Pain experienced during or after sex (dyspareunia) is quite common and can affect more than just life “between the sheets.” Given different definitions of dyspareunia, estimates of prevalence vary, but some experts speculate that up to 75% of women will experience painful intercourse at some point in their lives.
When Sex Hurts
Women experiencing painful intercourse may describe it by the location of pain, timing, or in other ways. Pain is entirely subjective and individualized. The reality of sexual pain is it can be experienced differently at various times in a woman’s life and often cannot be put neatly into one category. Likewise, there can be interchanging and overlapping causes and effects of sexual pain.
Women will often characterize pain as either superficial (near the entry of the vagina) or deep. Pain can also be described as happening with different body positions or actions, such as putting in a tampon. Pain can be lifelong or intermittent. Individualized diagnosis is paramount for determining the right treatment plan for women experiencing painful intercourse.
A myriad of medical conditions, injuries, treatments, and traumas can affect how we experience sexual activity. Common medications including blood pressure medication, anti-depressants, birth control pills, and cancer medicine can cause variations in arousal and lubrication leading to sexual difficulty or discomfort. Sexual pain can also occur more commonly at certain times in a woman’s life.
It is estimated that nearly all women will have pain with the first penetrative intercourse after childbirth, but around 30% may still have pain 18 months after delivery. Interestingly, this does not seem to be more associated with vaginal births. A study out of Australia found that a higher percentage of women experienced painful sex following c-section than after spontaneous vaginal delivery. Causes of painful sex after delivery can include scar tissue, pelvic floor dysfunction, and hormonal changes. Also noteworthy is the finding that pain was more often experienced at 18 months post-partum if the mother reported depression and fatigue.
Second Half Sex
Peri-menopause is another time when painful sex becomes more common. Painful or uncomfortable sex is a common symptom of “genitourinary syndrome of menopause” or GSM. Hallmark complaints include lack of lubrication, vulvovaginal (external genitalia) itching or burning, as well as urinary symptoms like burning with urination and urgency. Common cancer therapies can also thrust women forcefully into menopause and dramatically change sexual functioning.
Life changing events such as childbirth, cancer, and entering the “second half” of your life may involve changes in your sex life, but you don’t need to accept painful sex as your “new normal.”
Pain Begets Pain
We often talk about the cycle of pain which accurately describes what occurs when the body feels pain, whether physical or emotional. Just as our body flinches before an injection, when we anticipate sexual pain the body responds almost automatically. Muscles tense, limbs become rigid, and part of our brain lights up. No longer is sexual touch pleasurable, but it is now a threat. The body and brain are alerted to the threat and change to protect against it. Changes in the body and brain can lead to increased pain, which in turn leads to lack of response to, and avoidance of, otherwise welcomed sexual touch. Breaking the cycle of pain is certainly possible and rarely includes continuing to do an activity that elicits pain.
A Message to Partners
A sexual partner who experiences pain may affect your overall intimacy and can occasionally lead to conflict or hurt feelings. If your partner talks to you about the pain they experience with sex, this is not an invitation to “fix” another person’s body. It is often a request for support. Let them take the lead in managing their body in a way that is best for them. Listen, validate, believe, don’t fix.
Treatment for pain disorders are as varied and complex as the presentations themselves and there is no one-size-fits-all approach. Sometimes treatment is quick and easy, but if you find yourself suffering from ongoing pain, finding a care provider with expertise in sexual medicine is vital. A multi-disciplinary care team including a physician, physical therapist, and / or sex counselor is ideal.
Hormonal and non-hormonal medications can help with lack of arousal or lubrication, and urinary pain symptoms. Sometimes changing a medication you are currently taking can make a profound difference.
Do not underestimate the effectiveness of a high quality, body-friendly lubricant! Women at any age can benefit from lube, and not just for penetration. Lube can make lots of touch more sensual and enjoyable. Maintaining vulvovaginal tissue with intimate skin moisturizer may also be helpful.
Meditation and Mindfulness
Fascinating research over the last 20 years has proven the benefits of mindfulness in areas ranging from cancer treatment-related fatigue to obesity to cognitive performance. Mindfulness is a type of meditation which focuses on what a person is feeling and sensing without interpretation and judgment. Mindfulness can help with stress response and reduction, as well as chronic pain. Free courses can even be found online.
Experimentation and Reframing
If your only definition of sex is penis in vagina, it may be time to redefine your idea of sex. Sex can be pleasurable without penetration and even without a partner. Prompt yourself by simply asking: What feels good to me? How do I experience pleasurable, satisfying sex? Adding sex toys, aids, and products such as “bumpers” that limit deep penetration can be game-changing.
A specialized pelvic floor physical therapist can assist in diagnosing and treating a variety of pain issues pertaining to the muscles of the pelvis. This may or may not include Kegal exercises, which are not universally helpful for women, and can actually increase pain in some individuals.
At all stages in life, everyone is deserving of pleasurable sex. Open and honest communication with your partner (and your doctor) can make all the difference in realizing sexual satisfaction.
Elizabeth A. Phillips, MD
Centracare Urology – Vice-chairperson
Centracare Sexual Medicine
2351 Connecticut Ave. S.
Sartell, MN 56377
Phone: (320) 259-1411