Doctors Weigh In on Why Sex Can Be Painful and How to Work Through It

Updated on June 22, 2018 at 12:00 AM

Although not all of us experience mind-blowing orgasms, sex is generally considered to be a pleasurable activity for both parties. It may surprise you that approximately 75 percent of women report experiencing pain during intercourse at some point in their lives. Like everything else, the pain level ranges from mild to severe, and for some women it's a quick phase rather than a long-term problem.

But many women consistently experience moderate to intense pain during sex and can't pinpoint the reason behind it. Furthermore, the problem can be a source of embarrassment that prevents women from talking to their doctors and confiding in their partners. It's easy to chalk up the problem to "there's something inherently wrong with me" when, in reality, there are myriad reasons sex can be painful.

Experts weighed in and explained why sex can be painful. Once you get to the root of the problem, it's time to chat with your doctor about possible solutions, because they certainly exist.

Vaginismus

Dr. Vivika Joshi, OB/GYN at Dr. Felix, told POPSUGAR that some of the most common causes of pain during sex can be related to the mind and mental health. "Lack of confidence, relationship problems, stress, and other psychological issues can cause tension in the vagina and its surrounding muscles," she explained. "This is known as vaginismus and can make penetration painful or even impossible."

Joshi recommended speaking to your general practitioner to determine if your case of vaginismus is psychological, physical, or both. If the root of the problem is psychological, cognitive behavioral therapy (CBT) can be helpful.

Joshi also recommended "vaginal training" for women with vaginismus. "Plastic forms in gradated sizes can be used at home to help women get more comfortable with vaginal penetration," she explained.

Hormonal Changes

Hormonal changes — whether they're due to childbirth, menopause, or any other reason — can lead to pain during intercourse, according to Sandra Hilton, PT, DPT, MS of Entropy Physiotherapy and Wellness, and doctor of physical therapy who specializes in helping women recover from painful sex.

"Hormonal changes lead to less lubrication," Hilton explained. "The skin of the vagina and perineum are less lubricated with changes in the estrogen levels, making the friction and shearing forces of intercourse painful."

In these cases, treatment can be as simple as finding the right lubricant to use during sex.

Pelvic Muscle Guarding and Stiffness

"Muscles are made to contract and relax. Imagine if your hand was clenched and you didn't unclench it for days. Moving your hand or having something put in your hand would likely feel stiff and may be painful," Hilton said. "The muscles of the pelvic floor contract reflexively when we cough, laugh, sneeze, and exert effort. They can also contract in response to stress and in response to pain."

If you suspect pelvic pain is the culprit, Hilton recommended getting an assessment from a pelvic health physical therapist or an OB/GYN. The practitioner will "assess through a gentle vaginal or rectal examination the ability of the pelvic muscles to relax after contraction." A treatment program can then be formed, which typically consists of manual therapy, specific movements to restore motion to the muscles, and (in some cases) a medication that decreases the sensitivity of the nervous system.

Skin Irritation

Dermatological issues, such as Lichens Sclerosis, should be ruled out. This condition affects the tissue of the external vulva, causing it to thin and tear easily during intercourse. Certain dermatologists specialize in vulvar and vaginal disorders and they can take a biopsy to determine if a skin issue is the source of your pain.

"There are topical ointments that can eliminate or greatly reduce symptoms," Hilton said.

General Pain or Injury

As Hilton told POPSUGAR, it may initially sound strange that pain can cause pain, but it actually makes a whole lot of sense.

"Sometimes there is an initial injury like a fall, or rough sex, or trauma, or a muscle spasm that didn't go away. This can cause a protective pain response and the nervous system gets overly protective and sensitive to touch, pressure, or movement of the vulva and vagina," she explained. "The nerves in the area can become over-sensitive and diagnoses like Pudendal Neuralgia, Vulvodynia, and others are given to describe the painful area."

For treatment, Hilton recommended working with a provider who is well-versed in the most up-to-date science of pain. She said that treatment typically involves non-painful manual therapy, movement of the of the pelvic nerves, and an individualized return to normal tolerance of touch, pressure, and movement.

Not Feeling Safe

"Sometimes, there is anticipation that sex will be painful, and that anticipation itself can trigger protective reactions of muscle guarding and a protective pain response," Hilton explained. "The pelvic muscles contract to guard the pelvis and internal structures."

If this is the source of your pain, Hilton recommended working with a sexual therapist along with your gynecologist and a pelvic health physical therapist. In addition to CBT, she said that "specific mindfulness techniques such as yoga, Tai Chi, and Qi Gong have been helpful for restoring a sense of control and trust with movement."

Common Infections and STIs

"Infection and sexually transmitted diseases need to be ruled out as they cause inflammation, which irritates the vulvar and vaginal tissues," Hilton said. "Treatment of the underlying disease will reduce the symptoms and then a pelvic health physical therapist can help restore normal muscle function and tolerance."

Yeast infections and bacterial vaginosis are also common causes of painful sex, and they can be treated with antibiotics and anti-yeast medications.