Women, what causes painful intercourse?

Women are often influenced by the media, their educators, their peers and even healthcare professionals to believe that pain is just an inherent part of sex, but here’s the bottom line: 

It’s not. 

In a study of 591 women who reported pain during intercourse, 47% persevered through intercourse despite the pain. Thirty-three did not communicate their pain to their partner and 22% even feigned pleasure during the pain. 

Female dyspareunia refers to recurring or persistent pain in the genital area or within the pelvis before, during or after sex, and it affects between 12% and 44% of women (dyspareunia is suspected to be vastly underreported due to the myth that painful sex is inherent to the female experience). Women who experience pain during sex are far more likely to suffer from general psychological distress and increased depressive symptoms, so when you experience pain, speak up. If your provider encourages you to accept this pain, find a new provider. Because the source of your pain may be entirely preventable or treatable. Common causes of painful intercourse for women include:

Vulvodynia refers to pain affecting the vulva (the external female genital area) that is not caused by an infection, a skin disorder or another medical condition that lasts three months or longer. It is one of the most common causes of pain during sex and affects
 7-8% of women. Vulvodynia most often feels like burning, stinging and rawness, but can also present as aching, soreness and throbbing and is treated with a variety of therapies and medication.

Vaginal dryness
The walls of the vaginal canal and the
vaginal mucosa typically stay lubricated with a thin layer of fluid maintained by the hormone estrogen. A drop in estrogen at any age can cause vaginal dryness, resulting in painful penetrative intercourse (for both you and your partner). Vaginal dryness is treated with vaginal estrogen in the form of a soft, flexible ring, tablet, cream and lube. Lots of lube.

Sometimes insufficient foreplay is to blame for inadequate self-lubrication. Communicating your needs to a partner who is respectful of your pleasure is essential to improving your sexual health.

Endometriosis refers to growths that occur when cells resembling the cells of the uterine lining grow on the ovaries, fallopian tubes or bowel. These growths may cause painful intercourse because penetration can pull or stretch the endometrial tissue, especially if it grows behind the vagina. Additional symptoms of endometriosis include heavy menstrual bleeding and painful menstrual cramps. 

Many women with endometriosis find that certain sexual positions are less painful than others because they place less pressure on the areas that contain excess endometrial tissue. Positions that allow the woman to control the depth and speed of penetration are preferable (for example, woman on top) and missionary is often the most painful sexual position for women with endometriosis. 

Vaginismus is a condition in which the pelvic floor muscles spasm and constrict, essentially closing the vaginal opening and making penetration (with a penis or object like a tampon) difficult or impossible. Vaginismus can make penetration or gynecological exams unbearable.

Primary vaginismus is a life-long condition and is often experienced during a woman’s first attempt at penetrative sex, contributing to the myth that a woman’s first sexual encounter should be (and always is) painful. Secondary vaginismus can develop at any stage of life and is triggered by a specific event, like a sexually traumatic situation, childbirth or a new medical condition. Once underlying medical conditions are ruled out as possible causes of vaginismus in an individual, the condition is typically treated with a combination of counseling, pelvic floor control exercises, insertion and dilation training and education. 

As women, your sexual satisfaction is important, too. Engaging in regular (and satisfying) sexual intercourse can lead to a happier and more emotionally satisfying life and improve the quality of your romantic relationships, so don’t set your own needs on the back burner.