Pain during sex: what are the causes and what can you do about it?

One in five women experiences pain during sex. One in twenty women frequently feels pain during sex. These disturbing numbers require an explanation. What can make penetration so painful? And why you should never tell yourself just to bite the bullet.

What is pain during sex?

All too often, pain during sex is common. Usually the pain sets in during penetration, but you can also experience problems with your vagina or abdomen after sex. Some women are in so much pain during or after that they start avoiding sex altogether. That’s definitely not desirable.

Because while painful sex is common, it’s not normal. Some women think it’s just part and parcel of sex, that they shouldn’t complain, and instead just grit their teeth and bear it. Pure rubbish, of course. The pain can cause you to find it increasingly unpleasant when someone attempts to put a finger or a penis inside you. So much so that you may at some point have a full-on aversion to sex.

Symptoms of painful sex

Pain during sex means you frequently have one or more of the following feelings:

• Only pain during penetration
• Pain during any penetration, including inserting a tampon
• Deep abdominal pain when the penis is thrusting inside you
• Burning or stabbing pain, both inside and at the entrance of the vagina
• Throbbing pain that lasts for hours after sex

Deep or superficial pain

If you have pain during sex, you can feel it in several places:

Superficial pain during sex: you often feel this pain at the entrance of your vagina. Usually this is the result of too little foreplay or a dry vagina due to pregnancy, breastfeeding or menopause. Irritations or sores at the entrance to the vagina can also be a cause, as can a vaginal infection or skin condition. Vaginismus is another culprit. In this condition, you tense your muscles involuntarily. This makes penetration painful and sometimes even impossible because your vagina quickly resists any touch.

Deep pain during sex: some women feel the pain deeper or lower in the abdomen. They may notice that the pain is worse with one position than with another. Doggy style, for example, might be torture for these women. This can be caused by certain conditions, such as endometriosis, a prolapse of the uterus, an irritable bowel, or a cyst. Also a tilted uterus, which otherwise is not dangerous, can make some positions simply unbearable. Is this what’s going on with you? Then simply choose positions where penetration is not as deep, such as missionary or you on top.

What are the main causes of painful sex?

Women who experience painful sex usually suffer from a dry vagina, fear of penetration, or infections such as a yeast infection. But there can be numerous physical and mental reasons why you might experience pain during sex. Here’s a list the seven most common causes:

1. You are not moist enough

Although movies sometimes suggest otherwise, sex isn’t as simple as dropping your pants, sliding the dick in, and voilà! Most vaginas are shocked when a penis enters unexpectedly and without foreplay to make them moister. Because wet is the key word when it comes to smooth sex. When you’re aroused, your vagina becomes moist and your pelvic floor relaxes, allowing an erect penis to slide in more easily. You are a bit more open, which makes the whole event a lot more enjoyable. So take time for foreplay, especially oral sex, and make sure you’re horny enough at the moment. Is your vagina as dry as the Sahara even when you’re aroused? Maybe it’s because you’re in menopause? Sing hallelujah for lube!

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2. Your pelvic floor is too tense

Your pelvic floor is like a hammock of muscles and connective tissue under your pelvis. You often tense those muscles unconsciously when you are anxious or stressed. But if you have given birth vaginally, your pelvic floor muscles may have become too tight or too weak. Tena Lady might earn money from weak pelvic floor muscles, but too tight muscles are especially problematic during sex. Sometimes your muscles are so tense that you can no longer get a finger or a tampon inside your vagina. Because of the pain, women often have less desire to make love. As a result, the vagina becomes less moist and the pelvic floor tightens further, making it even more difficult to make love without pain. Tip? Don’t spend too long ignoring issues with your pelvic floor. See a sex therapist or pelvic floor specialist and in the meantime try to strengthen your pelvic floor muscles with vaginal balls or a pelvic floor trainer.

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3. You have a vaginal infection

Is the skin of your vagina red and irritated? Does your vaginal discharge have a different colour or smell? Do you have itching and crumbly bits of discharge in your underpants? Then you may have a vaginal infection. A yeast infection like candida can make sex incredibly painful and cause a burning sensation, but it’s nothing to be ashamed of. So just get over to the chemist’s and get yourself a treatment to quickly restore your vaginal balance. Have you noticed changes in your vagina and are unsure whether it is a yeast infection? Then it’s smart to see your doctor to check whether you have an STD.

Also read: What your vulva has to say about your health and hygiene

4. Your hormones are bothering you

When your hormones are out of balance, it can spoil your pleasure in sex. This usually happens during and after menopause, but contraception can also seriously disrupt your hormone balance. Because your body produces less oestrogen as a result of the pill, your vaginal tissues may become thinner and more sensitive. Their elasticity and moisture may also decrease, raising the risk of pain during sex. Is this your problem? Then consult your doctor for alternatives.

5. You have cysts

Do you ever have severe stinging or sharp pain during sex? Then you might have cysts on your ovaries. A cyst is a fluid-filled cavity that can grow on your ovaries due to hormone fluctuations. When you have sex, a cyst might burst sending a severe, stabbing pain shooting through your abdomen. When you’re not having sex, do you often feel a dull, vague pain in your lower abdomen? If you suspect you have a cyst, it’s best to visit your GP or gynaecologist for an examination.

6. You have endometriosis

In women with endometriosis, endometrium grows in places where it shouldn’t. It attaches to your ovaries or fallopian tubes and then causes heavy periods and pain in your lower abdomen or deep in the vagina. In the long run, sex becomes virtually impossible and menstrual periods become increasingly intense with increasing blood loss. If you suspect endometriosis, it’s very important to contact your doctor quickly for an examination.

7. You have irritable bowel syndrome

Don’t be alarmed: about 1 in 12 people in the Netherlands has irritable bowel syndrome and about 75% of them are women. Many people think of IBS as bubbling bellies, diarrhoea, and constipation and that’s all true. However, what many don’t realize is that such tension in your belly can also affect your sex life. Because of the sometimes heavy pressure on your intestines and stomach, pain might occur during sex. Apart from that, it’s not pleasant to go to bed with a bloated stomach that seems about to burst. Do you have IBS? Then see your doctor for advice.

The emotional effect

Don’t underestimate the emotional aspect of sex. Emotions are inextricably linked to sex and can play an important role in sexual pain. For example, being insecure can leave you feeling barely aroused and not moist, making penetration difficult. And when you’re anxious, your pelvic floor muscles might contract unconsciously in response to the stress you’re experiencing. These effects can make penetration a difficult exercise.

Women who have been abused in the past are more likely to suffer from a tense pelvic floor or vaginismus. But women with recurring fungal infections also notice that sex becomes more difficult over time, even when they don’t have an infection. In that respect, your vagina is smart, it remembers past pain and reacts to it by tensing the muscles in response to a perceived threat. That’s good when you need to be in defensive mode, but not so great if you just want to make love with your partner and there’s no reason to be on high alert. This reaction then makes the sex painful and you end up in a vicious circle.

Sex without penetration

The solution? First of all, it’s important that you learn to make love without pain. That may mean a long period of sex without penetration. Everything is allowed, from kissing to stroking to licking to massaging, as long as no penis tries to slip into your vagina.

Are you enjoying it and are your feelings of desire returning? Then slowly start experimenting with the penetration of a tongue, finger or small vibrator. If that goes well, you might be ready for the real thing again. Has your pain returned? Then don’t get discouraged and don’t set high standards for yourself. Just stop and try to slowly rebuild your pleasure. Don’t feel guilty and don’t feel ashamed: the most important thing is that you regain the desire and pleasure in sex – with or without penetration.

Get help!

Is the pain persistent and do you suspect that there are physical causes? Then don’t keep putting off doing something about it for too long! Visit your GP, a sexologist, or a gynaecologist. Together you can find out what’s causing your pain and start treatment. Sometimes the solution is a simple ointment or pill, sometimes you need pelvic floor therapy or you might need sessions with a sexologist who can help you rediscover the pleasure of sex.

Whatever you do, take action. Sex should be enjoyable and pleasurable, not torture that you see as an obligation to be performed!