Why do people experience pain during sex?

Sex is a natural part of life and for the most part and I would argue that the majority of people find it to be quite an enjoyable act (when consensual of course). Nevertheless, countless people all over the world experience some sort of pain during sex many unsure of the cause and unable to find a solution. This condition can lead to fractured relationships as well as other emotional effects (1). Pain during sex can cause negative ramifications, so if you are someone who experiences pain during sex, it is important to

1. Know that this is common but not normal

and

2. Address the problem

Pain during sex and pelvic pain during sex can be caused by various factors that we are going to discuss in this article below.

Reasons sex may be painful (and what to do about it)

Pain during sex, also known as Dyspareunia, is common but that does not make it normal. Approximately 3 out of 4 women will experience some sort of pain during sex (2) within their lifetime. That’s 75% of half of our population!! In many cases, this pain can be caused by a lack of lubrication being utilized during penetrative intercourse. But lucky for you, this can usually be remedied by relaxing your body, increasing the amount of foreplay, or simply using an increased amount of lubricant (1). In other cases, the reason behind the pain may be slightly more complicated:

Vaginismus - This is, unfortunately, a common condition that entails an involuntary spasm in the vaginal muscles, sometimes caused by fear of being hurt. (1)
Vaginal infections – These infections (which include yeast infections) can occur quite frequently. (1)
Difficulties with the cervix (opening to the uterus) - In this case, the penis can reach the cervix at maximum penetration. So, problems with the cervix (such as infections) can cause pain during deep penetration. (1)
Pelvic floor dysfunction - The pelvic floor muscles— these are the muscles that you clench when you want to stop urinating —can become painfully tight. It can cause an achy pelvis and pain with any kind of insertion. (3)
Ovarian cysts - These fluid-filled sacs on the ovaries often have no symptoms. However, if and when they rupture, they can cause a lot of pain and bleeding. (3)
Previous surgeries - This may leave behind scar tissue that can cause pain further down the road. (4)
Pelvic inflammatory disease – An inflamed pelvic region can especially lead to pelvic pain during sex. (4)
Not relaxing – Being tense during intercourse or being unable to be aroused can lead to pain during sex. (4)
Endometriosis - This is a condition in which the tissue which lines the uterus grows outside the uterus. (1)
Menopause – Menopause can cause the lining within the vagina to lose its normal moisture, thus becoming dry, which can lead to pain during sex (1).
Having a baby – Doctors usually recommend that you wait four to six weeks after having a child to engage in intercourse. Having sex too soon after giving birth can cause pain during sex. (1)
Sexually transmitted diseases - These may include genital warts, herpes sores, or other STDs. (1)
Injury to the vulva or vagina - Childbirth, as great as it is, can cause lots of tearing, some cases more serious than others, around the vaginal area. (1)
Vulvodynia - This refers to chronic pain that affects the vulva -- including the labia, clitoris, and vaginal opening. It may occur in just one spot or affect different areas from one occurrence to the next. Doctors aren’t sure exactly what causes it, and unfortunately, there is no known cure. But self-care combined with medical treatments can help bring relief. (1)

In addition, there are various other factors, especially related to your emotions and state of mind during intercourse, which can contribute to pain during sex. We have listed a few of them below:

Psychological issues – Emotional conditions such as anxiety, depression, concerns about your physical appearance, fear of intimacy, or relationship problems can contribute to a low level of arousal (4) In some cases this causes discomfort during intercourse (5).
Stress - Your pelvic floor muscles tend to tighten in response to stress in your life (4). This can contribute to pain during intercourse (5).
History of sexual abuse - Not everyone who experiences pain during sex and pelvic pain during sex has a history of sexual abuse. Nevertheless, if you have a history of sexual abuse and are experiencing pain during intercourse, please know that this may be a contributing factor to the discomfort (5).

What to do when sex is painful

One’s response to pain during sex or pelvic pain during sex varies depending on each unique situation and the condition. First and foremost, if you are experiencing paid during sex or pelvic pain during sex, you should seek advice from a medical professional as they will assess the problem and provide you with advice on how to proceed. Below are some instances of when you should seek medical advice:

If you have pain, unusual discharge, itchiness, or soreness around your genitals, it may be recommended that you are tested for thrush or an STI (6).
If your vagina is dry, it may be advised that you try using a lubricant – remember to use a water-based product if you're using condoms because oil-based lubricants can damage them and make them ineffective (6).
If you have an allergy or irritation around your genitals, it may be advised that you avoid using products that could be causing it (6).
If there's an emotional reason or anxiety that's causing problems, a counselor or sex therapist may be able to help – your GP or sexual health clinic can refer you to one (6).

For other conditions related to pain during sex that don’t necessarily have an underlying medical condition associated with it, sexual therapy may be the way to go. Sexual therapy can help facilitate emotional factors that may be contributing to the discomfort that you feel during intercourse. Here’s what a diagnosis for someone experiencing pain during sex and pelvic pain during sex entails:

A thorough medical history - When you go to speak with your doctor you might be asked about the time when the pain first began and how it currently feels. Your doctor might also inquire about your sexual history, surgical history, and childbirth. Make sure to answer truthfully because the answers are KEY to getting you the proper treatment.
A pelvic exam - During a pelvic exam, your doctor can check for signs of skin irritation, infection, or anatomical problems. They might also try to locate your pain by applying gentle pressure to your genitals and pelvic muscles.1 In addition, your care provider may do a visual examination using an instrument called a speculum to separate the vaginal walls. It is important to note that some people who experience pelvic pain during sex also experience pain during a pelvic exam (1).
Ultrasound – Your doctor may need to do an ultrasound if they suspect other issues may be leading to pain during sex (1).

Once more, pain during sex is common but that does not make it normal! There is no need to suffer in silence if you are experiencing pain during sex or pelvic pain during sex. If intercourse is causing pain, to the point that you even consider avoiding it, then you may need to speak to your doctor, more specifically a gynecologist (3). Pain during intercourse is a taboo subject and people find it hard to be honest about the difficulties that they are experiencing. As a result, these issues tend to be quite mysterious to the average individual. It is extremely important to not blame yourself if you are experiencing any of these issues. There is help out there and we urge you to seek it!

Perifit: Supporting you to strengthen your pelvic floor with games and biofeedback

Perifit advocates for everyone’s health and wellbeing and is committed to providing information on topics related to personal health such as reproductive and intimate health. Perifit offers a device and platform that uses the biofeedback approach to provide you with instant feedback on your pelvic floor strength and the quality of your contractions (Kegels) by using its internal sensor and mobile app (7). This device uses a program that can be accessed through your smartphone to provide pelvic floor biofeedback training to all users regardless of age or pelvic floor condition. Perifit offers a fun and engaging way to increase your pelvic floor strength.

Learn more:

References:

WebMD, ‘Painful Sex in Women Dyspareunia’ date accessed on 10/25/2021: https://www.webmd.com/sexual-conditions/guide/female-pain-during-sex
Healthline ‘What You Need to Know About Dyspareunia (Painful Intercourse)’ date accessed on 10/24/2021: https://www.healthline.com/health/dyspareunia#risk-factors
Cedars Sinai, ‘What women need to know about pain during sex’ date accessed on 10/24/2021: https://www.cedars-sinai.org/blog/pain-during-sex.html
Familydoctor.org, ‘Dyspareunia’ date accessed on 10/24/2021: https://familydoctor.org/condition/dyspareunia/
MayoClinic, ‘Painful intercourse (Dyspareunia)’ date accessed on 10/24/2021 https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
NHS, ‘Why does sex hurt’ date accessed on 10/24/2021 https://www.nhs.uk/common-health-questions/sexual-health/why-does-sex-hurt/
Perifit, ‘Strengthen your pelvic floor with games’ Perifit, date accessed on 10/25/2021: https://perifit.co/