What To Do If You’re Experiencing Sexual Pain

A study from April’s Journal of Sexual Medicine found that a whopping 30% of women experienced pain during their last sexual experience. Sadly, a lot of women operate under the assumption that sex is inherently painful, and that all you can do is grit your teeth and get through it. Nothing could be further from the truth. If sex is ever uncomfortable for you, here are some better ideas for what to do.

Why sex might hurt

First of all, let’s talk about some of the potential causes of your sexual pain, (don’t worry, we’ll get into how to fix it next):

• There’s not enough lubrication. One of the most straightforward causes of sexual pain is not being adequately lubricated. Vaginal tissues are extremely delicate and can easily tear or chafe if vigorous penetration is part of your sexual m.o. If there’s not enough lubrication to let your bits play together nicely, you’re even more susceptible to these types of injuries. One of my clients once described sex as feeling like her partner was sandpapering her vaginal walls. Sex is not supposed to feel like that!
• Anxiety. Anxiety can make your whole body, including your pelvic muscles, tense up. It can also make it more difficult for you to recognise pain in the moment, which can lead to even more pain. I’ve worked with clients who experienced sexual anxiety due to past sexual abuse. Others have had fears about pregnancy, sexually transmitted infections, penetration, or even pain itself.
• Vaginismus. Vaginismus is a specific medical condition where the muscles of the vaginal wall contract involuntarily, making penetration extremely painful or even impossible. The muscles in the vaginal wall are pretty strong, and they can really put up a fight if they don’t want to be penetrated. There are two types of vaginismus: primary and secondary. Primary occurs when a woman has never been able to have penetrative intercourse without pain. Secondary vaginismus is when a woman used to be able to have intercourse without pain, but developed pain at some point in her life. Vaginismus has a number of different psychological and physiological causes, including infections, sexual assault, fear and stress.
• Vulvodynia. When a woman experiences pain in her (external) labia rather than her (internal) vagina, it’s typically vulvodynia. Vulvodynia is experienced as a burning, aching, or irritated sensation. Generalised vulvodynia is felt all throughout the labia, while vulvar vestibulitis syndrome is felt specifically at the entrance to the vagina. Vulvodynia hasn’t been very well studied, but it’s thought to be caused by hypersensitivity, allergies, nerve issues or genetics.
• Other Medical conditions. Sexually transmitted infections, remnants of the hymen, endometriosis, cysts, fibroids, injuries from childbirth, skin conditions, side effects from birth control pills and interstitial cystitis can all cause pain during sex.

Please note that, sadly, this is by no means an exhaustive list of all of the potential causes. Sexual pain is no joke.

How to alleviate mild or new sexual pain

If your sexual pain is new or relatively mild, there are some simple techniques you can try for reducing your discomfort before pursuing more in-depth treatment options.

Spend lots of time on foreplay

If you have a hard time relaxing or feeling present during sex, you may need to give yourself more time to warm up. Most of us are in such a freaking rush all day, every day and we often approach sex in the same harried manner that we treat the other items on our to-do list. I know sometimes sex can feel like just another thing to get through, but it should be fun and enjoyable! Give yourself permission to ask for and take up all the time you need. Try not to have any sort of penetration until you’re actively craving it. If penetration isn’t an enticing option at any given time, try other fun activities like masturbating with your partner, or getting them off with your hands and/or mouth.

Use lube

If you’ve been reading After Hours with any regularity, you know that I’m kind of obsessed with lube. Lube is one of the easiest ways to make sex less painful and more pleasurable. It helps whatever penis, phalange, or sex toy you’re using slide in and out without any of that unpleasant chafing or sandpapering I discussed earlier. It’s also a non-negotiable for anal sex. Let’s just put it this way: sex without lube is like using a Slip ‘N Slide without water. You might be able to muscle your way down it, but it’s just SO MUCH SLIDE-IER with lots of water!

I’ve heard way too many women say that they should be able to get “wet enough” on their own. To them, resorting to using lube feels like admitting defeat. Ladies, a coin-sized drop of silicone does not need to make you feel like a failure as a woman. Especially if it could help reduce or eliminate your sexual pain.

Start with your fingers

Try easing your way into penetration by having you or your partner use one finger at first. When one finger is moving in and out with ease, switch to two fingers. Work your way up to four before penetrating with a sex toy or penis.

Go slow and shallow

Despite what you may see in porn, some women’s bodies just can’t take a lot of deep thrusting. Some sexual pain is caused by partners that end up hitting the cervix. Wild, animalistic sex has its time and place, but you may want to experiment with slower, gentler, shallower sex, especially at the beginning of a sexual interaction. If your partner is particularly well-endowed, full penetration may not be possible.

Take breaks

It’s also a good idea to take little breaks to give yourself a chance to breathe and relax. Most of us get distracted during sex, so these types of breaks can help you get re-centered. If you feel embarrassed about asking for a time-out in the moment, try agreeing on a code word or symbol with your partner, to let them know that you need a second.

Get familiar with your PC muscles

Your PC muscles wrap around your entire pelvis, and are frequently involved in sexual pain (remember, vaginismus is experienced as involuntary muscle contraction). You can develop greater familiarity with and control over your PC muscles with exercise. The best way to locate them is to notice which muscles you need to use to cut off your flow of urine the next time you’re peeing. To exercise your PC muscles, pulse them 20 times in a row. Then practice squeezing, holding for a few seconds, and releasing. Repeat 10 times. Go through this routine 1-3 times a day.

If you feel yourself tightening up or starting to feel pain during sex, take a few deep breaths in through your nose and out through your mouth, and try to focus on relaxing your PC muscles. Try to get to the place in between squeezing up and bearing down. It might even help to visualise the muscles being nice and soft. You can try squeezing and releasing them once or twice, which should help re-familiarise you with what it feels like when they’re relaxed.

For lingering or intense sexual pain

If the low-hanging-fruit approaches didn’t work for you, you may need to look into more in-depth treatment options. Here are some to consider.

Do your research

Sadly, sexual pain just isn’t covered on the internet in a thorough and useful way, so you’re gonna have to hit up Amazon. I highly recommend reading a book or two about sexual pain before taking your next steps (I’ll explain why below). I really like Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain by Deborah Coady. When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain by Andrew Goldstein is another good option. If you think you know the specific condition your pain is caused by, you can look up more specialised books.

See your doctor

The reason I recommend reading up on sexual pain first is that most doctors are ill-prepared to treat sexual pain. Up until very recently, most sexual pain conditions were considered psychosomatic. Many of my clients had dutifully visited their OB/GYN, only to be told to “relax” or “just have a glass of wine.” Of course there are plenty of great doctors out there, but there are many more that don’t take sexual pain seriously. The more research you’ve done on your own, the better prepared you’ll be for serving as your own advocate. Don’t be afraid to ask your doctor for a referral to a specialist, or to shop around until you find a doctor who seems to know what the hell they’re talking about. It’s worth meeting with your OB/GYN and your GP. Finding adequate medical care can be an unbelievably frustrating process, but it’s vital that you keep looking for quality treatment.

See a physical therapist

If you suspect that your pain issues have any sort of physiological component, I highly recommend seeking out a physical therapist who specialises in sexual pain (a simple Google search of sexual pain physical therapist in your area should bring up some options). A PT will work with you hands-on to discover the specific location of and triggers for your pain, and can prescribe exercises (similar to the PC ones described above) to help decrease the pain. PT can be life-changing for so many women!

Go to psychotherapy

Let’s face it – being in pain during sex sucks. The physical aspect of the pain can be excruciating, but the mental consequences can be just as horrific. Sexual pain can cause depression and anxiety, lead to mind/body dissociation, and can drive a serious wedge between you and your partner.

It’s really important to have someone you can talk to about the emotional challenges you’re facing. Psychotherapy is crucial for women who have experienced sexual abuse, but even being able to vent about a crappy doctor’s appointment can feel like a huge weight off of your chest. There are some psychotherapists who specialize in sexual pain, or you can see a hypnotherapist for help with relaxation techniques. Even if you can only afford infrequent sessions, a psychotherapist can be a great person to have in your corner.

If you’ve experienced sexual pain, please share tips or words of encouragement in the comments!