Dr. Sophia Murphy, DBH, SXI

*Disclaimer: This article references information specific to those with a vulva who were assigned female at birth. Information specific to pain during intercourse in people with a penis or transgender women is lacking.

Have you ever felt pain during sexual activities or intercourse? If you answered yes, you’re not alone. For people assigned female at birth with vulvas, 75% report pain during sex at least some point in their lives (1). While the experience can be distressing and even discouraging, read on for more information and ways to maximize pleasure during sex.

Dyspareunia The medical term for pain during sex/intercourse is dyspareunia. This includes pain in the genitals which can also occur before or after sex. Pain may be specific to penetration during sexual activity and can even occur with insertion of a tampon. Pain may be described as ranging from burning, to intense shooting pain in response to pressure, and even throbbing pain which can continue after sexual activity. People sometimes wonder what is wrong with them and can internalize the experience as an indicator that they are “broken.” If the above information resonates, the emotional toll can be great. It’s important to remember that all people are deserving of pleasure and no one is broken. Like any challenge, there are options for support!

Common Reasons People Experience Pain During Sex

1. Lack of lubrication: sometimes pain during penetration is simply a sign that the vagina is not primed for insertion. Certain prescriptions can contribute to vaginal dryness so be sure to review side effects of any current medications. This can be solved by allowing more time for arousal and natural lubrication of the vagina or the addition of a quality lubricant. When selecting a lubricant, be sure to review ingredients and even test the product on a small part of external skin to identify potential negative reactions. Overall, use of lubricant is associated with increased sexual satisfaction!

2. Injury to the vaginal canal/tears/trauma: it’s not uncommon for the vagina to experience small (or significant) injury as a result of various incidents (childbirth, surgery, recent intercourse where the vagina was not well lubricated) which can contribute to pain. Be sure to consult with your medical provider to identify or rule out physical contributors to pain.

3. Illness and medical conditions: when pain occurs with deep penetration, it can be an indicator of a larger issue such as pelvic inflammatory disease, endometriosis or even uterine cysts. Consult with your medical doctor for more information on diagnosis.

4. Emotional concerns: Oftentimes our bodies physically alert us to psychological concerns. When stress is high either individually or in relationships, pain during sex can occur due to the inability to relax, become aroused, or be engaged during sexual activity. For some people who have experienced sexual abuse, engaging in sexual activity may be triggering and cause the body to try to protect itself. This is not “bad” although it can add to the stress.

What to Do When pain during sex has become persistent, it’s important to ask for help. Because of stigma and societal norms which teach us that sex “should be easy,” people often shy away from speaking up and may begin to avoid sex at all costs. This can lead to distress and disconnection from one’s body and from one’s relationships. All people deserve to feel safe in their bodies and enjoy sex (if they want to)! Start by seeing your medical doctor or TBD Clinician to rule out or identify any medical conditions that may be contributing to pain. Some people may also benefit from pelvic floor physical therapy. If vaginal dryness is a side effect of a current medication, sometimes just knowing this can make all the difference! And a little lubricant can go a long way.

Redefining sex as more than intercourse can help relieve pressure to perform. Explore sexual stimulation to the vulva and other erogenous zones. When ready, support yourself in using various items for penetration (fingers, dilators*) to start small and build up to something with a size that works for you! You can work with a professional for support and guidance if needed (see below)! For situations where medical conditions have been ruled out, it’s important to check-in internally regarding stress or other emotional factors. Practicing mindfulness is an excellent tool to increase one’s internal awareness of their body or the sense of interoception. Learning to be present, slow down, and feel your own experiences is a great way to identify what you need and when.

Becoming more aware of what is arousing and what feels good maximizes the experience of pleasure. If more stimulation is needed to become aroused, or if lubrication would be helpful, it’s important to practice assertive communication and take ownership of boundaries. Seeing a psychotherapist can help with processing any past abuse or trauma. Working with a sex coach can help with learning more about your body, your sexual wants/needs, and how to improve your sexual experiences!

References:

1. Cedars-Sinai Staff (2018, September 12). What women need to know about pain during sex

2. Mayo Clinic. (2023). Painful intercourse: Dyspareunia

• Dilator Options https://www.hellomilli.com/ https://www.intimaterose.com/

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.