What To Do When Sex Hurts

Are you experiencing painful sex?

If so, you’re not alone. It is estimated that 3 out of 4 women will experience painful sex at some point in their lives. That’s a whopping 75% of women that occasionally (or maybe often) experience pain with intercourse.

One of the most disturbing facts about sexual pain is that it is still not completely understood by most doctors. That means if you mention this pain to your doctor, you might see that your doctor is dismissive, tells you that you’re over anxious or stressed, or simply says that pain is an unfortunate reality as you age. This is a tragic set of responses because you really shouldn’t have to experience pain with sexual intercourse.

Why do I have pain with sex?

Painful sex is known as dyspareunia, but this is a “catch-all” word that is used to describe any type of sexual pain regardless of why the pain is actually occurring. The following terms are descriptions of specific causes for sexual pain. Knowing the specific causes can help you better understand where your pain is coming from.

Provoked vestibulodynia (PVD): This term describes sexual pain that originates from the entrance to the vagina. Women who experience PVD could have a number of different medical conditions at play, but they all find that the pain is centralized in the vulvar vestibule (the entrance to the vagina). While there are several causes, the most common reasons for women to experience PVD are hormonal changes, tight pelvic floor muscles, and an increased amount of nerve endings in the vestibule.

Hypertonic pelvic floor muscle dysfunction: This condition is also sometimes called vaginismus. When a woman has this condition, she will experience muscle spasms around the vagina, bladder, and anus which can cause pain with vaginal penetration. If the spasms are happening often or are intense enough, you can also experience constipation and trouble with urination.

Vulvar and vaginal atrophy: This condition is due to hormonal changes in the female body. With menopause, the decrease in estrogen and testosterone can result in a thinning of the vaginal walls. This can lead to dryness, irritation, tearing and pain. The elasticity of the vagina shrinks and there can be a narrowing to the opening of the vagina. Lubrication during foreplay can take longer than it did in the past.

Vulvar and vaginal skin disorders: The vagina as well as the skin of the vulva can be quite susceptible to inflammatory skin conditions which can lead to pain.

Interstitial Cystitis (IC): Women with IC, (painful bladder syndrome), will find that they have issues with frequent urination due to inflammation of the bladder lining. Sex can be quite painful and can lead to an even greater frequency of urination.

Endometriosis and/or Chronic Pelvic Pain: With endometriosis, the uterine tissues grows outside of the uterus which can cause severe pain throughout the month that can increase with sexual activity.

Generalized Vulvodynia: This is most often caused by tight pelvic floor muscles and injury to the pudendal nerve. This condition causes women to experience vulvar pain even in the absence of trying to have sex.

Gastrointestinal Conditions: Two gastrointestinal conditions that can cause painful sex are irritable bowel syndrome and ulcerative colitis.

Pudendal Neuralgia: This is a condition that occurs when the pudendal nerve has become damaged. This nerve is responsible for carrying sensations from the external genitals, the lower rectum, and the perineum to the brain.

Other chronic pain issues: Even non-vaginal pain disorders can make sex painful. For instance, chronic pain anywhere in the body can mean significant discomfort no matter what positions you try. Jason Graves at My Beloved is Mine, vulnerably shares his marriage story and how he and his wife handle the pain in their sexual relationship due to a hysterectomy and fibromyalgia. His article is a must read if you and your spouse are in this category.

Non-medical reasons for pain with sex

While the medical conditions listed above will require going to a doctor and getting treatment outside of a counseling relationship, I don’t want to neglect telling you that sometimes, sexual pain can be caused by non-medical issues. In these cases, getting some education about sexuality and seeking counseling can bring about some highly positive changes in your marriage.

Anxiety: Severe anxiety or stress related to sex can be a cause of pain for women, particularly early in their marriage. If a woman is a virgin when she marries and she heard friends or family talking about sex as painful, she may find that the anxiety that sex might be painful can actually end up causing her to be in pain. The fear basically becomes a self-fulfilling prophecy. Women with anxiety disorders can find that sex is painful because they can’t calm their thoughts or feelings prior to making love.

Inadequate Foreplay: Many women need about 10-15 minutes of active foreplay for the vagina to be ready for sex. If adequate foreplay and lubrication is not happening, the vagina is unlikely to lubricate properly which can make sex painful. Sometimes, when women have experienced painful sex in the past, they will shy away from foreplay because they would rather “get it over with” in regards to sex. Rushing through sex can actually make sex more painful.

Treatment Options To Consider:

  1. First of all, see a medical provider. In particular, if the descriptions of any of the medical conditions sounded familiar to you, talk to your gynecologist about possible treatment options. Look for a doctor that specializes in women’s health and who understands the complexity of working with female sexual pain.
  2. Consider seeing a pelvic floor specialist. While this may be a recommendation that your doctor will already give you, pelvic floor specialists work with women experiencing painful intercourse and can help you understand where the pain is coming from and what steps to take to work on healing. They’ll tell you specific treatments that will be helpful based on the location of your pain and when your pain occurs.
  3. Communicate, communicate, communicate. Make sure that you are speaking openly to your spouse. Let your husband know that the pain exists and work together to seek treatment. If your spouse is not supportive or fails to understand how sexual pain is impacting you, ask your spouse to seek counseling with you. A certified sex therapist will understand the dynamics of sexual pain and how your relationship is impacted, and can provide you with tools and strategies for staying bonded in the midst of the sexual difficulties.
  4. Expand your sexual repertoire. Sex really isn’t just about vaginal penetration. There are other ways to engage in sexual intimacy with your spouse other than just penile-vaginal penetration. You can watch this five minute video where I answer a reader question about painful sex and offer tips for expanding your sexual repertoire.

  5. Adjust your self-talk. Lower self-esteem and negative self-talk are two ways that sexual pain impacts a woman. It is natural to wonder if you’re being a good wife or what it will mean to your husband if you can’t have sex. But, go back to point four (expanding the sexual repertoire) and feed yourself true messages. “My husband loves me. My husband wants to work with me so that I get well. My husband didn’t marry me just for sex. While sex has changed for now, I can still enjoy my husband and my body.”
  6. Refuse to give up on your marriage. While a lack of penetration can feel like a sexless marriage, please know that research actually shows that you can still feel quite connected when you both have the right perspective. For tips on feeling more connected when penetration isn’t possible check out Chris Taylor (of the Forgiven Wife)’s posts on the subject here and here.
  7. If you haven’t grabbed your copy yet, you can check out my free guide with tips for increasing overall intimacy in your relationship. While there is a focus on sexual relating, there are also tips for loving one another well and for becoming better friends.
  8. Consider actually working with a sex therapist that can help you focus on both healing from sexual pain through talk therapy while also helping you improve your relationship overall. You can learn more about sex therapy here and here.
  9. Check out my favorite book on this subject, “When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain” by Drs. Goldstein, Pukall, and Goldstein. They list the following five reminders in the introduction:
    –Sex should not hurt
    –Sex should feel good.
    –Sex should occur when and how you want it.
    –Sex should be part of a healthy relationship.
    –Sex should not be the centerpiece of a healthy relationship.

You can read more about their five fundamental truths and learn techniques for ridding yourself of pain by following the outlined treatments in their book. (By the way, the link for the book is an affiliate link. If you decide to purchase through the link, it costs you nothing, but helps me support my chocolate addiction.)

Their book gives you tips for talking to your doctor so you can better explain what’s going on with your pain. The more prepared you are to talk about exactly what is happening in your body, the more likely it is that your doctor will be able to help you.

Please know that painful sex does not mean that you are going to lose your relationship. Work on improving the pieces that you can work on now (communication, conflict resolution, and just generally feeling more connected) while you seek out the specific treatments for sexual pain.

Praying God’s greatest blessings on you, your marriage, and your sex life. Be fully well, friend!

11 thoughts on “What To Do When Sex Hurts”

  1. Thanks for the great article. One additional possible cause for painful intercourse is a skin condition called Lichen Sclerosus. Most common in menopausal women, and especially those with low thyroid, it is a skin disease that causes white patches of skin on the perineum, around the vagina and the anus that can become brittle and inflamed. Though not curable, the symptoms can be controlled using steroid ointments.

    1. Thanks so much for your insight, Ruth. It seems like if the white patches are visible, maybe a spouse would be able to see them or the wife could see them herself with a mirror? This could be really helpful for ladies looking to get help from their doctors. I definitely believe in getting all of the information you can on your body and symptoms when seeking out your doctor’s help.

  2. Very helpful information. I, like Jason’s wife have Fibromyalgia and it can make intercourse with my husband sometimes unbearable. We had to realize that sex is not the only way to be intimate and show our love for eachother.

  3. My own thoughts:
    During a certain time of my cycle I always felt uncomfortable right as my mestrual cycle was ending. If a woman has a similar feeling…just skip sex that day. It is okay to have rest.

    Regarding the above comment about lichen sclerous…that condition along with other “lichen” type diseases can be made worse by shaving your pubic area.

    The piece that you link to about the wife who had a hysterectomy and can hurt for a long time after having sex. Absolutely frightening. Why on earth would someone expect sex if it would cause their partner that much pain? I’m having a hysterectomy next week. I know the healing process will be slow. I plan to give my body plenty of rest. I know my husband would not be someone who would want to cause me weeks of pain. I don’t get that way of thinking at all.

    1. Hi Kate and thanks so much for your comment and thoughts.

      It’s definitely okay just to take a day or two to rest when your body is in pain. I 100% agree with you. And, I appreciate your comment that lichen-type disease can be made worse by shaving the pubic area. It’s important for women to know what can make situations or conditions worse so they can avoid those things, or at least not have sex afterward.

      As for the piece with the hysterectomy, I’m sure that’s pretty scary since you have the procedure coming up. I expect that you’ve sought medical advice and the benefits for the process outweigh the costs. I’ve known of quite a few women that suffer from pain after hysterectomy, so definitely talk to your doctor about strategies to reduce any lingering pain and the best ways to heal up afterward. The article I linked to is by Jason Graves. He’s a colleague of mine, so I know what he was trying to express is that there are times that his wife wants to engage in sex and not that he’s pressuring her. Unfortunately, I’ve worked with enough couples to know that not all men take that approach. It is definitely not healthy to demand or pressure a spouse for sex when they’re in pain. Healthy marriages learn how to self-sacrifice when these issues arise. But, I’ve also worked with many women who desperately still want to connect through sex even when pain is involved. They feel like the moment of connection that they both feel is worth the pain she will experience later. All in all, these situations call for a couple to be open and honest with one another.

      Praying for you and your upcoming procedure. May you have a speedy and full recovery!

    2. Hi Kate,

      I just read your comment on my post. If I somehow gave the impression that I was demanding sex from her no matter the pain, I must have failed in my wording. That is FAR from the reality. I love her dearly and would never want to cause her that pain. There are times where she desires it no matter what, and I was saying that it hurts me to know I am hurting her. I hope this clears things up. The overall point of my article was that we need to find more ways to be intimate besides sexually…. for those of us who cannot indulge regularly.


  4. Miss I really don’t know what to do anymore also is not really my first time when I’m try to tell my friend that when I’m doing sex with any position it hurt 😞 they laughed at me 😭😣 and say that I’m lying it can’t be hurt but idk what is wrong with me but please miss can you do something for me I’m begging you please 😣🙏

    1. Hey there Dieunipha. First of all, I’m so sorry to hear that you’re having constant pain. That definitely is no laughing matter.

      I want to encourage you to look for a “pelvic floor therapist” or a “pelvic pain specialist” in your area. They are the best choice for understanding exactly where the pain is coming from and what steps you need to take to see the pain decrease. Out of everything listed in this article, they would be my top choice as a primary referral. After you begin working with them, you’ll have some clear answers regarding your best next steps.

      Best wishes to you and don’t give up looking for a solution!

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