Do Women Feel Pain During Sex

Do Women Feel Pain During Sex (Dyspareunia)?

Do women feel pain during sex? The experience of pain during sex, also known as dyspareunia, is widely experienced by women throughout their lifetime for various reasons that we will discuss in this post.  Note that by saying ‘sex,’ we speak about vaginal intercourse, or penetrative sex, or PIV (penis-in-vagina), and will use these terms interchangeably herein.

Painful sex does not discriminate – it can affect any woman regardless of gender, education, cultural or religious background.  However, common as it may be, experiencing pain during penetrative sex is not normal nor should be accepted as inevitable.

Physical Causes of Pain During Sex (Dyspareunia)

Lack of Lubrication / Vaginal Dryness

Vaginal lubrication during sexual arousal is the body’s natural and built-in response with the purpose of facilitating penetration and comfort.  Sexual arousal triggers increased blood flow to the genitals, which then triggers the production of moisture.  However, this automatic response is subject to interferences and malfunction because of hormonal changes, certain medication intake, stress, diminished levels of estrogen in menopause, cancer treatment, and other medical conditions.

Vaginal Atrophy

Vaginal atrophy, also known as Genitourinary Syndrome of Menopause (GSM), describes various menopausal signs and symptoms including vaginal dryness, sensation of burning upon friction (such as when the penis thrusts inside the vagina), reduced vaginal elasticity, and diminished vaginal lubrication.  No wonder the menopausal vagina may be sad about penetrative sex, and its owner – the suffering woman – reluctant to engage sexually.  But there are solutions so reach out to your medical professional.

Medical Conditions

Potential medical causes for dyspareunia include hormonal imbalances, endometriosis, pelvic inflammatory disease, pelvic floor dysfunction, vulvodynia, interstitial cystitis, uterine fibroids, ovarian cysts, or postpartum complications after childbirth.

Vaginal Infections

Vaginal infections are quite common and often make sex painful.  In this category are included yeast infection, bacterial vaginosis, sexually transmitted infections, and other dermatologic conditions involving the female genitals.  Furthermore, medications or topicals prescribed for treatment of infections often result in increased genital and vaginal dryness thus further increase of sexual pain during intercourse. It’s important to maintain good sexual health to prevent chronic pain and a visit to your gynecologist.

Psychological Causes of Pain During Sex

It is important to always remember that the genitals are connected to our stress response system and are, therefore, under its influence when it comes to sexual arousal.  This connection is unisex, found both in males and females.

Stress or Anxiety

Dyspareunia and stress or anxiety are a two-edged sword that could be the cause, or the result, of painful sex.  As a cause, reasons such as performance anxiety, worries about fears, poor body image, “will he like me,” or “will I do it ‘right,” or “is it going to hurt” will surely bring about anticipatory anxiety and vaginal tightening up upon penetration, thus pain.  When dyspareunia is the result, then the pain experienced during intercourse may trigger anxiety reaction that results in sexual reluctance to engage, or even sexual shutdown.  Seek professional help to sort it out.

Decreased Libido

Sexual arousal for a woman begins ‘between her ears’ because her mind is THE on/off switch to her libido.  As such, is there a surprise that it is not easy for woman to ‘get into it’ when she is not feeling good, when her vagina is dry and uncomfortable, and when sexual intercourse causes pain?  Furthermore, feeling a duty to engage despite not wanting to, or if coerced or forced to engage, will certainly kill any libido hope, and repetitive pressure as such will result in ongoing painful sex, an angry, resentful woman, and relationship breakdown.  This can be fixed with proper help.

Past Trauma

Past trauma leaves an imprint on the body and the mind via the stress response system. If the traumatic event or events were of sexual nature, they will have a significant emotional and physical effect on the woman in general, and on her experiences and perception of intimacy and sexuality in particular.  To each woman her own trauma memories and journey of recovery; there is no one-size-fits-all nor a specific sexual response.   As such, pelvic floor muscle tightening, vaginismus, fear and anxiety with body withdrawal, flashbacks and negative associations, memory triggers, and dissociation may all present during sexual engagement, often culminating in painful intercourse.  Professional intervention is urged.

Communication Breakdowns

Intimate communication is a must and without it, there is no sharing or exchange of how one feels, what are one’s sexual preferences, and what is the state of the relationship.  Lack of sexual communication will certainly kill the woman’s sexual desire and sexual satisfaction and is a shortcut to painful sex.  Don’t let this continue without fixing.

Religious or Cultural Causes

Different religions and culture have a sexual code that must be followed, as well as sexual beliefs, expectations, frequency of sexual engagements, and the role of the woman in the sexual arena. The incidents of painful sex increase dramatically when these codes place an undue burden on the woman, and if they restrict her ability to explore and experiment sexually and intimately, and if they prohibit her from saying NO if she is not sexually interested.

Primary or Secondary Vaginismus

Vaginismus, or Genito-Pelvic Pain/Penetration disorder, is characterized by the inability or great difficulty with vaginal penetration.  Primary vaginismus is when the woman has always struggled with this condition, whereas secondary vaginismus is the result of disruptive life’s events.

Many women with this condition can have penetration albeit with deep pain and emotional duress.  Ongoing sex under these conditions will worsen the situation, not help it.  Intervention is needed!

How to Alleviate Painful Intercourse & Maintain Good Sexual Health

Vaginal Moisturizers and Lubricants

 These non-hormonal preparations are inserted into the vagina but are used for different functions:

  • Vaginal moisturizers are like a hand lotion for dry hands: their purpose is to lubricate the vaginal canal and would, ideally, be inserted at bedtime so they can do their ‘job’ while the woman is sleeping;
  • Vaginal lubricants are specifically used for vaginal penetration at time of intercourse. They are of a consistency that withstands the normal friction associated with sexual intercourse (or a dildo).  Note: it is recommended to stay away from lubricants that are oil-based as they may cause irritation so read ingredients carefully.

Hormone Replacement Therapy

Barring medical contraindications, vaginal estrogen hormone replacement therapy is an essential component of addressing Genitourinary Syndrome of Menopause (GSM), and the only one to restore/reverse the estrogenic decline.

These preparations are by prescription only and are available as a cream, a tablet, or a vaginal ring.  Clinically speaking, we have found that the cream version works best, despite a bit of it leaking out, but with the additional benefits of easily adjusting the dose, and of being able to also be applied to the menopausal vulva, the area between the vaginal lips.

Speak with your healthcare provider about which option would work best for you.

Genital Hygiene

Genital hygiene plays an important role in helping painful intercourse anytime in the woman’s life, and more so in menopause and during & after cancer treatment:

  • Proper hydration. Be mindful of factors that affect hydrations, such as winter heating, certain medications (allergy pills included), insufficient fluid intake, dark urine;
  • No hot water on genitals, only lukewarm as hot water tends to chaff and make them super dry and painful to touch and separate;
  • Use mild soaps, no scented soaps, no scrubbing;
  • No douching unless medically advised;
  • Use a topical ointment like Aquaphor Healing Ointment or Vaseline on your genital lips if they feel sticky, dry and when engaging in sweaty activity like cycling, running, rowing, etc.

Relaxation Techniques

Always good to attend to the mind-body connection by incorporating relaxation techniques to help reduce discomfort and improve overall sexual experience. Examples of relaxation techniques include deep breathing, mindfulness meditation, progressive muscle relaxation, playing relaxing music, yoga, and imagery.  However, these should not be done during intimacy so as to allow you to be ‘in the moment’ when you are sexually engaged.

Vaginal Dilators & Pelvic Floor Physical Therapy

A home dilator kit, or dilation program, done on your own or under the guidance of a pelvic floor physical therapist, may often be a suitable solution to restoring vaginal elasticity and pain-free intercourse.  Be sure to use ample lubrication and increase sizes gradually.  If in doubt, seek professional guidance.

Medical Management

Consult with your healthcare provider if you cannot resolve the painful sex on your own. They will conduct a comprehensive evaluation to identify the case and suitable remedies.

Counseling or Therapy

Mental health professionals offer a variety of services to address breakdowns mentioned above, including panic and anxiety interventions, improving communication,  libido and sexual counseling, abuse and trauma therapy, EMDR.  Choice clinicians include social worker, psychologist, or sex therapist/counselor.  Explore and find the one the works best for you.

Religious Guidance

Seek support and advice from your cultural and spiritual leader for guidance and discussion of available modification and adjustments.  A female guide would be ideal as she can better understand your painful sex from within.

Get Help Online for Most Common Causes of Painful Sex in Women

There is no reason for living with painful sex!

Sadly, women often choose to live with pain and suffering instead of speaking up and searching for solutions.  They tend to believe that it is ‘their fault’ and that ‘nobody will listen to them,’ which is so sad.  We encourage every woman to hold her head high and to advocate for her needs regardless of feeling inadequate and hopeless.

We welcome your inquiry and have in-person and virtual treatment programs for overcoming painful sex so do not hesitate to Contact us.

About The Author

Dr. Ditza Katz

Ditza Katz, PT, Ph.D., is the founder of Women’s Therapy Center, a practice specializing in urogynecologic rehabilitation, treatment of female sexual dysfunction, breast & female cancer rehabilitation, and management of somatic disorders. Dr. Katz holds an undergraduate degree in Physical Therapy, a Master’s degree in Pastoral Psychology & Counseling, a doctorate in Clinical Sexology, and clinical training in manual therapy and urogynecology. Dr. Katz is a Diplomate with the American Board of Sexology, Professor at the American Academy of Clinical Sexology located in Orlando, Florida, and the only physical therapist in the USA who is a clinical sexologist.

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