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Why is sex painful?

Let me start by saying that sex, no matter what that looks like for you, should not cause undesired pain. If you’re into spanking or BDSM then, after mutually establishing boundaries with your partner, some controlled pain can be part of the fun, but unwanted pain during sex is not fun and is a debilitating problem for many people.

Pain with vaginal penetration is called dyspareunia and occurs with more than just penis-vagina sexual intercourse. It can occur when anything is inserted into the vagina including a finger, tampon, or speculum. With dyspareunia, pain can occur at the opening or deep inside the vagina. It is often described as burning, stabbing, poking, or hitting a wall and can last only during the activity or continue for hours or days afterwards.

Pain can be caused by a variety of factors, but the most common are:

  • Vaginal dryness due to hormonal changes

  • Pelvic floor tension due to muscle overactivity, fear, worry, or stress

  • Prolapse

Vaginal dryness is a result of changes in estrogen and testosterone hormone levels. Yes, women have testosterone, too. This hormone is vital in the vaginal walls as it is converted to estrogen and used to produce vaginal lubrication. Hormonal changes can be due to pregnancy, breastfeeding, or menopause where normal biological changes are occurring in our bodies. Vaginal dryness can also occur with birth control, specifically low dose oral birth control. We are still learning how this happens but recent research has shown that these medications can decrease free testosterone and change the balance of estrogen and progesterone in our bodies reducing lubrication. Many people who have gone through chemotherapy and/or radiation to the pelvic area also report vaginal dryness. This is in part due to the medications and partly due to the tissue healing from radiation.

The treatment for each of these causes can begin with something as simple as adding a lubricant to your sexual activities. If you’d like more information on lubricants, get my free guide here. Changing your birth control or using a vaginal estrogen cream can also improve dryness. If your dryness began after treatment for cancer, using a vaginal moisturizer without hormones in it is typically the safest option. Replens is a great option for a vaginal moisturizer.

Fear, worry, and stress can increase tension in the pelvic floor, narrowing the vaginal canal and leading to increased pain for you or an inability to tolerate penetration at all. These feelings fire up our fight or flight system and our body naturally wants to protect itself. In order to overcome this fear or stress, working with a licensed mental health therapist is vital to address your concerns. A pelvic health PT can work with you on understanding your anatomy, the physiology of sex, and resolving physical causes of pain. Dilators are often used as part of therapy for people who experience this type of dyspareunia. You can read more about dilators here with this free guide.

Prolapse of the bladder, uterus, or bowel can cause pain and discomfort during sex because the vaginal canal is being partially or fully blocked. Addressing the prolapse is fairly simple and uses gravity to pull the organ into a more optimal position. Lay on your back with your hips resting on pillows. You will probably need 2-3 pillows depending on their thickness. Stay here for 5-10 minutes. You can also do kegels in this position to help with pelvic floor strengthening and support of the organs. Plan to do this shortly before any sexual activity. You may also find that various sexual positions are more comfortable than others and I encourage you to try new ideas and see what works for you.

Even though I've introduced these as three separate reasons for pain with sexual activity, you may find that more than one resonates with you. That is often the case when I am working one-on-one with patients. You can do any or all of these treatments at the same time, but keep track of what works so you know what to keep doing.

Please don’t let pain with sex stop you from having your healthy sex life. Help is available. If you have any questions or would like further recommendations on lubricants or on professional help with mental health services or pelvic health physical therapy, give us a call, text, or email, and we’ll be happy to help you find the treatment that’s right for you to have a healthy, (unwanted) pain-free sex life.

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