When Having Sex Hurts

It has widely been acknowledged that modern sexual education is far from comprehensive. Too often, sexual education focuses almost exclusively on reproduction, contraception, and STI prevention; which are all important and necessary discussions. However, there is little room for an open dialogue surrounding pleasurable as well as joyous sexual experiences. Or room for an open dialogue on what to do when sex just isn’t working out and when having sex hurts.

By glossing over these aspects of human sexuality, a lamentable and often inadvertent message is sent. That sex should and always will be easy. What’s more, if you find that sex is not so simple, then something must be inherenetly wrong with you. 

But the reality of sex is far from this idea that sex is and always will be “easy” or “simple.” For many, sex is an increasingly difficult subject to approach. Sex is perhaps one of the most widely talked about topics and yet sexual dysfunction and pain during sex are left largely ignored.

If sexual dysfunction is brought up, it is usually described as a problem experienced later in life and certainly not at the beginning of one’s sexual experiences. In truth, sexual dysfunction can happen at any age and to anyone, including to individuals who have previously experienced pleasurable sex. 

Pain during sex is more common than people realize. Approximately 75% of women report experiencing pain during intercourse at some point in their lives. Pain might be common, but unsurprisingly not many people talk about their experiences. Unfortunately, because there are not a lot of people sharing information about painful intercourse, several individuals continue to struggle silently and are prevented from obtaining the help they need.

Dyspareunia and Vaginismus When Sex Hurts

Dyspareunia is the medical term used to describe pain experienced during sexual intercourse. There are a multitude of reasons why someone may experience painful sex. Physiological and psychological factors may contribute to the development of dyspareunia. For some individuals, dyspareunia occurs after menopause due to decreased estrogen levels in the body. This drop in estrogen leads to vaginal atrophy and may result in discomfort during sex. Others report painful sex following a c-section. Low estrogen levels, scaring, and pelvic floor dysfunctions are a few reasons why someone may experience painful intercourse after having a c-section.

Vaginismus, or pain penetration disorder, refers to a condition in which the outer third of the vagina repeatedly contracts and spasms, which can prevent penetration completely or make penetration exceedingly uncomfortable. Like dyspareunia, vaginismus can be caused by both physical and/or psychological factors. Oftentimes, the pelvic floor muscle spasms are a learned response to a fear-inducing situation. Repeated negative or traumatic penetrative experiences at the doctor’s office, during tampon insertion, or with intimate partners can actually train the pelvic floor muscles to tighten. The nervous system goes into fight or flight mode and attempts to protect the body by preventing the negative situation, in this case, penetration, from happening. 

Individuals who experience vaginismus or dyspareunia can seek treatment. Due to the sensitive nature of painful sex and the various physiological and psychological components that go along with it, managing and treating it is a very individualized experience. No two treatment plans will be the same. That being said, attending physical therapy to relax the pelvic floor muscles is common for those who suffer painful sex.

During treatment, individuals build a therapeutic reliance with their therapist and learn about certain exercises, practices, and even sex positions that can help decrease uncomfortability during intercourse. Psychotherapists and other licensed mental health professionals can also aid with the psychological aspects associated with dyspareunia. Regular therapy can rewire the nervous system to refrain from engaging in a fear response when presented with fear inducing situations such as gynecological exams and penetrative sex. 

The first place to start your treatment plan would be to obtain an official diagnosis from your doctor. Depending on a client’s specific diagnosis and health history, several other providers besides pelvic floor therapists and counselors may be suggested, such as nutritionists, gynecologists, and even dermatologists. Nutritionists can help identify changes to diet that may increase well-being and overall health. Some skin conditions actually contribute to painful sex and for this reason, a client may consider seeking dermatological treatment in conjunction with pelvic floor therapy. In addition to regular visits to healthcare professionals such as those listed above, engaging in relaxing activities such as mindfulness meditation and yoga may be beneficial. 

It is important to remember that every journey will be different, but that there are resources out there. With the help of an empathetic and supportive team of healthcare professionals, painful intimacy can be addressed as well as managed, so that individuals can begin to feel more comfortable with their bodies. 

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