In our culture, women’s sexuality isn’t often talked about honestly or openly. We’re either keeping it totally private or glorifying the experience to a point that is unrealistic. So as women, we either feel the pressure to keep mum or to boast about our exciting and perfect sex lives. And if something doesn’t feel right, it’s hard to know who to talk to.
Painful sex is actually a common experience for women, with up to three out of four experiencing painful sexual activity in their lifetime. Often, they have a sense that it’s the normal thing—something to be expected. But while pain with sex is common, it is not normal. And it can be helped.
There can often be a sense of shame associated with painful sex. For some, pain with sex will be brief and reversible; for one in six women, the pain will be significant.
The most common type of painful sex is called dyspareunia, which means pain associated with sexual intercourse. I often hear from patients at the end of an exam or another routine appointment that their sexuality is of concern. But because pain with sex is more than a peripheral issue and one deserving of our focus, I like to have an appointment treating it that way, talking in-depth about history — medical and personal — and potential treatments. A physical exam is usually part of the process, but we work sensitively with each patient at their comfort level, as underlying trauma can often be linked to painful sex.
Painful sex can happen at any age. Women who are younger and pre-menopausal could be experiencing vulvodynia, which is a nerve disorder, or possibly a hormonally-driven disorder called endometriosis. Those post menopause may have pain or dryness due to loss of hormones, muscle or pelvic floor issues. Women who’ve recently given birth may also experience a hormonal shift with low estrogen levels affecting tissue sensitivity. There can be several underlying causes, and at that first appointment we’ll try to narrow down the source.
Once identified, treatments will vary. It’s about your body and your origin of discomfort. If the cause is hormonal, there are plenty of products to restore healthy hormone levels again. Other times, treatment may be multidisciplinary, involving physical therapy, possibly dilator therapy and psychology.
There are some things you can try at home, such as:
- Increasing partner communication. Talk before, during, and after sex. What felt good? What didn’t?
- Trying effective, non-irritating lubricants. If using condoms, choose water-based or silicone lubricants. Natural oils can also be used if condoms are not required. (Learn all about lubricants >)
- Focusing on arousal. This is not just about lubrication! It’s also about increasing blood flow to the genitals and elongation of the muscles and connective tissues there.
- Playing with other sensual activity. If vaginal penetration is the main source of pain, try other intimate activities.
- Relaxing before sex. A warm bath or mindfulness practice can help relax your body and mind.
Ultimately, we know pain during sex is common but that doesn’t mean it has to be accepted. Our sexual function permeates so much of our well being and even minor interventions can make a big impact. The longer the pain goes on, however, the more it becomes a pattern and an unnecessary side effect of intimacy.
With the right assessment and care plan, we know women can feel assured about their bodies — and feel great while having sex.