Most folks want to enjoy pleasurable, pain-free sex. But experiencing pain during sex is far more common than is talked about. So often there are multiple causes at work, making it difficult to understand and treat the issue. There can also be a lack of knowledge and advocacy for women’s sexual health. “It’s important to remember that many doctors don’t have training specific to sexuality — and many receive no education in pleasure,” says O’Reilly. So, to bridge the information gap, we chatted with sex experts Kat Kova (MSc) Registered Psychotherapist and Jess O’Reilly, Sexologist (PhD) and Host of the Sex With Dr. Jess podcast about some common reasons you may experience pain during sex and how to start when seeking treatment.
Disclaimer: This article is intended to provide educational information. Please seek specific medical from your healthcare professionals if you’re experiencing painful sex.
Reasons why sex might be painful for you
Pain during sex can be caused by a number of reasons, from physical conditions to a lack of desire and arousal. Here’s what the experts say about dyspareunia and its causes.
But first, what is dyspareunia?
Dyspareunia is the broad medical term for painful intercourse. According to O’Reilly, it can be caused by a number of factors from the physical (like an infection or trauma to the genital region) to the psychological. For those with a vagina, “it generally involves persistent or recurrent pain in relation to vaginal penetration,” she explains. Dyspareunia is more commonly experienced by women, with about 75% experiencing painful sex at some point in their lives, according to the American College of Obstetricians and Gynecologists.
Can endometriosis and ovarian cysts make sex painful?
Endometriosis, ovarian cysts, and any condition that includes pelvic pain can also lead to painful sex (both penetrative and external), O’Reilly shares. Those with endometriosis may experience sharp or jabbing pains during sex as penetration stretches the endometrial tissue. Painful sex for those with an ovarian cyst may indicate a rupture (often caused by the activity). Many treatments for endometriosis can cause vaginal dryness, so without proper lubrication, penetration may cause additional irritation.
Can vaginismus make sex painful?
Another common reason women experience pain during sex is vaginismus. O’Reilly describes vaginismus as a condition that involves the sudden and painful contraction of the muscles around the vagina upon penetration. This involuntary contraction can be highly distressful to those experiencing it. It’s the body automatically reacting with fear to any form of penetration. It may be experienced during sex, but also during other penetration, like inserting a tampon. “Some find the tightening sensation so severe that they cannot handle any degree of penetration and others describe a burning sensation that develops as penetration is prolonged or deepened.”
Can sex be painful because of stress?
While there are plenty of physical conditionals that can be causing painful sex, the source can also be related to your mental health as well. “If we’re stressed, our body is going to be way more tense typically, and our muscles are going to contract and that can include the pelvic region. We may hold quite a bit of tension in our pelvic floor, and that can [cause] pain during penetration for folks,” Kova says. She goes on to explain that for most people, stress can cause reduced feelings of arousal. “We experience stress as something that’s telling our body we’re in danger. So if we’re under stress, the idea is that we’re probably not going to be very aroused.”
Can sex be painful because a lack of arousal?
Sexual arousal is the physical and emotional changes that occur in the body as a result of sexual stimulation, writes the ACOG. Therefore, without becoming properly aroused, penetrative sex can be uncomfortable and painful for some people if they haven’t produced enough fluid for lubrication. “We might kind of like push ourselves to engage in sex anyways, we might rush it, not take our time, not use our sexual voice to say no,” Kova says. O’Reilly shares her advice: “Don’t rush or feel pressured into specific activities — instead focus on pleasure of all kinds (erotic touch, emotional connection, full-body exploration, vibrations, oral, kissing).”
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Can sex be painful because of past trauma?
Kova highlights the role of trauma (including experiencing sexual assault) in painful sex, sharing, “Not everyone that’s had trauma will experience sexual pain. And trauma is not always the reason for sexual pain… but it certainly can play a role.” She goes on to explain that our bodies have a memory and whether conscious or not, it may trigger a stress response when in a similar situation. This can also be a cause of vaginismus. To help feel safe, Kova recommends, “Safety [is often the] main goal of survivors of sexual trauma. And there’s so many different ways that you can do that. I think one is finding a trusting partnership where the person understands your triggers, your boundaries, and how to work with you on creating the conditions of safety for when you do decide that you want to be sexually intimate.”
What should you do if sex hurts?
Both Kova and O’Reilly agree: the first step is to speak with your healthcare providers to assess for medical issues. Both encourage working with a pelvic floor physiotherapist you trust. “They have specialized training to assess and provide specific exercises that can help to address dysfunction of the pelvic floor,” O’Reilly says. As a next step, she suggests considering speaking with a sex counsellor or therapist who can support you with the emotional components of painful sex.
“As a psychotherapist, it is our job to know what we can treat and what we can’t treat, and to find out what is the nature of the concern,” Kova explains. Kova often works in tandem with these gynecologists and pelvic floor physiotherapists because when it comes to treating painful sex, it often requires multiple approaches. She shares, “It’s an issue that maybe starts off more simple, even though it’s not simple to treat a medical issue or a psychological issue, but that over time, it just tends to be exacerbated by things like anticipation of pain, of feeling like you don’t have anyone to turn to, feeling hopeless, and then not taking proper action to or not getting enough answers.”
Don’t be afraid to advocate for yourself if your healthcare provider isn’t taking your concerns seriously. O’Reilly recommends letting your doctor know that this issue is important and you don’t want to dismiss it.
Let them know that sex and pleasure are important to you and integral to quality of life.
If you feel your concerns are not being addressed, don’t be afraid to seek another opinion.
What are some ways to make sex hurt less?
Besides following the treatment plan of your healthcare providers, O’Reilly recommends exploring pleasure more generally. “Start with the non-erotic: touch, food, smells. Tune into pleasure mindfully and allow yourself to feel without judgment. Oftentimes when we’re dealing with painful sex, we shut down other types of pleasure, so the first step can be relearning to enjoy touch and other sensations in the body,” she recommends.
Kova shares a similar sentiment, urging folks to follow what feels good and find their own sexual voices. “Sex is not about performance. It’s really, truly about your pleasure. And if you’re having painful sex, don’t have sex in that way that causes pain. There are other forms of sexual intimacy that you can share with your partner or partners. And you get to determine what that is. So again, just dismantling sort of what sex should look like, and follow what feels good.