Paul H. Byerly
Some of the causes of sexual pain are simple and easy to deal with, some require medical help. If you seek medical treatment, be sure you find a doctor who takes your pain seriously; in the past sexual pain was often dismissed as mental or emotional. While the mind can be a factor, most sexual pain has a very real physical component. The good news is that most sexual pain can be cured, and much of what can’t be fully cured can be reduced.
We start below with the most easily resolved problems. Be aware that pain may be from a combination of problems. Also, realise that fear of pain makes any pain worse. If a woman has suffered sexual pain in the past, and especially if it’s common, her husband will need to be gentle and very understanding. Any impatience on his part will just make things worse.
Sexual intercourse causes friction, and too much friction will cause pain. A woman’s natural lubrication is designed to reduce the friction, and thus prevent pain, but there are a number of things that can result in a woman producing insufficient lubrication. Hormonal changes brought on by pregnancy, childbirth and nursing can all leave a woman too dry for intercourse to be comfortable. Menopause reduces vaginal lubrication below needed levels for many women. Birth control pills can reduce lubrication to insufficient levels, as can the normal hormonal changes of a woman’s cycle. In addition to a lack of lubrication, the consistency of vaginal lubrication can change in a way that makes it less effective. Finally, a woman may lubricate well initially, but not continue to lubricate well enough for prolonged intercourse.
Regardless of why, a lack of lubrication is easily resolved with an over the counter lubricant. Sexual lubricants are available at any drug store or chemist shop. Water based lubes can dry out, especially during prolonged sex. If this is a problem, a silicone based product may be preferred. For more information, see our lubricants article.
Recent studies1 have found that women are more likely to suffer pain during intercourse if their partner is circumcised. The reason for this is that the foreskin reduces friction between the penis and vagina. If he’s circumcised, she may benefit from use a lubricant even if she feels she lubricates sufficiently. A non-sticky, long lasting lubricant would be best.
His size, primarily the width of his penis, can also be an issue. Despite our society’s obsession with penis size and claims that a woman’s vagina can stretch a great deal, the simple physics of the matter are that a larger penis means more friction. Again, a lubricant can help.
Problems related to his penis are more likely to result in discomfort than full on pain, but this is still a problem. Discomfort will interfere with her climax, and may reduce her interest in intercourse.
Women’s sex organs are far more delicate than men’s sex organs – a fact many men don’t fully appreciate. Rough handling of the vulva during foreplay can leave her tender, as can excessive or rough penetration with the fingers. Starting intercourse before she is fully aroused (not just lubricated, but aroused and ready for intercourse) can lead to discomfort and pain. Entering too quickly or thrusting hard and deep can be a problem. He should enter slowly, at her direction. Being still for a short time after full insertion will give her body a chance to adjust.
The angle of penetration can be an issue. If he is not in-line with her vagina, he puts greater pressure and friction on one area of the entrance of her vagina, which can lead to pain during or after sex. Rear entry sex can cause trouble for this reason. Rear entry can also hurt if he goes too deep. If any of these seem like a source of pain, try sex with her on top. When she controls the movement, pain is far less likely.
A “feast or famine” schedule, with long periods of inactivity separated by bouts of sex multiple times a day, is likely to cause her problems. Any sudden increase in frequency, such going from once a week to every other day, can leave her sore. Because sexual arousal dulls pain, she may not be aware until after sex. If you want to increase frequency, do so gradually. If you are going on vacation and expect to have sex much more often than usual, a few extra times the week before you leave may prevent problems. A good lubricant will also reduce problems associated with increased frequency.
“All night long” sex may sound like fun, but in reality, her body is not built for that. Prolonged intercourse can cause pain, and she will probably hurt before he feels any discomfort. As with frequency, prolonged intercourse is something you can work up to gradually, but there is some limit for every woman.
Yeast or bacterial infections of the vagina and urinary tract infections cause anything from discomfort to significant pain.
Yeast infections are common – it is estimated that 75% of all women will have a yeast infection at least once in their lifetime. Symptoms of yeast infection include itching, soreness, and possibly a white, cottage-cheese-like discharge. While over the counter remedies are available, it is strongly recommended that you see a doctor the first time you suspect you have a yeast infection. After that, you can be more sure that you do have a yeast infection, making self–treatment a reasonable option. If you have frequent yeast infections see a doctor.
Bacterial vaginosis (BV) is a condition in which the balance of naturally occurring bacteria in the vagina changes, resulting in overgrowth of certain bacteria. BV usually occurs during a woman’s reproductive years. The causes of VB are not known, but douching has been proven to increase a woman’s risk. Most women with this infection exhibit no symptoms. The most common symptom is a fishy smell, especially after intercourse. If there is a discharge, it is white or gray and may be thin. Painful urination and pain at the entrance to the vagina may occur. Diagnosis requires a lab test. Treatment is with antibiotics, and it is critical to use the full course of antibiotics even though the condition will seem to be gone before all medication is taken.
Urinary tract infections (UTIs) cause pain and burning with urination, and can make intercourse painful. Medical treatment usually clears UTIs up easily. In addition to making sex painful, sex can cause UTIs. Vigorous or prolonged sex, or a sudden increase in sexual frequency, can force bacteria into the urethra and cause an infection. Urinating immediacy after sex can wash bacteria out. Post sex urination is advised for all women, and is a must for those who suffer from UTIs.
Sexual transmitted diseases (STDs) can irritate or damage the sex organs, making sex painful. Some STDs can be symptom free for months or years, so an STD does not necessarily indicate adultery. Diagnosis and treatment always require a doctor.
The vulva and vagina are delicate, and chemicals can easily irritate the tissues, resulting in pain. A common problem is spermicides, either stand alone or on condoms. Eliminating the spermicide will show you if that is the problem. Condoms without spermicides are available if needed. A latex allergy can also be a problem – if you suspect this, try non-latex condoms. Although uncommon, lubricants can also cause problems. Change brands and types – from water based to non-water based or visa-versa.
Other sources of genital irritation are soaps, feminine hygiene products, bubble bath, and laundry products. Do not use soap on the vulva, washing with warm water is sufficient. Use only unscented tampons and pads, and try different brands. Some women find that all cotton products make a difference. Avoid the use of “feminine hygiene sprays”, special washes and towelettes , and do not douche. Discontinue any products used in bath water, or better yet shower for a couple of weeks. Try changing laundry detergent and discontinue use of any dryer products. If this seems to be an issue, try using a very mild soap for washing underwear. Be sure all panties have a cotton crotch. If you shave your pubic hair, change any shaving product you use, or try not shaving for a while.
Chemical irritations can be difficult to find because a product may change its formulation without you knowing it, or you could become sensitive over time. A product that is only mildly irritating may not be a problem until a woman becomes sexually active, or increases her sexual actively level. A product may become a problem due to changes in the genitals related to hormones or age. The best bet is to keep the vulva and vagina as chemical free as possible.
Andrew T. Goldstein, MD and Lara J. Burrows, MD, MSc have speculated that hormonal changes resulting from birth control pills can cause changes in the vulva and vagina that result in sex being painful. One form of chronic genital pain known as vulvar vestibulitis (more below) is 6.6 times more common in women who have used birth control pills2. Studies on other forms of hormonal contraception have not been done, but it is likely they have a similar effect.
Resolving pain associated with birth control pills requires discontinuing the pill and receiving estrogen and androgen supplements to bring those hormone levels back to normal. Most pill-induced pain can be eliminated within six months.
Vulvodynia is a chronic pain syndrome of the vulva that has no identifiable cause. Vulvar vestibulitis (VV) is a subcategory of vulvodynia that affect the vestibule – the entry to the vagina. Pain may come and go randomly for no discernible reason, or may be worse at times for unknown reasons. The vulva can become so sensitive than even very light touch causes extreme pain.
Once relegated to “all in her mind” these conditions are now taken seriously by most medical professionals. A great deal of research is being undertaken, but the condition is mostly still a mystery, and remains difficult to treat. A new product called Neogyn Vulvar Soothing Cream (AffLink) has been clinically shown to help reduce pain associated with vulvodynia, including significantly reducing pain during sex3.
On-line support groups4 can be a great source of help for those suffering from vulvodynia and vulvar vestibulitis. In addition to an understanding ear and suggestions that can help, these groups are the best way to learn about new research and treatments.
Oxalates are consumed in food, and excreted in the urine. If a woman is sensitive to oxalates, she will experience urethral pain. Cutting out foods high in oxalates will help, but it may take up to six months for pain to be completely gone.
Physical damage or deformity of the vulva or vagina can make sex painful. This can include naturally occurring deformity, damage caused by sexual assault, damage from childbirth, and scars left from surgery. Endometriosis and pelvic inflammatory disease are other possible causes. Pain may come and go or change intensity due to hormonal fluctuations.
In some cases, a topical cream can help. Changing the position used for sex will solve some problems. In some cases, surgery is required. Find a doctor with experience dealing with such issues, and be an active part of treatment.
Vaginismus is a conditioned response that causes the muscles around the vagina to contract tightly and painfully during any attempt at penetration. This condition results from previous sexual molestation, a painful medical procedure on the genitals, or fear of sex. See this article for more information.
Women: don’t hide or try to bear pain – aside from robbing you of sexual pleasure, this is harmful to your marriage. Men who find they have been unknowingly causing their wife pain during sex react with guilt, anger, and depression. I spoke with one man who was so distressed to learn of his wife’s years of pain that he become unable to have an erection with her.
Men: If she seems to experience pain, stop and ask her. Don’t let her down play it. Some women have been taught sex is supposed to hurt, and that they are supposed to “just take it”. This is wrong, and it prevents her from enjoying sex the way God intended.
Find other ways: Don’t become non-sexual because of pain; find ways to enjoy sex that don’t hurt. Do this as you work on the pain, making sex better now as you move towards what it should be. Learn to use different positions, provide pleasure with your hands and mouth, or get a vibrator.
2 Use of Oral Contraceptive Pills and Vulvar Vestibulitis: A Case-Control Study American Journal of Epidemiology Volume 156, Issue 3Pp. 254-261
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