Painful Sex: A Guide to Remedies, Treatments, and What to Use For Lube
While we often imagine sex d to be exciting, fun, and intimate the reality for many individuals is that sex is painful.
It might surprise you to learn that painful sex is actually very common. Nearly 3 out of 4 people have experienced pain during sexual intercourse at some point in their lives For some individuals, pain during intercourse is a temporary problem, but for others, it’s a chronic concern.
There are a wide range of reasons why someone might experience painful sex.. In this guide, we’ll look at some of the many reasons people experience pain during intercourseand steps toward making sex more comfortable and pleasurable.
Dyspareunia
Painful sex, also known as dyspareunia encompasses any kind of genital pain that’s experienced during or after sexual intercourse. Pain can either be experienced externally around the vulva or internally in the vagina, anus (known as anodyspareunia) or deep in the abdomen or pelvis.
Pain associated with dyspareunia can vary in severity and quality, from mild to severe and aching to sharp or burning.
What Is Sex?
Defining sex is an important part of understanding pain with sex, and everyone's definition of sex is different. Sex is so much more than penis in vagina. We can break sex down into two categories:
Intercourse: Any sexual activity that involves penetration, which can include but is not limited to a penis, finger or toy.
Outercourse: Any sexual activity that does not involve penetration, which can include masturbation, oral sex, external touch.
Dyspareunia can occur with both intercourse and outercourse. For the purpose of this blog post, both intercourse and outercourse will be referred to as sex.
What Causes Pain During Sex?
The causes of pain during sex range significantly from person to person. Some of the most common reasons people experience pain during sex include the following:
Gynecological problems: Medical causes like endometriosis, ovarian cysts, or hormonal imbalances can be to blame.
Infections: Pain during intercourse can be a product of urinary tract infections, yeast infections, STIs, or pelvic inflammatory disease.
Lack of lubrication: One of the biggest culprits can be a lack of lubrication. Natural lubrication fluctuates based on your hormones, arousal and hydration and may be a result of a changes in any of these areas. Lack of lubrication can be caused bysomething as simple as not feeling connected to your partner or not having enough foreplay. A lack of lubrication can also be a result of taking certain medications as these affect arousal and sexual desire.
Pregnancy and birth: During pregnancy and following childbirth your pelvis undergoes massive change. Pregnancy causes fatigue and often resulting irritation to the muscles inside and outside of your pelvis which can contribute to pain. Birth can lead to common pelvic floor injuries like perineal tearing, leading to scar tissue in the vulva and/or vagina which can cause pain if left untreated.
Fear-Tension-Pain Loop: When you’ve experienced pain before during an activity before, your body learns to expect pain during that activity. When your body expects pain, it tenses to prepare itself for the pain experience. When the muscles in and around your pelvis are tensed during sexual activity, particularly during penetration, this can lead to pain, strengthening this cycle.
Inflammatory diseases: Diseases like inflammatory bowel disease, and Sjögren's syndrome, are known to cause painful intercourse.
Do Emotional Factors Contribute To Painful Sex?
Sexual activity,emotions and socialization run hand in hand — many of these non-physical factors can make sex less enjoyable or can contribute to pain. Factors tied to psychosocial influences, such as cultural norms, shame, relationship stressors, or a history of physical or sexual trauma can lead a person to feel tense or fearful during sexual activity, contributing to the same fear-tension-pain loop we discussed above.
This is a challenging topic to do justice in writing. All too often when patients come see us in the clinic, they’ve been told before that their pain is in their head. Other unhelpful but common pieces of advice include recommending alcohol to “loosen up.”
If you experience pain with sex, the pain is not in your had. Alcohol is not the solution and your emotions are not the problem. With that sound, humans function as a result of their mind-body connection, so in order to do full justice to a physical problem, we have to acknowledge the potential impact on and of the brain.
As pelvic floor physical therapists, we treat the physical directly with tools and techniques like manual therapy, dilators and exercise. But for folks with chronic symptoms that have psychosocial components, sometimes treating the physical isn’t enough. In that case, your PT may recommend meditation, sex-therapy or a variety of other tools to help integrate the physical and mental.
When Should I See a Doctor About Painful Sex?
While it’s not uncommon for folk to feel uncomfortably talking to their health care professional about painful sex, the sooner you do so, the sooner they can help you get to the root cause of the issue. If you’re experiencing any of the following symptom for the first time, you should consult your doctor.
New pain with no known cause in your genitals
Unusual discharge
Itching, burning or discoloration in the vulvar or vaginal opening
New pain with urination or changes to bladder function
Consulting your OB-GYN or other medical professional is an important step in ruling out any gynecologic conditions that could be the root cause of pain. But what if your medical provider says that you’re all clear, with no infection or obvious cause of your new onset of pain? That’s when you want to consider pelvic floor PT.
When Should I See a Pelvic Floor Physical Therapist About Painful Sex?
Trained pelvic floor physical therapists are expert in sexual health and managing sexual pain. Pelvic floor PTs use a variety of diagnostic tools and treatment techniques to address the root cause of your pain and help you get back to pleasurable sex. Here are some reasons you would want to see a pelvic floor PT:
Pain during vaginal or anal penetration
Clitoral pain or pain in the vulva
Pain during any kind of genital contact
Pain associated with anticipation around genital contact or penetrative sex
Overactive pelvic floor muscles with or without sex
Inability to orgasm or pain during or following orgasm
Changes in sexual sensation
Medical causes have been ruled out but pain persists
Consulting a pelvic floor PT can help you have a more pleasurable and fulfilling sex life, at any stage of your life.
How to Make Sex More Comfortable
While you should talk to your medical provider and consult a pelvic floor PTif you’re experiencing painful sex, there are plenty of at-home methods you can try and tools you can use to help make sex more comfortable.
From communicating with your partner and spending more time on foreplay to finding the right lubricant, there are many ways to experiment with what works for you. Below are some basic self-help methods you can test out:
Don't rush sex: Rushing sex rarely puts anyone in the right mood. Whether you’re having sex with yourself or with a partner, give your body time to enjoy the experience. Many people respond best to sex when they feel safe and energized or tired and anxious. Pick a good time that works for you (and your partner).
Communicate: Make sure you’ve communicated to your partner that sex can be painful for you. This allows them to help create a space where you both can pause if necessary or find another sexual activity that works better to make sex more enjoyable.
Create a relaxing environment: This one can’t be said enough. Set the tone for an enjoyable sexual experience. This will look different for every person but might include things like starting out with a massage, taking a bath, lighting candles, meditation, turning on a playlist, or disconnecting from your phone to help put your body and mind in the mood.
Use lubricant: There’s no shortage of lubricant options out there, so if you’re experiencing pain as a result of vaginal dryness this might be one of the first and best things to test out. For individuals with a vulva, choose a high-quality, water-soluble lubricant as these tend to be the best for reducing irritation and sensitivity. Additionally, water-based lubricants are one of the best options use with condoms and sex toys.
Consider different positions: For some who experience pain, being on their back allows them to fully relax and find a comfortable position. For others, being on top during sex allows them to feel in control, allowing them to enjoy themselves more. Sometimes penetration hurts more in one position than the other because the way your anatomy matches with your partner's anatomy or the toy you’re using. Switching up positions is a great way to experiment.
Focus on the journey, not the destination: Have you ever treated sex like it only “counts” if you or your partner have an orgasm? Sex does not have to be goal oriented. Acknowledging and removing an end goal from sex can open you up to better enjoy the entire experience without worrying about whether it will be “successful”.
Take penetration off the table: If penetration hurts but other forms of sexual activity are pleasurable, take penetration off the table (in the short term). Taking penetration off the menu can help reduce the anticipatory pain, allowing yourself or your partner to find ways to pleasure you without the stress of pain looming over. You can do this for a week, a month, or longer if it works for you.
Best Lubricants for Vaginal Dryness
Again, there’s no shortage of different lubes available. Below are some of the most common types of lubes and the best lubricants for vaginal dryness.
Water-Based Lube
Water-based lubes are some of the cheapest, safest, and most comfortable lubricant options, especially when it comes to vaginal dryness. Water-based options tend to be one of the least irritating and most satisfactory options for people of all genders. The downside is that water-based lubes tend to wear off or dry out faster than silicone, hybrid, or oil-based options, so you’ll just want to be prepared to have extra on hand.
Silicone-Based Lube
Silicone-based lubes offer the most amount of lubrication and don’t dry out during sex. Silicone-based lubes are less likely to cause vaginal irritation, and some people prefer them over water-based lubricants for this reason.
The downside to silicone-based lube is that they tend to be expensive and far more messy than water-based lubricants. The stains can be hard get it out of your bedsheets if you spill. Additionally, you shouldn’t use silicone-based lubrication with silicone toys as this can cause degradation of the material.
Natural Lube
If you prefer natural products or tend to have sensitive skin, a natural or oil based lube might be the best option for you. Natural lubes tend to be the best lubricants for people as they don’t contain ingredients like parabens or glycerin, which can be irritating for many individuals with vulvas. Some great options include coconut or olive oil, but make sure you use a fresh container.
Ready to have enjoyable sex?
Contact us here to schedule an appointment, today. Our team of experienced pelvic floor PTs are experts at determining the root cause of painful sex and developing a treatment plan to help you meet your goals.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.