Despite progress made in sex positivity discourse, stigma still persists when it comes to talking about sex. When we do talk about sex with our friends, it’s often about how great it was the night before — not how painful or uncomfortable it left us feeling. We might feel embarrassed about the pain, or even come to expect it. In fact, the myth of all penetrative sex being painful is one that’s planted early on in young girls’ heads, leaving many of us to fear “the first time.”But what does painful sex mean? Many women, trans and non-binary folk have experienced slight pain during intercourse, but while occasional irritation is usually harmless, persistent pain during sex (also known as dyspareunia) can be a sign of an underlying health issue. Dyspareunia is not a unitary disorder, meaning it is often associated with another biological or psychological issue. Don’t let that scare you! Painful sex is nothing to be embarassed of and is often easily treated. If sex has become a source of pain and discomfort for you, we encourage you to take control of your own physical, sexual and emotional health. Sex should be a source of joy, never suffering.

Why does sex hurt?

Symptoms of painful sex are different for everyone, varying from sharp initial pain to lingering pain hours after sex. You might feel pain at penetration by a penis, fingers or sex toy, or perhaps pain with every penetration, including putting in a tampon or menstrual cup. Other symptoms include deep pain during thrusting, burning or aching sensations, or throbbing pain that continues after intercourse. For pain at penetration, MayoClinic and the NHS cite the following potential causes:

• Lack of lubrication: While movies lead us to believe that penetration ought to occur just seconds after some steamy kissing, this is not the case for many of us with vaginas. Foreplay is important — not just because it feels good, but because it’s usually required to naturally lubricate the vaginal walls. And if foreplay leaves you feeling turned on but you’re struggling to get wet, sometimes some good old-fashioned water-based lube can do the trick.

Certain antidepressants, birth control pills, high blood pressure medication or even antihistamines can affect sexual arousal. Hormone changes during your menstrual cycle, after childbirth or during menopause are also common culprits.

• Irritation, inflammation or infection: Like any bodily organ, the vagina can also become injured or infected. Injuries from an accident or surgery can leave long-term irritation or pain. An infection to the gential area — such as a common urinary tract infection (UTI), also known as thrush — or a skin condition such as eczema can cause infection or inflammation. A sexually transmitted infection (STI) such as a chlamydia, gonorrhoea or genital herpes may also be the cause.
  
• Vaginismus: a condition that causes muscles in or around the vagina to spasm and tighten, making penetrative sex painful. Experts have not been able to pinpoint how many people suffer from the condition, since it is not commonly discussed with doctors. This is just another reason why normalising open, judgement-free discussions about sex is so important.

In addition to conditions pertaining specifically to the vagina and genital area, painful sex can also be a symptom of something else. If sex for you is accompanied by deep pain that does not subside after penetration, look into the following conditions:

• Endometriosis: Pain during intercourse is one of the most common endo symptoms, as build-up of endometriosis scar tissue gets irritated easily during penetrative sex.
• Uterine fibroids: non-cancerous growths that develop in or around the uterus and affect around 1 in 3 women globally.
• Ovarian cysts: cysts on the ovaries that are common and usually harmless, but if one ruptures it can cause pelvic pain.
• Pelvic inflammatory disease (PID): an infection of the uterus, fallopian tubes and ovaries. It sometimes causes a deep pain during sex that is felt inside the pelvis.
• Adenomyosis: a condition wherein the tissue that normally lines the womb grows into the muscular wall of the uterus. In addition to dyspareunia, heavy and painful periods are the most common symptoms.

Irritable bowel syndrome (IBS): IBS affects your digestive system, usually leading to bloating, diarrhoea, stomach cramps and constipation. There is evidence linking IBS to dyspareunia and lack of sexual desire.

The emotional link

Pain during sex is often caused by physical issues, stemming from both short and long-term concerns. However, the link between emotional health and physical symptoms should also be examined. According to a study on psychological factors behind sexual pain, “the pain experience is influenced and maintained by emotional, cognitive, behavioral and biological factors.” Depression, anxiety, insecurities and fear of intimacy or relational trauma can all trigger discomfort or lack of arousal. Even high stress levels can tighten your pelvic floor, making sex painful. Your emotional and psychological health are just as important as your physical health, and should not be neglected when considering potential causes for dyspareunia.

When should I be concerned?

Most people with vaginas will experience slightly painful intercourse at some point in their lives. Tears, irritation, thrush and certain STIs are all common culprits that are often easily resolved. But when one-off pain becomes consistent, lube doesn’t help, you’re experiencing frequent UTIs, bleeding after sex, struggling to pee, beginning to fear sex, or finding that the pain is disrupting your intimate relationships — it’s time to see a doctor

.Self-advocacy at the doctor’s office

A good gynaecologist will ask about your medical and sexual history, fostering an open, shame-free discussion. Next, your gynae will likely conduct a pelvic exam or in some cases a pelvic ultrasound. Receiving a pelvic exam is the standard approach to diagnosing dyspareunia, so if your gynae doesn’t offer you one right away, make sure to ask for it. That brings us to ways you can self-advocate for the care you deserve. Since painful sex can have many causes, it’s important to keep track of your symptoms to point yourself in the right direction. Doctors at MayoClinic and Healthline recommend making a symptom list and keeping a diary leading up to your appointment to give your doctor a comprehensive view of your pain. A symptom diary should include things like:

• when the pain began
• if you experience pain every time you have intercourse, or only sometimes
• any medication, vitamins or supplements you take
• any other symptoms such as painful urination or periods
• methods you’ve tried to alleviate the pain (ie lube, painkillers)

Arming yourself with as much information as possible before going into the appointment is a great way to self-advocate. It’s even useful to go in with a list of questions you want to ask the doctor. If you feel uncomfortable with a doctor’s diagnosis (for instance, if you’re told not to worry and that the pain will go away on its own), don’t be afraid to seek a second medical opinion. Remember that you are the expert on your own body so if something feels off, trust your gut. Pain and fear of pain are not a healthy part of sex, so your symptoms should not be brushed off.

Painful sex remedies

Once you’ve seen one (or several) physicians, you will hopefully have a clearer understanding of the causes behind your pain. There is a wide variety of remedies for painful sex, both medical and non-medical, and the best options for you will depend on the issues linked to your pain. For infections and medical conditions, your doctor can prescribe a medication specific to the issue — such as birth control or antibiotics. If you are post-menopausal, you can look into medications specifically targeted at vaginal lubrication such as ospemifene or prasterone. For non-medical remedies, talk to your doctor about pelvic floor exercises or desensitization therapy, which focus on self-touching and pelvic training. Classic counselling or sex therapy can also be helpful, especially if you’ve been experiencing painful sex for a long time and have come to fear sex. Cognitive behavioural therapy (CBT) is especially useful for changing negative thought patterns. Syrona has CBT therapists on hand to help you. There are also simple remedies you can try at home. Some people report that taking over-the-counter painkillers, emptying their bladder or even taking a bath before sex can prevent pain. And if standard lube isn’t cutting it for you, why not try out CBD lube designed with dyspareunia in mind? Being open about your pain with your partner and fostering a safe, relaxed environment for sex is important for everyone, but especially for those struggling with dyspareunia. And there are of course alternatives to penetration: sensual massage, mutual masturbation and oral sex all make for nourishing sexual experiences. Dyspareunia is a vast condition with several different variations, causes and treatments. If sex hurts for you, it is not something you should grin and bear. Keep track of your symptoms, find a gynaecologist who makes you feel heard, and prioritise your sexual and mental health. You deserve it.

This article was written exclusively for Syrona Health by Emma Olsson

References

• https://www.psychiatry.org/home/search-results?k=Dyspareunia
• https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967#:~:text=Many%20women%20have%20painful%20intercourse,before%2C%20during%20or%20after%20intercourse
• https://www.nhs.uk/common-health-questions/sexual-health/why-does-sex-hurt/
• https://www.nhs.uk/conditions/fibroids/
• https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405
• https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/
• https://www.healthline.com/health/ibs-symptoms-in-females#chronic-pelvic-pain
• https://journals.sagepub.com/doi/full/10.2217/WHE.13.19
• https://www.mayoclinic.org/diseases-conditions/painful-intercourse/diagnosis-treatment/drc-20375973
• https://www.healthline.com/health/dyspareunia/signs-to-see-your-doctor#Preparing-for-your-appointment
• https://bnf.nice.org.uk/drug/ospemifene.html
• https://bnf.nice.org.uk/drug/prasterone.htmlhttps://pthelp.com/blog/2018/5/27/proven-help-for-painful-sex-pelvic-floor-physical-therapy
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659238/