Painful Sex: What It Is, Causes, Treatments

By Lisa Hochberger

If you ask us at Pepper to define sex, you can bet our definition will not be focused on penetration alone. However, if you ask the average American on the street what sex is, there is a good chance that they would slot the word “penetration” in there, and skip over the phrase “painful sex”.

Unfortunately, sex and pain have become synonymous for many, especially for the people who are penetrated. Sex is not meant to be an uncomfortable or painful activity, and despite what you may have heard, it not something that a person should withstand.

So, we get to the bottom of painful sex, from what causes pain during intercourse to how normal it is to experience it and how you can treat it - including with the help of sex toys and a curated Pepper Kit.

What causes painful sex?

The causes of painful sex (or dyspareunia) can vary for a variety of reasons to people of any age, sex and gender. For people with vulvas, it can include pain with initial penetration, deep penetration and thrusting, or just before penetration. Some people live with pain they hold in their body, that due to an immense intensity, it infringes on their ability to enjoy pleasure.

Other people hold pain in. This includes but is not limited to trauma, hormone imbalance, inability to access the erotica persona, lack of moisture and/or lack of desire, so it is important to think about how we can have sex that is worth wanting. Sex does not have to equal penetration to feel good. Pleasure happens when we relax!

Below are some causes of painful sex.

Vulvodynia

Some people experience chronic pain around their vaginal opening that may be signs of vulvodynia. Vulvodynia is difficult to diagnose and commonly overlooked by doctors as there are no specific diagnostic tests. It is commonly associated with chronic pain disorders. The most common (80%) type of Vulvodynia, Provoked Vestibulodynia (PVD), is pain that manifests when pressure is applied to the vulvar vestibule (area between the bottom of the clitoris and the labia minora (including urethral opening and vaginal opening).

Pain can be provoked by a tampon, sitting, sexual intercourse, gynecological exams and from wearing fitted pants. Some people describe their vaginal pain to a sharp burning “knife-like” feeling. Experts have categorized vulvodynia based on different pain locations (the whole vulva, localized or mixed) and situations that elicit pain (spontaneous, upon contact or mixed), temporal pattern (intermittent or constant) and onset (primary or secondary).

What’s more, vulvodynia may not only cause physical pain but mental pain also: studies show that it impacts the mental health of vulva owners and their partners.

Genito-Pelvic Pain/Penetration Disorder (Vaginismus)

Genito-Pelvic Pain/Penetration Disorder (Vaginismus) is current or involuntary spasms of the muscle around the outer third of the vagina that interferes with sexual intercourse. Vaginismus was a term used in the DSM-IV but has since been re-defined as sexual pain disorder.

Diagnosed today as Genito-Pelvic Pain/Penetration disorder, it is a problem that causes psychological distress in individuals and couples. This disorder can make it difficult for a vagina to receive penetration from a penis, finger, tampon, dilator or dildo. People with vaginismus often avoid sex and fear the pain they associate with it. If you are experiencing fear or panic from sex, as well as uncomfortable and/or painful sex, sex therapy is indicated for treatment.

Vulvar Dermatoses (Vulval Skin Conditions)

Some chronic skin conditions such as Vulvar Dermatoses (Vulval Skin Conditions) or Lichen sclerosis (LS) and erosive lichen planus can occur on the skin of the genitals. Skin infections on the genitals can cause itching, burning, pain and sexual difficulties, which can ultimately lead to uncomfortable sex.

Vaginal Atrophy

50-60% of people with vulvas are suffering from postmenopausal Vaginal Atrophy as a result of hormonal changes. Vaginal atrophy can cause dryness (that may result in vaginal fissures), itching, burning, vaginal discomfort, painful urination and spotting and/or pain during intercourse.

Vaginal dryness can hinder sexual functioning and pelvic floor health for vulva owners. If you believe that you are experiencing vaginal atrophy ask your doctor to test your estrogen for deficiency. Estrogen deficiency can cause changes in the labia, clitoris, vagina, urethra, bladder and introitus.

Other causes of painful sex

Pain as a result of STIs, disease or other physical chronic pain experience
Pain as a result of giving birth. On average, 24% of postpartum women experience pain during sex (often times at the vaginal opening)
Pain as a result of chronic conditions
Pain as a result of endometriosis
Pain as a result of having (past or present) pelvic inflammatory disease
People with penises who have tissue tightness or increased blood flow to the pelvis
People with penises who experience a tightening of the muscles follow contraction

Is pain during sex normal?

Pelvic pain is relatively common (24% of women experience chronic pelvic pain), though this does not mean you should be experiencing discomfort and pain during intercourse. Unfortunately, due to a lack of sexual health education, painful sex is not something that is discussed in our culture. People often express pain to their family and friends when it involves body parts not associated with their genitals, but when it comes to genitals people tend to be silent. This is problematic because the narratives around pain during sex have been silenced.

When people have consistent pain during sex there can be various consequences. Some people shut down when they experience painful sex as a result of feeling shame or embarrassment. All too often, my clients feel like they are alone in their pain and unable to share it with their partner. This can cause emotional insecurity for both the partner experiencing the pain during intercourse and the partner who is unaware of why their sexual intimacy has talking a halt.

In many cases, individuals remove their own pleasure from the equation of having sex; instead, they have sex to perform for their partner. They want to keep their partner happy but this often is ineffective. As a result, a desire discrepancy can form and physical pain is reinforced in the body, making pleasure harder to obtain.

What should I do if I experience painful sex?

If you’re experiencing pain when having sex, stop what you are doing immediately. When our body experiences something painful the autonomic nervous system has the ability to remember what has happened. If we have pain in our gentitals during sex and we continue to have sex, our sympathetic nervous system or “fight or flight response” will unconsciously start to kick in. This can cause our pelvic floor muscles to clench causing tightening of the vagina or the penis. With this, it is important to act quickly and figure out the culprit.

How do you treat painful sex?

See a doctor

In all sex therapy, the first step to treating painful sex is getting a medical doctor to check for any health problems. Of course STIs, syndromes and other diseases should be ruled out. The root cause of an issue may not be uncovered by a physician and if you are not getting the answers you need it may be beneficial to seek out a pelvic pain specialist.

Visit a sex therapist

If it is hurting during sex, reach out to a sex therapist. Sex therapists are regular therapists that also have a speciality in sexuality. Sex therapist are not just focused on sex, rather they are are trained to help clients uncover emotional pain they are storing in their bodies. Through the process of uncovering emotions, clients are able to release pain and relax their muscles (including their pelvic floor). It may also be important to see a pelvic floor physical therapist.

What can I do to make sex less painful?

Mindfulness and sensuality

To make sex less painful, we challenge you to think about the way you are having sex. What makes great sex, sex worth having, sex worth desiring, sex free from pain?

Sexuality researcher Peggy Kleinplatz, Ph.D. posed the question and found that optimal sex is about being present, embodied, focused, and in sync with a partner. It may sound surprising, but Kleinplatz’ found that orgasm, attraction, lust, desire, and chemistry were only minor components of optimal sexual experiences.

If you want to have great and pain-free sex we encourage you to embrace your sensuality. Think of sensuality as the way you experience pleasure. This can occur through all of our senses as well as in our mind.

Eroticism and foreplay

We can have great, less painful sex through touching and feeling one another. Great sex can be experienced through true embodiment. Think sensual baths (a major turn-on), massage oils or using a personal massager on your partner.

Or you might be less in a massage and bath mood and more in a fantasy mood. When is the last time you took the time to dress up for your partner? Eroticism is powerful so think about the erotica persona that you would like to tap into each time you’re having a sexual moment. When sex is an embodied experience it is extremely pleasurable.

Relaxation

We know that sex and relaxation might sound extremely cringy for busy people. However, people who have experienced chronic painful sex (vulvodynia) or erectile pain or unpredictability have probably noticed that their bodies clench at the thought of it. Clenching is the opposite of pleasure. Remember that clenching is an autonomic nervous system response.

The thought (conscious or unconscious) of a painful experience lights up the “fight or flight” within us, particularly when associating pain and sex. Embodiment techniques help us move away from clenching and into expansiveness. Pleasure is expansive. Take a deep breath and feel your body expand into a relaxed state. Your autonomic nervous system is finding its homeostasis.

Our genitals naturally work to our benefit when we move out of our heads and into our bodies. Set your body up for “feeling” by using your breath, massage, baths, fantasy, and movement. It is important for you to feel safe in your body.

Can sex toys help with pain during sex?

In a relaxed state, our body might be in a better place for penetration or erection. However, no matter how relaxed we are, a penis or dildo penetrating a vagina or anus that is too large may be too much for a person to handle without feeling pain.

The Ohnut, an intimate wearable, can help people manage and potentially reduce pain during sex, by allowing a person to customize how deep penetration goes. We highly recommend trying it.

We recommend that individuals who are experiencing painful sex stop having any form of penetration that causes pain. Pain can result in cyclical patterns of anxiety about sexual penetration and can sabotage future pleasurable penetration. The most important thing you can do is address your sexual pain and then resume sexual activity.