Let's start by saying that I bet if I asked to see raised hands on whether you've ever felt a sharp, burning or cramping pain during sex, I'd see a lot of hands in the air.
We know that moms are having less sex lately, but whether you’ve had a baby or not, pain during sex is, unfortunately, highly common.
“Even though women feel this way, we're told that it’s normal,” says Alexandra Fine, Founder and CEO of Dame Products. “If we think about the overall narrative of what it's like to have sex for the first time, women are told it's going to be or might be painful.”
But pain during sex is *not* normal. Here’s what to know about what could be causing your pain, and how to bring up the discussion with your partner and your doctor—because you deserve to enjoy pain-free sex.
What is pain during sex?
Generally, pain during sex for people with vaginas is referred to as dyspareunia. Dr. Sarah Bjorkman, MD, board-certified OB/GYN, explains dyspareunia as the medical term for “recurrent or persistent genital pain that happens just before, during or after intercourse.”
However, within that definition, there is a lot of variation. “It can then be classified as superficial or deep, primary or secondary,” she says.
Dr. Bjorkman explains these distinctions as:
- Superficial dyspareunia, also referred to entry dyspareunia, is pain localized to the vulva or vaginal entrance
- Deep dyspareunia is pain that happens with deep vaginal penetration and is perceived inside the vagina or lower pelvis
- Primary dyspareunia occurs with the first sexual encounter
- Secondary dyspareunia begins after previous sexual activity was not painful
Although it’s estimated that 10% to 20% of the population is dealing with dyspareunia, Fine says that understanding just how many people are truly affected by dyspareunia can be difficult, as it’s likely under-diagnosed. “Personally, I know a lot of women report feeling dismissed when they bring this up with their caregivers. It is really unfortunate, and women feel that their concerns are invalidated,” she shares.
To get down to the root cause of what’s causing your pain, it’s important to notice how and when you feel pain during sex. By paying attention to certain triggers or sensations, you can then be better prepared to discuss your issues with your healthcare provider.
Common causes of pain during sex
When it comes to finding the cause of your pain, Dr. Sarah Bjorkman lists common culprits, including:
- Superficial issues on the vulva and/or vagina, such as
- Skin disorders
- Underlying disorders, such as
- Ovarian cysts
- Uterine fibroids
- Interstitial cystitis
- Irritable bowel syndrome
- Musculoskeletal/pelvic floor dysfunction
Beyond these possibilities, pain during sex can also be linked to poor vaginal lubrication, aging and childbirth.
Additionally, the relationship between your mental and sexual wellness can also be contributing to your pain. Anxiety, depression, stress and trauma can all negatively affect the way you experience sex.
When should you seek treatment?
If sex is causing you distress in any way and you want to be having sex that’s not painful, then it’s an issue that deserves treatment, says Fine.
Because there are so many causes of dyspareunia, there isn’t one treatment that will work for every person experiencing it. But finding something that helps is important for maintaining wellness. When you visit your doctor, come prepared to answer questions about your sexual history, as well as what kind of pain you’re experiencing and when it occurs.
In addition to mental health issues causing dyspareunia, the reverse can also happen: dyspareunia can sometimes create mental health issues.
“Dyspareunia can have a major impact on a woman’s physical and mental health,” says Dr. Bjorkman. “[It can] affect relationships with partners, ability to conceive, body image and self-esteem, so it’s incredibly important to talk to your doctor if you are experiencing this.”
Finding relief from pain during sex
Although the causes and treatments outlined by your doctor will vary, there are some ways you can make sex less painful. By looking for ways to promote wellness, you might be able to enhance the treatment options set forth by your healthcare provider.
Try sex without penetration
If penetration is causing pain, you can still enjoy sex and intimacy with your partner without it. Oral, mutual masturbation, and massages will still promote sexual intimacy as you treat the source of your dyspareunia.
Try pelvic floor therapy
Fine is a big proponent of working with a pelvic floor therapist, citing it as “one of the best ways to go about fighting dyspareunia.”
“It has a lot to do with practicing a new movement over and over again, and learning how to relax your pelvic floor and tighten your pelvic floor. I’m actually doing it as we are talking about it!” she says, emphasizing the simple tips from PT—like breathing techniques and how to contract your muscles—can be helpful after just one session.
Try mental health therapy
For some of us, sex can be linked with a lot of negative emotions, including poor body image, sexual trauma and abuse, and anxiety and stress. By finding a professional to talk to, you can learn methods to deal with these emotions and triggers in order reevaluate your relationship with sex and find pleasure.
Try communicating with your partner about it
As Fine notes, one way to minimize pain during sex is to talk to who you are having sex with about what exactly you’re feeling.
“Being able to speak up when you’re having that pain, so you can stop having it, is also really important,” she shares. “Simply saying, ‘Hey, this hurts. I don’t want to be having sex anymore,’ is easier said than done in the moment.”
But by varying sex positions or introducing sex toys, you can learn new ways to both increase your sexual pleasure and decrease pain.
Try increasing lubrication
Vaginal dryness is something that can happen in many different kinds of people, from new parents to those who are approaching menopause.
“Using lubricant is essential. Researchers have found that one of the most common reasons why we’re having painful sex is just because we’re not lubricated enough,” says Fine.
“Use lube, so much lube! Sometimes [sex without lube] can create a burning sensation—and people don’t realize that is actually caused [by] dryness. Using lube is very helpful—and the quickest fix for painful sex.”
How to talk about pain during sex
Currently, the data on pain during sex is inconsistent and underreported since many people don’t know how or when to define it. Some might be embarrassed to talk about sexual pleasure with their doctors, while others might just expect pain to be a natural part of penetrative sex.
But it doesn’t have to be this way.
“I think there is a real gendered gap in how we understand sex,” says Fine. “There’s this notion that for men, sex is supposed to be pleasurable, and for women, they don't expect sex to feel pleasurable always.”
As our understanding of both sexual pain and pleasure increases, the language around it does, too. “I think the trend is moving more toward describing dyspareunia under the umbrella of female sexual pain (FSP) disorders, or vulvovaginal or pelvic pain that is provoked or exacerbated during sexual contact. Dyspareunia specifically, or pain with penetrative intercourse, is one type of generalized pain disorder,” adds Dr. Bjorkman.
But beyond how it’s defined, she stresses, “If you have recurrent pain during sex, you should talk to your OB/GYN! Your sexual health is really important, and there are treatment options that can help.”
Dr. Sarah Hartwick Bjorkman, OB-GYN and Motherly’s Maternal Health Advisor
Alexandra Fine, CEO and founder of Dame Products and licensed sexologist