Life is full of little pains and stressors. If there’s one place where stress and pain should melt away, it’s in the bedroom. Sensual pleasure is one of the few free, healthy rewards we can give ourselves and our partners, but when sex becomes the cause of pain, our mental and physical states can suffer. Vaginal or vulvar discomfort can range from a slight chafing or burning sensation to tear-inducing, excruciating pain. No matter the intensity, your body is trying to tell you that something isn’t up to health standards.
The best way to diagnose the cause of painful sex is with a visit to a gynecologist. Always get a professional opinion on your health before attempting to cure yourself at home. Often the solution is simple and effective but involves a round of medication or a change in diet or lifestyle that are better left to the discretion of a medical doctor.
Before you assume the worst, check out our list of some of the most common causes of pain during sex (and then get your doc on speed-dial).
STIs
STIs, or sexually transmitted infections, are illnesses of the genitals or reproductive organs that are contracted through unprotected partner sex and usually curable with medication. They’re generally spread through contact with another person’s genitals or sexual bodily fluids, but this doesn’t mean you’re in the clear if you avoid a partner’s penis or vagina.
Some STIs can be spread from mouth-to-genital contact, or from your partner touching their genitals with their hands and then touching you. STIs contribute to painful sex by irritating the tissue inside the vagina and around the vulva. A prescription of pills coupled with a topical cream is usually enough to clear up infections.
Vaginal Infections
There is scarcely a vagina that hasn’t battled with excess yeast or unwanted bacteria, and the same goes for urethrae and urinary tract infections. Similar to STIs, a visit to a health professional and a prescription is usually enough to kick the itching and pain within a couple weeks. Bacterial Vaginosis, yeast infections, and urinary tract infections all disrupt the sensitive balance of good bacteria and pH levels within your body.
The achy or itchy tissue is telling your brain to take action. Your local Planned Parenthood can usually fix these issues in a pinch with a walk-in appointment if your regular doctor is overbooked.
Vaginismus
Involuntary tightening of the muscles around the vagina is referred to as vaginismus. There is usually no physical cause. It is a distressing condition that can potentially stop your sex life, cause relationship problems or even prevent you from starting a family.
The severity of symptoms can vary from woman to woman. At one extreme, some women are unable to insert anything into the vagina, including tampons or having sex. Others may tolerate penetrative sex, but experience burning or stinging sensations. Vaginismus is involuntary and is triggered by the fear of pain. The vaginal muscles tighten up as a protective mechanism.
In the majority of women, a physical cause for the vaginismus cannot be found. There is usually an association with unpleasant past sexual experiences such as rape or sexual abuse. Memories of clumsy and painful sexual encounters at a young age may also trigger vaginismus. Feelings of guilt and shame around sex are also contributory, as may occur with strict upbringing or with cultural and religious taboos. The fear of getting pregnant and other psychological problems have also been associated with vaginismus. Other physical causes of painful sex must be differentiated from vaginismus. These may include infections, vaginal dryness, trauma from childbirth and other disease conditions like endometriosis. Sometimes there are oversensitive nerves at the vaginal opening, a condition called vestibulodynia, which usually presents with severe pain.
Women experiencing vaginismus symptoms should make arrangements to be seen by either their family doctor or a gynecologist. Personal questions may be asked, and if necessary, you can always request to be seen by a female physician. An examination will be necessary to exclude other conditions, and in some cases, a referral to another specialist may be suggested. It may be helpful to bring your sexual partner along.
Treatment of vaginismus often involves a team of specialists. Self-help techniques may be the starting point. You can be taught how to use graduated vaginal trainers in the privacy of your home. They are useful in helping relax the vaginal muscles, allowing a gradual tolerance for penetration. Relaxing and touching techniques with a bath, massage, and breathing exercises are a good way of knowing your body. You may require a physiotherapist to teach you pelvic floor exercises that help relieve vaginismus symptoms. If other physical conditions such as infection or vestibulodynia are present, concurrent treatment should be offered. Very few cases of vaginismus require surgery as a treatment option. It may only be used if another condition amenable to surgery is contributing to the vaginismus.
Referral to psychosexual specialists is often beneficial. Counseling usually helps with underlying psychological issues, fears, and anxieties. Cognitive-behavioral therapy (CBT) changes any irrational and incorrect beliefs you may have about sex. Patience is often required, as complete cure tends to take several weeks or months.
Sexual Positioning & Lubrication
If your doctor issues a clean bill of health, a lack of good lubrication or awkward sexual positioning could be to blame. Even if it feels like your vagina is properly lubricated, it might not be enough to fully reduce the friction created during intercourse. In short, it never hurts to add a little extra lube. Sexual positioning is also a big comfort factor, especially during certain times of the month.
Right after your period and immediately following ovulation, the sensitive cervix will harden and hang lower inside the vagina, making it more susceptible to being bumped during penetration.
Some women are born with a tilted cervix that might make deep thrusting consistently uncomfortable. Getting in at least 20 minutes of foreplay can help remedy cervix pain since the entire uterus lifts with proper arousal in a phenomenon called ballooning or tenting. However, if something feels not-quite-right even after you’re warmed up and well-lubricated, try a sex position that allows for more control over penetrative depth, such as woman-on-top.