TL: DR. No, sex should not hurt (unless that’s what both parties have fully consented to do). While sex might be uncomfortable at times, messy at other times, it shouldn’t be consistently painful. If it is, it’s time to talk to a medical provider about this.
For people with vaginas, pain during sex is an unfortunately common experience that is often not talked about. Approximately 10-20% of U.S. women experience dyspareunia, meaning pain with sexual intercourse. These folks are at higher risk to have difficulty with their relationships, diminished quality of personal life, anxiety, and depression - not to mention, they are missing out on the potential physical, emotional, and mental health benefits of a healthy, consensual sex life.
Unfortunately, many people are too nervous to bring up their concerns - maybe someone has been told by a partner that there’s something wrong with their anatomy (cue eye roll here). Maybe some folks have been dismissed by partners or even healthcare providers for those concerns. Some people don’t bring it up because they think pain should be normal (it’s not!).
What can cause pelvic pain?
There are a number of reasons why vagina owners may experience pelvic pain during sex, some of the common of which we’ve included below. It's also possible that everything is normal and you just need to figure out the right positions, lubricants, partners, or types of sex that work best for you.
Please note: This article is most relevant for those who identify as female and/or have vaginas who participate in some kind of penetrative sex (such as an object/toy, genital organ, finger being inserted into a vagina).
- Skin: Some folks, typically those who have pain with entry, may have a dermatologic condition such as inflammatory skin diseases that cause discomfort during sex.
- Infections: Sexually transmitted or non-sexually transmitted infections can be a source of vulvovaginitis, which is a fancy word for inflammation of the vulva or the vagina. Things like a yeast infection, bacterial vaginosis, gonorrhea, and chlamydia are common culprits here. In some cases, pain during sex can be a sign of pelvic inflammatory disease, which is what happens when an infection spreads into the upper genital tract, such as the uterus and ovaries. Regular STI screening is important to do to prevent this kind of infection spreading!
- Gynecologic Organs: Pain can come from different anatomical structures, like the vagina, uterus, or the muscles of the pelvic floor. Sometimes this can come from the position of your uterus. For example, a retroverted uterus that tilts toward the rectum instead of forward might have more pain with certain sex positions. Other folks may have masses on their ovaries, such as cysts that cause pain more on one side than the other. Other people may have pain due to problems such as endometriosis, which is when tissue that grows inside your uterus starts to also grow outside of your uterus. Many of these conditions can be identified with an ultrasound or a pelvic exam.
- Pelvic floor or muscle related pain: With vaginismus, some folks have involuntary contraction or tightening of the pelvic floor muscles in response to penetration (something being inserted in the vagina). With pelvic floor dysfunction, some women experience pain throughout the pelvic floor because their pelvic floor muscles have trouble coordinating. For pelvic floor dysfunction, women usually also experience symptoms like gastrointestinal or urinary symptoms like straining to have a bowel movement or having frequent urination.
- Age-Related Changes: Over time, especially around the time of menopause, some women have a change in their vaginal tissue that causes a sensation of burning or dryness that causes discomfort during sex. For some women who experience this, there are options such as lubricants and/or potential hormone therapies that can help restore some of the moisture and comfort in this area.
- Recent Pregnancy: Pregnancy and delivery can be tough on a woman’s body and recovery can be a long process, depending on what happened during the process. Breastfeeding itself can even cause some vaginal dryness and pain due to hormone changes.
- Psychosocial factors: Some folks with a history of psychosocial stress or even things like anxiety or depression may be more likely to experience pain during sex. Some of those who have experienced sexual abuse may experience these symptoms more (if you have experienced sexual abuse, please see below for some resources for you).
- Other causes of pelvic pain during sex might include things that are less common, but caused by other bodily systems. For example, some folks can have pain coming from their bladder, such as with interstitial cystitis.
There are a lot of reasons that people might be experiencing this, so it’s important to work with a healthcare provider that you trust to figure out what’s going on and to figure out a treatment plan that works for you.
What should I do if I have pelvic pain?
- If you feel comfortable, check yourself out first. Grab a mirror to examine the outside of your genitalia. Do you see a weird rash or unusual bumps/lumps? Noticing weird discharge or bleeding? Is this occurring monthly in association with your period? If so, track it. If you notice anything unusual, this is good information for your healthcare provider
- Talk to your partner(s) about what you’re experiencing. Some folks need longer or more foreplay or a more comfortable environment before being able to enjoy sex and allow the muscles of their pelvic floor to relax. Some folks need a different position of their bodies or of their partners’ bodies. Some people need extra lubricant jelly to see if this improves the comfort.
- If you have experienced sexual trauma and believe this pain could be related, there are resources for you. You can contact your healthcare provider or consider calling resources like the National Sexual Assault Hotline 800.656.HOPE (4673) to get connected with a trained staff member.
- Talk to a professional that you trust and who takes your concerns seriously. Schedule an appointment with a healthcare provider, such as a primary care provider or a gynecologic provider. Your evaluation may include things like answering some questions about your symptoms and your sexual history, testing for infections, a pelvic exam, and/or maybe even some imaging. Your treatment will depend on the reason you’re having the pelvic pain in the first place. There are a range of options, ranging from pelvic floor physical therapy, medications or hormone therapies to help with the pain, special lubricants, hormone therapies, etc. that can help you with this.
It may take some time, but the goal is to help you have the safest and most satisfying sexual health you can.
This article provides information about sexual health, healthcare and/or related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of TBD HEALTH INC.
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