Why does sex hurt?
Having pain or discomfort during sex is common, nearly 75% of women experience pain during sex at some point during their lives but it is not normal.
If you are having pain during sex you are not the only one, and it doesn’t mean you will always have pain, there is hope, your body is resilient and capable of healing.
I have helped hundreds of women eliminate pain and reclaim their sex lives, healing is possible!
Healing takes time, it is a process that starts with understanding the mechanisms of pain, identifying and addressing your personal root cause and retraining your brain and nervous system.
Painful sex (dyspareunia) can look many different ways, including:
- Pain at the opening of the vagina on initial penetration
- Pain felt deeper inside during sex
- Pain only with deep thrusting
- Difficult and/or painful orgasms
- Constant burning and stinging of the vulva or vagina that gets worse with sexual activity
There are also a few common medical diagnoses that are often associated with pain during sex:
- Vestibulodynia = Pain at the opening of the vagina
- Vulvodynia = Burning pain at the vulva
- Vaginismus = Involuntary pelvic floor muscle spasm
- Painful or uncomfortable bladder symptoms could be a sign of recurrent UTIs or interstitial cystitis
- Deeper thrusting pain could be due to pelvic floor muscle tension or endometriosis
- Any raw or burning pain or discharge that starts out of nowhere one day may be an infection – go see your doctor!
Your pelvis is an incredibly complex area of your body, you have multiple muscles, nerves, blood vessels, and organs all occupying the same small space.
Everything is connected. For example, if you are constipated you may need to urinate more frequently and sex might be more uncomfortable or painful simply because your rectum is taking up more space and putting pressure on the surrounding organs.
That being said, your brain and nervous system play a role in painful sex as well.
Let’s Dive a Little Deeper and Identify 4 Surprising Reasons Sex Might Hurt:
1. It’s not in your head but it is in your brain
Before we go any further we must talk about how pain actually works. Pain is a protective mechanism, it is a direct result of your brain’s opinion of how much danger you are in. That being said, YOUR PAIN IS REAL, it is not in your head.
There are many factors contributing to pain and the good news is, your brain and nervous system can be retrained. Sometimes pain is connected to a physical injury, infection or tissue damage but sometimes it is not.
For example, if you step on a nail, your brain will give you pain to alert you that tissue damage has occurred at your foot, but if you are running out of the way of a speeding car, your brain will assess the situation and decide that the ability to run and survive is the most important thing so it may not give you nail-in-foot related pain until you are safely away from the car.
Your brain and nervous system can also “turn up the volume” on pain when a situation feels dangerous, especially after injury or trauma to a sensitive area.
I see this a lot in my practice, where women continue to have pain after a UTI, sexual trauma, a yeast infection that has physically healed.
Your brain remembers the previous injury/trauma and associates any activity near your genitals as potentially dangerous.
There are physiological changes that occur when your brain decides to give you pain as well including muscle guarding and sensitization or “turning the volume up” on local nerves in the area that your brain is trying to protect.
A great example of how the nervous system response can change based on the environment is being home alone during the day vs. being home alone at night.
During the day, you barely notice or respond to creaks and cracks of the house because of your brain associates daytime with safety.
At night, however, we feel more vulnerable, less safe and your brain will “turn up the volume” on all your senses, sensitizing your ears to pick up any small noises and giving you that jolt of adrenaline so you are ready to respond to potential danger.
To retrain your brain and nervous system and decrease your experience of pain start paying attention to what makes you feel safe and what makes you feel less-than safe (anxious/ upset/ angry/ afraid).
When you feel safe, your nervous system will feel less of a drive to over-protect you and you will experience less pain.
You can also start to train your mind to start considering activities that were once seen as dangerous as “safe” activities by visualizing yourself doing these activities and feeling safe.
I often have my clients practice visualizing themselves having enjoyable, pain-free sex 5 min every day.
2. Pelvic floor muscle tension
Pelvic floor muscle tension is another reason for pain during sex. It can occur as a part of your body’s protective mechanism, secondary to stress, past experiences with pain or as a result of guarding when sex is hurting for another reason.
Sometimes, you may even have an involuntary contraction of your pelvic floor muscles during sex, this is called vaginismus – this can feel like pain, discomfort or even like a wall blocking anything from entering your vagina.
Your pelvic floor is a hammock of muscles that sit at the base of your pelvis.
They support your internal organs (bladder, rectum, and uterus) and just like the other muscles in our body, they need to have enough strength to contract (to support our spine, generate orgasm, and hold our poop and pee IN), relax (to allow for pain-free sex, let poop and pee OUT, and allow us to generate contraction) and lengthen – (to learn more about your pelvic floor muscle anatomy check here).
Your pelvic floor muscles are some of the most protective muscle in our body and we can hold tension/stress in our pelvic floors just like we do in our shoulders.
They’ve actually seen that the pelvic floor is one of the first muscles to contract when we are under times of fear, stress, and anxiety as a protective mechanism.
When pelvic floor muscles are tight, it can cause pain during sex. Think about when you have sore muscles after a hard workout, there may be tender to move or to touch, the same thing happens with your pelvic floor.
This may feel like sharp or sore pain deeper inside the vagina or at the bottom of the opening of the vagina. You may also have pain or difficulty reaching orgasm.
Your pelvic floor muscles are also very closely related to your hip muscles and your back muscles.
This means that your best bet for pain-free sex is to choose positions when your legs can be relaxed like laying on your back or your side and put pillows under your legs and support your legs during sex.
This allows your pelvic floor muscles to stay more relaxed (more relaxed pelvic floor muscles generally means less pain, yippee!)
If you think you may have pelvic floor muscle tension or tightness a pelvic floor physical therapist can help!
3. Hormones, or lack thereof
Hormones like estrogen and testosterone are responsible for making our vaginal tissue thick and healthy with good blood flow and ability to lubricate when needed.
During breastfeeding and menopause, you will have lower levels of sex hormones to support your vaginal tissue.
When this happens it usually feels like stinging/burning/sandpaper at the opening of the vagina and is often accompanied by redness and vaginal dryness. This pain at the opening of the vagina is referred to as vestibulodynia.
Shockingly, oral birth control pills can also have a similar effect. When you are on the birth control pill, your liver produces a protein called sex hormone-binding globulin (SHBG). SHBG binds to your sex hormones like estrogen and testosterone and stops them from doing their job in your body.
Think of your sex hormones like a group of puppies at the dog park, when the puppies (your estrogen and testosterone) are off-leash they can run and play (do their job in your body – support your tissues, help you produce natural lubrication and a natural drive to have sex), when they are on their leash they cannot run and play and do their job in your body.
SHBG comes into the dog park and puts all the little puppies on leashes, the puppies are still in the dog park but they can’t run and play (your hormones are being produced but can’t do their job).
When your body is not able to use all the estrogen and testosterone you are producing your libido decreases and you may have burning or stinging at the opening of the vagina or struggle with vaginal dryness.
If this sounds like you, you may want to ask your doctor to test your hormones levels. Often adding topical hormonal support and/or a vaginal moisturizer can be very helpful with decreasing your sensitivity and pain.
4. Not enough foreplay
Why is foreplay so important? Because it actually physiologically changes the whole shape and size of your vagina!
Not only does more foreplay give your body a chance to warm up but the vagina lengthens 200% when aroused.
If you are struggling with pain during sex please seek out help, find a pelvic floor physical therapist, gynecologist, functional medicine doctor or sexual medicine physician.
Know that you are NOT crazy and any provider that tells you to “just have a glass of wine and relax,” is likely not going to be a good fit for you and your healing journey.
Know that with the right team of providers to support you, you can and will heal. In the mean-time, have patience and kindness with yourself.
Give yourself permission to opt-out of any sexual activity that does not make you feel good and focus your energy on connecting with yourself and your partner in a pain-free way (cuddling, kissing, maybe just touching or oral sex).