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Painful Sex

Written on . Posted in Sexual & Reproductive Health.

Painful Sex

Painful sex involving the vagina, vulva, or pelvic area is a common problem. 3 out of 4 people with a vagina will experience it at some stage in their life. For some this pain may be temporary, while for others it may be a longer-term problem Sex is a normal and enjoyable part of many people’s lives and is often an important part of a relationship. Pain with sex can be upsetting and can lead to avoiding sex and intimacy, which in turn can affect your relationship.

Where Can The Pain Occur?

Pain with sex can occur on the outside genital area (the vulva), in the area surrounding the vagina, just inside the vagina itself, or deep within the vagina or pelvis. It can occur just before, during, or after sexual activity.

What Types Of Pain Are There?

  • Irritation
  • Burning
  • Stabbing
  • Aching
  • Throbbing
  • Cramping

The pain can be mild, moderate, or can be severe enough to prevent any sexual activity. Pain with sex can happen just once, can be short term, recurrent, or long term.

What Causes Painful Sex?

Painful sex can have a lot of different causes, although sometimes a physical cause cannot be found.

  • Pain in the vulval area may be caused by infections such as thrush, a skin condition such as dermatitis, changes to the skin that can occur after menopause, or the cause may be unknown.

  • Pain at the entrance to the vagina when penetration with a penis, finger or sex toy is attempted can have several causes including:

    • Lack of lubrication
    • Lack of sexual arousal
    • Infections or skin conditions
    • Spasm of the pelvic floor muscles (this is called vaginismus)
    • The presence of damage or scarring following childbirth or surgery
    • Changes that can occur after menopause
  • Pain on deep penetration may be caused by:
    • Lack of arousal
    • Infection
    • Conditions related to the ovaries such as ovarian cysts
    • Endometriosis
    • Lower back problems
    • Bladder or bowel problems
    • Sexual positions that involve deep penetration

  • Pain can also be due to how the nerves in the genital and pelvic area respond to touch, and how the brain interprets messages from these nerves. This can happen with no tissue damage and with no specific known cause.

  • Emotional or psychological causes of pain are common and may be a part of the picture, or a cause of the pain. 

 How can I get help?

If you experience painful sex, it is important that you see a doctor who has a special interest in this area. They will be able to help you with tests to identify any possible causes, to prescribe medication if needed, or to refer you to other medical specialists such as dermatologists and gynaecologists

Managing painful sex usually means receiving care from a few different health professionals. The doctor will discuss this with you, and will explain the role of pelvic health physiotherapy, psychological and counselling support, and sex and relationship therapy in managing your situation.

Seeing a pelvic health physiotherapist

Painful sex can contribute to, or be a result of, a change in the way the pelvic floor muscles, tendons, and ligaments work. For example, involuntary muscle spasm can occur, which can lead to the pain continuing or increasing. Pelvic health physiotherapists are specially trained to work with these issues and are skilled at assessing this and helping you to resolve the problem.

Counselling support

Emotional, psychological, and relationship factors play an important part in painful sex. They can be a cause of pain in sex or can be part of the problem.

Counselling with an experienced sexual and relationship counsellor can be very valuable in improving the situation for you and your partner. Counselling with an experienced sexual and relationship counsellor can be very valuable in improving the situation for you and your partner.

  • Self-help strategies There is a lot that you can do yourself to improve your experience of sex.
  • Talk to your partner about what you like, and what does and doesn’t feel good for you.
  • Create good conditions for sex such as:
    • Making special time for it.
    • Allowing some time to unwind and relax first.
    • Making sure that you are comfortable, and that the room is not too cold or too hot.
    • Not feeling rushed and making sure that you cannot be disturbed (have a lock on the door if you have children or housemates who may interrupt you).
    • Drawing the curtains or dimming lights if desired.
    • Putting on some music if that feels good.
    • Turning your phone off.
  • Empty your bladder before sex because having a full bladder can feel uncomfortable during sex.
  • Use plenty of lubricant. If you are using condoms make sure it’s a water-based lubricant. Some lubricants are also vaginal moisturisers which can be helpful. If you are not using condoms then a pure food grade vegetable oil such as sweet almond oil can be an excellent lubricant, as well as a good vaginal moisturiser.
  • Talk about what you want, if you just feel like some pleasurable touching then talk about that with your partner. If penetrative sex feels too difficult then discuss something else such as mutual masturbation, oral sex, or just sensual touching or massage. Intimacy does not have to involve penetration.
  • Allow yourself to focus on sexy thoughts. Read or look at something sexy.
  • Try let yourself be present in the moment and not get hooked by anxious or stressful thoughts-just notice the come and go. Focus on your body and any pleasant sensations you are feeling. Your attention will naturally drift, and thoughts will come in, just notice these thoughts again and gently refocus your attention back on your body and on pleasant sensations. Being present in the moment like this can be a very helpful skill in managing pain and increasing pleasure during sex.
  • Make sure that you have plenty of pleasurable touch and foreplay and feel ready for sex before attempting any penetration.

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