. Counseling/therapy – Sometimes anxiety around sex being painful or poor communication in a relationship can be a bigger factor than you think. Painful sex can put strain on a relationship as well. It may be beneficial to talk to a professional counselor or a sex therapist.
  5. Surgery – This is the last resort your healthcare provider will go to. Those with stubborn or severe vestibulodynia may want to consider an outpatient procedure called vulvar vestibulectomy—this removes some vestibular tissue.

Pain with sex, while fairly common, should not be considered normal—aka something you just have to live with. Nor should it be something you are forced to live with. There are many reasons why sex is painful for you and most respond to lifestyle and self-care options or medical treatment. Instead of normalizing sex being painful, let’s take back the narrative, call it common, get the help we deserve, and make sex pleasurable again.

*In this article "women" refers to anyone who identifies as such. Dyspareunia (painful sex) can happen in many intimate situations.

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