Painful sex is something that a lot of women deal with and but not many of us feel comfortable talking about it or bringing it up to our doctors.
Let’s set things straight at the beginning, sex should not be painful! If there is painful sex, then something is not right. Whether you have a medical problem, or you have a psychological problem or there just isn’t enough foreplay. Usually something can be done about it.
Sometimes painful sex can be the first sign of a more serious medical condition so it’s definitely worth getting it checked out!
Common Reasons Why You’re Having Painful Sex
Infections of any part of the female reproductive system can cause painful sex. This includes infections or inflammation of the bladder or urethra (called cystitis or interstitial cystitis).
Infections of the vulva, vagina and cervix can cause pain due to the inflammation of that area. Friction against this “raw” area can cause pain with any repetitive movement.
Infections with STIs (sexually transmitted infections) can spread up through vagina and uterus to involve the fallopian tubes and ovaries. Sometimes they can cause abscesses to form which can be extremely painful, especially if they burst!
Endometriosis is another big player when it comes to painful sex. Endometriosis is a medical condition where the normal menstrual lining of the uterus starts to grow or implant itself on other organs in the pelvis. It can grow on the outside of the uterus, the ovaries, or even the bowel or bladder.
This condition can lead to heavy or irregular periods which can be really painful.
Did you know the medical term for painful menstruation is “dysmenorrhoea” – the more you know!
With endometriosis, the pain during sex usually occurs with deep penetration, and it may be worse just before the start of menstruation. Some people report that the pain is positional so trying a different sexual position may help lessen the pain with penetration.
Unfortunately endometriosis is very difficult to diagnose because of how vague the symptoms can be. Usually the best way to diagnose it is to go for diagnostic laparoscopy, which is a surgical procedure where they can put small cameras into the abdomen and look for the endometriosis growing where it is not supposed to. Other less accurate options includes going for an ultrasound or an MRI Unfortunately what these imaging tests can see is limited.
Treatment can be with different types of medication, sometimes including the contraceptive pill. If medication doesn’t help then there are a few surgical options as well.
3. After Surgery or Episiotomy
Sex after surgery is a common reason for pain. Whether this surgery was a major operation performed on the organs in the pelvis or a simple episiotomy during vaginal childbirth, the body may still need some more time to heal.
Painful sex after an episiotomy may last a few months but it should improve with time. If you find that you are still having pain 4-6 months after childbirth, it may be worthwhile to see your doctor to make sure everything is okay.
4. Skin Conditions
Any skin condition that can occur on the rest of your body can occur on your vulva. This includes allergic reactions, psoriasis, chronic yeast infections and lichen sclerosis. All of these can cause itchiness which can lead to scratching and sore, raw skin – and painful sex
Certain sexually transmitted infections like herpes simplex and HPV can cause ulcers or warts on the vulva which can be very painful.
Ingrown hairs are often a forgotten culprit. So many women are removing their pubic hair using all sorts of methods – from shaving to waxing to epilating and more.
When the pubic hair grows back, the hair follicle can get stuck under the skin and become “ingrown”. This ingrown hair can get infected and develop into an angry bump that causes pain when there is any movement or friction in that area.
5. Not Enough Lubrication
I don’t think it can be said better than that!
Trying to have sex without adequate lubrication of the vagina (or vulva for that matter) is just asking for all kinds of trouble. Not only will it not be as pleasurable, but it can lead to painful sex. Sometimes it can be physically impossible to penetrate the vagina.
The causes of inadequate lubrication can range from not enough foreplay to your mental state and hydration level, to certain medications and medical conditions. The list is endless!
On the PLUS SIDE, there are tons of different lubricants on the market! I have created a handy Lubricant Guide to help you find a lubricant that suits your needs. Feel free to check it out and screenshot it. Take it with you to your local supermarket or pharmacy to find one that will work for you.
Vaginismus is the big word we use to describe involuntary muscle spasms of the opening of the vagina. This is a medical condition where the pelvic floor muscles tighten in anticipation of anything entering the vagina. This condition can make sex extremely painful or even physically impossible.
Because these muscle spasms are involuntary, it can even make pelvic exams or Pap smears almost impossible. If you have trouble putting in a tampon, it can be a sign that you may have this condition. If this is the case, you should definitely make an appointment to see your doctor.
Currently, vaginismus is considered to be largely a psychological condition but there may be some physical contributors as well. We still need to do much more research in this area.
Vulvodynia is another big word we use to describe persistent pain of the vulva. This is a diagnosis that we give only after we have ruled out any other identifiable cause.
The pain can involve the whole vulva or be restricted to a certain area. It can happen spontaneously or be provoked (by touch or trying to insert something into the vagina).
If you have vulva pain with even the softest touch of an earbud, you may have this condition. This condition is a result of your nerves incorrectly interpreting any touch as a painful stimulus. This can be treated.
There are many reasons why you’re having painful sex, but I want to make sure you know that it is NEVER meant to be a normal part of sex. Don’t ever let anybody tell you to just drink some wine and close your eyes – not even your doctor!
Get the help you need so that you can enjoy sex the way you deserve to. You can get help by making an appointment with your local GP or Gynaecologist. If they cannot assist you, try to find a sexual health physician in your area who has experience in treating painful sex conditions.
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Disclaimer: This blog contains my opinions and doesn’t reflect the opinions of the Department of Health of South Africa or The Southern African Sexual Health Association. All information is accurate and true to the best of my knowledge, but it’s possible that there may be omissions, errors or mistakes. While I am a qualified medical doctor, I am not your doctor. The information presented on this blog is for entertainment and/or informational purposes only and shouldn’t be seen as professional medical advice. If you rely on any information presented, it’s at your own risk. Please consult a professional before taking any sort of action. I reserve the right to manage this blog as I see fit, including the right to remove harmful or unhelpful comments.
- Medscape. [Online]. Available from: https://www.medscape.com/viewarticle/493989_1 [Accessed 30 December 2018].
- Kruger, T.F, Botha, M.H. Clinical Gynaecology. (4th ed.). South Africa: Formeset Print; 2014.
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