The reasons for experiencing pain during sexual activity can be very numerous. For this phenomenon, a special medical term has been coined — dyspareunia. This concept includes constant or recurrent genital pain that occurs just before intercourse, during, or after it.
It should be noted that intercourse specifically refers to vaginal penetration, so pain can be caused by the penetration of the penis, fingers, sex toys, and even tampons.
How this pain is felt
The pain itself can be felt in various ways.
- Pain only during the penetration of the penis or phallus.
- Pain with any penetration, including the insertion of tampons.
- Pain deep in the pelvic area during penetration.
- Burning or aching pain.
- Pulsating pain that continues for long hours after intercourse.
Pain sensations can also be divided this way:
- primary pain — a situation in which a woman experiences pain throughout her sexual life;
- secondary — develops randomly at different periods of life;
- complete — a woman experiences pain throughout the entire act of intercourse;
- situational — arises from a specific partner or a certain type of stimulation;
- superficial — felt only during penetration;
- deep — the pain focus is located in the cervix or lower abdominal cavity, felt during or after penetration;
- pain during intercourse that occurs without direct physical impact (may have a psychological origin).
How common is this phenomenon
According to various data, dyspareunia affects a third of women at different times in their lives. The difficulties with a more precise assessment are that, firstly, many women do not consider pain sensations an abnormal component of sex and therefore do not consult a doctor. Symptoms of others are often overlooked by doctors themselves.
Some studies Pain experienced during vaginal and anal intercourse with other-sex partners: findings from a nationally representative probability study in the United States show that 30% of women experience pain during vaginal sex, others report that 8–21% specifically refer to diagnosed dyspareunia, and 15% have it in a chronic form. Finally, 30% of women experience Consultation about Sexual Health Issues in the Year after Childbirth: A Cohort Study constant pain during sex one year after giving birth.
In Russia, the situation is similar. Medical science candidate, obstetrician-gynecologist Tatiana Rumyantseva reported that about 30% of women seek medical help with complaints of unpleasant sensations during sex.
Frequent causes of pain
1. Lack of lubrication
Most often, vaginal dryness is due to insufficient foreplay. However, there are other reasons: hormonal imbalance or taking medications. These include antidepressants, blood pressure medications, sedatives, antihistamines, and some contraceptives.
A drop in estrogen levels after menopause, childbirth, or during breastfeeding can also be a reason.
If you are not taking the aforementioned medications, have had a blood test for hormone levels, then try extending the foreplay.
Clinical professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine Dr. Jane Minkin says that it takes at least 20 minutes to produce enough lubrication.
This time is necessary for the labia, clitoris, and vaginal canal to start becoming erect. It is possible that a woman is naturally lacking in lubrication: one way to address the issue includes using water-based lubricants.
2. Surgery, trauma, irritation
This can be trauma from an accident, pelvic surgery, episiotomy (a cut in the vagina during childbirth to enlarge the birth canal), female circumcision, anatomical changes such as endometriosis, ovarian cysts, or surgical scars.
All of this can cause very painful sensations, especially if there is a wound that has not fully healed.
In this case, you will have to refrain from vaginal sex, take time for proper treatment, and resume sexual activity only when the doctor decides that the wound has truly healed or the trauma will not be a concern.
3. Inflammation, infection, irritation
An infection in the genital area or urinary tract can lead to painful intercourse. Eczema, allergic reactions, irritation from new soap, inflammation, and irritation from thrush — all these are also reasons why penetration into the vagina becomes painful.
If irritation arose after starting everyday use of something new, it's advisable to remove the new item and see if the irritation or allergic inflammation subsides. Here’s what can cause such symptoms:
- perfumed soap;
- douching;
- vaginal perfumes;
- baths with foam or bath bombs;
- fragrant toilet paper;
- thongs or other narrow synthetic underwear.
4. Vaginismus
Vaginismus is painful spasms upon opening the vagina. It can be an involuntary response to stimuli such as a painful previous sexual experience, experienced violence, unresolved conflicts regarding one's sexuality (for example, strong complexes), feelings of shame regarding sex due to conservative upbringing.
This condition means that involuntary contraction of the vaginal and pelvic floor muscles can be so strong that it’s impossible to insert even a tampon into the vagina.
Dr. Shannon Chavez, a licensed clinical psychologist and certified sex therapist, says that since the muscle contraction is involuntary, it can occur even when a person is aroused and wants to have sex. According to her, many women with vaginismus do not share this with either doctors or loved ones.
Vaginismus can be caused by both physical and psychological factors or a combination of both. A gynecologist can help relax or retrain the muscles. Most likely, assistance from a psychologist or psychotherapist will be needed to cope with the anxiety and stress that intercourse causes.
5. Congenital anomalies
For example, there is Mayer-Rokitansky-Küster-Hauser syndrome, a rare disorder of sexual development where there is a complete absence of a properly formed vagina or absence of a vagina altogether. Or a person is born with incomplete reproductive organs.
In these cases, attempts at penetration can be very painful. According to Dr. Minkin, treatment will involve surgery or the use of vaginal expanders.
6. Atrophy of vaginal muscles due to menopause
Pain caused by the atrophy of vaginal muscles (thinning of its walls) is common among postmenopausal women who do not take medications for estrogen replacement.
The secretion of natural lubrication completely depends on the level of estrogen changes. The quickest solution to the problem is using estrogen vaginal cream. But of course, you need to consult a doctor and choose the most appropriate solution jointly with them.
7. Interstitial cystitis
This condition refers to chronic inflammation of the bladder without any known cause. Painful intercourse is a common symptom.
A doctor may perform cystoscopy (a procedure for the internal examination of the bladder) and stretch the bladder wall to try to improve the patient’s condition. Other treatment methods include rinsing the bladder with dimethyl sulfoxide, as well as oral medications.
8. Vulvodynia
This condition causes chronic pain in the vulvar area. Moreover, according to Dr. Minkin, pain occurs not only during penetration but also with any other actions that put pressure on the vulva. For instance, biking or even just sitting.
Minkin says that doctors do not know the exact medical reason but believe it may be due to nerve inflammation, which causes hypersensitivity and pain.
There is no treatment for vulvodynia, but it may be possible to alleviate symptoms. This is quite a common phenomenon, affecting up to 9% of women at some point in their lives.
9. Endometriosis
Endometriosis is also one of the most frequent causes of severe pain deep in the pelvic area during sex.
It takes an average of Endometriosis fact sheet 9.28 years for a woman to finally receive this diagnosis and treatment. This data comes from a scientific study Women’s Sexual Pain and Its Management that discusses how women endure these nine plus years:
“Anyone who constantly encounters complaints of dyspareunia knows that women tend to continue sexual contact, if necessary, just by gritting their teeth.”
Endometriosis occurs when the tissue that constitutes the uterus grows on other organs, and the pain during sex from endometriosis is among the strongest.
Endometriosis cannot be cured, but hormonal therapy or surgical intervention may be used to improve the condition.
Besides endometriosis, chronic pelvic pain can be caused by tissue scarring from infections, uterine prolapse, pelvic inflammatory disease, fibroids, ovarian cysts, and so on. Dr. Minkin believes that deep pelvic pain is definitely a reason to see a doctor because you may need to remove fibroids or cysts.
10. Uncomfortable positions in sex and a large partner's penis
It is possible that you feel comfortable and good in some positions, but others cause pain during penetration, especially deep penetration.
In this case, it is important to communicate with your partner about it to search together for new, comfortable positions for both of you.
A large penis or phallus can also cause discomfort and pain. However, Dr. Minkin says that it is unlikely that the penis is "too big" for the vagina or that it will damage the cervix. After all, the vagina can accommodate the head of a baby with a diameter of 10 centimeters.
In this situation, using more lubrication and avoiding positions in which penetration is too deep and causes pain may help.
11. Psychological problems
Fear and anxiety related to penetration can create a mental barrier. This, in turn, can lead to unconscious tension of the pelvic floor muscles during sex, which creates a physical barrier to penetration.
You may have had a negative sexual experience, experienced sexual violence, harassment, boundary violations. In such cases, the body anticipates pain and discomfort during sex, and the brain shifts into combat mode.
According to Dr. Chavez, low self-esteem and body acceptance issues can also diminish arousal and cause tension or a nervous reaction during sex.
In this situation, overcoming these psychological barriers will entirely depend on your willingness, as it will require effort on your part. Only you decide whether you are ready to consult specialists and undergo what is likely a lengthy therapy.
Why it is worth consulting a doctor for any discomfort
In Russia, according to gynecologist Tatiana Rumyantseva, in the overwhelming majority of cases of dyspareunia, the cause is inflammation of the vaginal mucosa, diseases of the pelvic organs and adjacent organs, atrophic changes of the mucosa. Vaginismus and vestibulodynia (a type of vulvodynia — Ed. note) are rare but require special attention due to difficulties in diagnosis and treatment stages.
According to Rumyantseva, one should not postpone a visit to the gynecologist:
“Any pain during sexual contact that interferes with pleasure (especially if such sensations were not previously experienced) is a reason to consult a doctor.”
Also, bleeding or unusual discharges after intercourse is a reason to make an appointment. The main cause can be identified by a gynecologist, but later, you may need the help of a psychiatrist, psychologist, or urologist, depending on the primary cause of your condition.
Typically, pain during penetration does not require emergency help, but seek it if the following symptoms arise:
- a new attack of pain or sensations sharper than before, lasting longer than a few minutes;
- bleeding in combination with pain;
- nausea, vomiting, or rectal pain;
- changed discharges.
It is also important to mention that the internet often suggests using anesthetics in such cases to continue sexual intercourse.
Tatiana Rumyantseva commented on such recommendations: “Since the causes of dyspareunia are numerous (and most require treatment), prolonged self-administration of anesthetics is not recommended, as this may lead to the progression of the underlying disease (for example, endometriosis, vaginitis, and others), in which pain during sex is one of the symptoms.
Anesthetics can mask a serious problem for an extended period, so their temporary use is only possible until the cause of pain is determined.
If "true" dyspareunia is diagnosed, then anesthesia does not fall into treatment standards and is not an effective means.”
