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Pain During Vaginal Intercourse

Many women feel pain the first time that they have sex, but with enough time and practice they get to know their bodies to learn how to minimize or eliminate discomfort, as well as what feels good for them. For other women, intercourse never feels pleasurable or else it becomes painful as a result of aging, childbirth, a medical condition, a new partner or for other reasons that a woman can't seem to pinpoint. It can be a difficult and frustrating experience for women to meet with healthcare provider after healthcare provider, trying to get to the bottom of what may be causing her pain during sex.

The fact is that most women will experience some form of pain during intercourse at one time or another. Dyspareunia, the clinical name for painful intercourse, is reported in 15 percent of women at any given time , according to the Association of Reproductive Health Professionals. Pain may be felt in the vagina, deep inside the pelvis, or at the opening of the vagina. Sensations of pain can range from dull to throbbing to a burning or tenderness of the skin. Some women experience pain during intercourse, others after intercourse.

When a woman wants to have sex with her partner, but can't because it hurts, she may feel inadequate or even fear that she will never enjoy intercourse, or that her relationship may be affected or that her partner may feel hurt or rejected. However, pain during intercourse is a real issue that women can do something about. In most cases, a few adjustments during sex or getting to the root of a medically-based problem can provide helpful solutions. If emotional issues are at work, as a result of relationship problems or past abuse, treatment with a therapist can help.

Whatever the case, various interventions and a healthy dose of patience on the part of both partners can often make intercourse comfortable—and pleasurable—once again.

Table of Contents

Common causes of pain during vaginal intercourse.

The most common causes of painful sex also happen to be the most treatable. For most women who are in good health, painful intercourse is usually the result of vaginal dryness or a vaginal infection. The best treatment is to get checked out by a doctor to confirm whether a bacterial or yeast infection is present and, if so, get treatment. If vaginal dryness is the culprit, a woman may be helped by using a store-bought lubricant or spending more time in foreplay to reach maximum arousal before intercourse. Menopausal women may find that certain vaginal moisturizers recommended by her healthcare provider may be particularly helpful. Another common culprit is that he's hitting her cervix with each thrust. Often, this indicates that she's not as aroused as she needs to be. When a woman is maximally aroused before intercourse, she benefits from a vaginal tenting process, in which muscular contractions pull the cervix farther back into the body, lengthening the vaginal canal.

Other common causes of uncomfortable or painful penetration are underlying health issues that require treatment beyond foreplay and a lubricant. These include: endometriosis; a tipped or retroverted uterus; scar tissue from a c-section, hysterectomy or other pelvic surgery; interstitial cystitis; and vulvodynia, a painful condition that is estimated to affect as many as 15% of women. Conditions like dyspareunia can also be a factor, causing genital pain as well as difficult penetration or painful sex.

Keep in mind, too, that many women experience pain as a result of hormonal changes during menopause and after childbirth, especially if a woman is breastfeeding. Certain medications decrease vaginal lubrication, too, including certain anti-histamines, anti-hypertensives and anti-depressants.

When pain is not happening every time a woman has intercourse, it is less likely that a chronic condition is causing the pain, though it's still possible. If more foreplay and using a lubricant aren't doing the trick, it is important to make a visit to a health care provider and perhaps to get a second (or third) opinion if needed, as many healthcare providers have had little training related to vulvovaginal pain conditions.

Pain during vaginal intercourse and declining sexual desire.

When sex hurts, it makes sense that a woman would want to stop having it. Pain is the body's signal that something is wrong, and sex is part of the same feedback system.

Sexual desire will often decline as a woman finds that intercourse is uncomfortable or painful, whether the pain is occurring all of the time or some of the time, since she will fear when the pain will happen next time or simply not enjoy sex. It is important to intercept this vicious cycle as soon as possible to prevent pain during sex from becoming a larger issue that affects the relationship.

Women can do their part by talking to a partner about the pain. Reassure him that you want to have sex, and that you love him and are attracted to him, but that intercourse is really hurting you. Clearly communicating what is going on can help a woman to feel heard and can help her partner to understand her experience, and not to feel personally rejected. Partners can do their part by trying to understand what a woman is feeling and supporting her. Then work together to try to respond to it.

Even though many cases of vulvovaginal pain are caused by medical conditions, the experience of pain and how it affects sex can take its toll on relationships. As such, some couples find that it is helpful to work with a sex therapist who can provide support and guidance as the couple learns to adjust their sex life in response to the pain.

Strategies for reducing pain during vaginal intercourse.

Many women love intercourse for the intimacy and closeness it provides with a partner, as well as for the physical pleasures of intercourse itself. As a result, when intercourse becomes painful, both partners can feel distraught. The first strategy for making intercourse more comfortable is a visit to a health care provider to rule out an infection or other medical condition. Treating a bacterial or yeast infection will generally solve the problem.

If an infection isn't the problem, vaginal dryness often is. Try using a store-bought lubricant to make sex more comfortable. There are hundreds of varieties on the market, and a lubricant can help ease penetration, not to mention add some novelty to sex.

In fact, spending more time in foreplay may be the best treatment of all for painful intercourse, since the more aroused a woman is, the more her vagina lubricates and expands. At high levels of arousal, muscular contractions pull the uterus up in to the body, making the vagina longer, which can make more room for a partner's penis. Waiting until both partners are at peak arousal can be a great strategy for minimizing pain, and encourages couples to expand their sexual repertoire.

If painful intercourse is the result of a health condition, which requires treatment in its own right, a woman should visit her health care provider and explore options for treatment. In the meantime, couples still can find other ways to be sexual and feel connected, including manual and oral stimulation, sensual massage and sex toys.

Tips for easing back into sex, with atrophic vaginitis.

Up to half of all menopausal women experience atrophic vaginitis, the thinning and hardening of vaginal tissues as a result of declining estrogen levels, which can lead to pain during intercourse. Atrophic vaginitis also may occur at other “low estrogen” times in a woman's life, such during breastfeeding or after cancer treatment.

Many women are embarrassed to reach out for help, or rationalize the symptoms as a part of aging and a reason to stop begin sexual, especially if they don't have a partner. However, in addition to affecting a woman's relationship, atrophic vaginitis can also lead to problems with vaginal infections and incontinence, so it's important to seek treatment with a health care provider.

Estrogen replacement is the most common treatment for atrophic vaginitis, but an active sex life is helpful, too. This includes masturbation and partner sex, since both bring increased blood flow to the genitals, and with that comes oxygen and moisture to keep tissues healthy. Women who haven't been sexually active can ease back into sex with masturbation, or with sexual activity with a partner that doesn't include penetration. The use of dilators, in gradually increasing sizes, can help, too.

However, it may take some time to get the vagina to the point where penetration is comfortable and enjoyable, up to two years for some women, though most women respond sooner.1

Partners with large penises: Intercourse positions to make vaginal intercourse more comfortable.

Many women find that sex with a new partner can be uncomfortable if his penis is larger than prior partners, if it has been a while since she's had sex or if it is her first time having sex. Likewise, many women in long-term relationships can find that penetration becomes painful as a result of age, childbirth and breastfeeding, or a variety of other health conditions.

In all of these cases, the key to making intercourse more comfortable is lubricant, lubricant and more lubricant, in addition to getting to the bottom of any underlying health issues for women who've noticed a change with a current partner) There are also several positions that can make sex more comfortable, by giving a woman more control over the depth and angle of penetration.

The best intercourse positions for women who are experiencing pain with a new partner include woman-on-top, side-by-side, the spoon and missionary, in which a woman keeps her legs extended to lengthen the vagina. A grinding motion is better than deep thrusting in all of these positions.

It's always good for a woman to be as aroused as possible before attempting intercourse, to take advantage of the changes that occur to her sexual anatomy. At high levels of arousal, the vagina expands in length and lubrication increases. However, it's still possible for a woman to be very aroused and lubricated, but feel pain because a partner is so large. In most cases, a woman will adjust to a new partner's size, but these positions are always a good stand-by for making intercourse more enjoyable.

What type of expert to see for help.

It can take a lot of courage to seek help for vaginal pain. Some women may get help on their own, and others may go with their partner for support and to work through the issue together.

If a woman thinks something may physically be wrong, or a side effect of medications she is taking, it can be helpful to see a doctor. Making an appointment to see a gynecologist for a physical exam and to do some general tests can help narrow down or rule out the cause.

If the cause may be psychological in nature, it's helpful to see a sex counselor or sex therapist. In general, sex counselors and sex therapists tends to get specific training about sexual issues that sabotage sexual satisfaction, especially when anxiety, insecurity or other factors are involved. It is important to find a counselor or therapist who is certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). As, experts with this certification have had training related to both relationship issues and sexual concerns.

Following is a quick reference guide for the various academic degrees and licenses a mental health professional might obtain:

  • Psychologist: Usually has a PhD, PsyD or EdD in psychology or other mental health specialty.
  • Social Worker: An MSW pr PhD in social work.
  • Counselor/Therapist: An MA or MS in clinical psychology, counseling, mental health, or sexology.
  • Psychiatrist: An MD in psychiatry, generally licensed to prescribe medication. Some, not all, psychiatrists are trained to provide therapy, in addition to prescribing medication. Many people see a psychiatrist in conjunction with a therapist.