The Number One Thing i Hate the Most About Sex

 

Sex is supposed to be enjoyable, full stop—but unfortunately, painful sex is an issue that many women and those who were assigned female at birth continue to deal with.

"Sex isn't supposed to be painful, yet painful sex is pretty common," June Gupta, WHNP, director of medical standards at Planned Parenthood Federation of America, tells Health. According to the American College of Obstetricians and Gynecologists, nearly 3 out of 4 women experience painful sex—technically called dyspareunia—at some point in their lives, and even that number may be off due to underreporting. "Painful sex is often not reported because I think a lot of women assume it's normal or are embarrassed to talk about it with their partner or their healthcare provider," Jaclyn Bonder, MD, a specialist in physical medicine and rehabilitation at Weill Cornell Medicine tells Health.

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But just because it's extremely common doesn't mean it isn't an issue that should be dealt with. Occasional pain happens for a lot of reasons, many of which might have more to do with how you were feeling emotionally during sex than anything physical. But there are many physical causes of painful sex, too.

If the pain you felt during sex was a one-time thing, or something that happens just when you're extra stressed or only when you're feeling bad about your body, you probably don't need to see a doctor. But if you consistently feel pain during sex, are afraid to have sex because you worry about pain, or always have pain in certain sexual positions or during your period, that may be a sign that something physical is going on and a doctor can help.

Doctors who specialize in women's health classify painful sex in two ways: pain on insertion or deep pelvic pain—and both can be due to a variety of reasons. Here's what you need to know, according to experts.

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What to know if you feel pain on insertion

The umbrella medical term for pain on insertion is "vulvodynia" and it can have many different causes or no apparent cause at all, which doctors term "idiopathic vulvodynia."

Vaginal dryness

One reason you might feel pain as a partner puts their penis, fingers, or a sex toy into your vagina is because there's not enough natural or synthetic lubricant. Vaginas get dryer for several reasons, though one of the most common is menopause. "When someone goes through menopause the vaginal tissue gets thin and sensitive, their labia decrease in size, their vagina feels tighter and dryer," Nicole Bullock, DO, FACOG, an OB/GYN with Abilene Physician Group in Texas, tells Health. "Inserting anything vaginally is going to become an issue."

Other reasons someone might have dryness in their vagina is because they've started a new birth control that affects their estrogen levels, because they're breast feeding, or because of certain cancer treatments.

What can help: If you're dry because of menopause or breast feeding, try over-the-counter vaginal moisturizers ("yes, just like using facial moisturizers"), Mary Jane Minkin, MD, FACOG, Clinical Professor of Obstetrics at Yale University School of Medicine tells Health. If those don't work, try an internal vaginal moisturizer that includes some estrogen. Talk to your doctor about trying a new birth control if you think that's contributing. And, of course, lube is a vaginal dryness remedy that makes sex better at any age.

Infection

Yeast infections, bacterial vaginosis, urinary tract infections, and sexually transmitted infections are some of the most common causes of pain during sex, according to Dr. Gupta. Infections typically cause some swelling and inflammation in the vagina, which can make sex very uncomfortable. If you have a strange vaginal discharge; your vulva is itchy, swollen, or uncomfortable; or you have pain when you pee, check in with a doctor.

What can help: Vaginal infections can usually be treated with over-the-counter medicines or antibiotics prescribed by your doctor.

Vaginismus

Vaginismus is a little-known condition that causes vaginal muscles to clench and tighten, especially when someone tries to put anything inside — a penis, sex toy, or even a tampon. Sometimes, the muscles spasms characteristic of vaginismus can be related to past sexual abuse or trauma or emotions around sex like fear and shame, Dr. Minkin says. But other times vaginismus happens even without past trauma or after having worked through trauma in therapy.

What can help: A doctor will suggest someone with vaginismus use a set of vaginal dilators, which are like a set of dildos ranging in width from small (about the size of a finger) to large, to slowly stretch their vagina. Dr. Bullock would also suggest pelvic floor physical therapy. "All of my patients could benefit from pelvic floor physical therapy," she says. A pelvic floor therapist can help you realize when you're clenching your vaginal muscles and how to relax them.

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What to know if you feel deep pelvic pain

Deep pelvic pain is the term women's health providers use when talking about pain people feel with penetration. A bit different than pain on insertion, this deep pelvic pain is felt further inside the vagina, closer to the cervix. Like with pain on insertion, deep pelvic pain can have many different causes.

Tilted uterus

If the pain you feel during sex seems to happen only in certain sexual positions, it's possible that you have a tilted uterus. Between 20 and 30 percent of people assigned female at birth have a uterus and cervix that tilt backward toward their spine rather than forward toward the belly like usual. Usually, a tilted uterus and cervix causes no problems and most people don't even know their uterus is tilted unless a gynecologist tells them so, according to Dr. Bullock. But sometimes certain sexual positions can be uncomfortable or painful for people who have a tilted uterus because the penis or sex toy hits their cervix.

What can help: If a titled uterus is causing pain during sex, you can find new, more comfortable sex positions. Talk to your sexual partner(s) and be detailed about what hurts so you can find pleasurable sex positions together. Products like the Ohnut can also help. The Ohnut uses three stretchy, donut-shaped rings to provide a bumper so that the penis or sex toy doesn't go as deeply.

Endometriosis

Endometriosis is a strange and complicated disease that causes tissue like that which lines the uterus to grow outside the uterus. That tissue can then swell and bleed each month just like the ones inside the uterus and can cause inflammation, lesions, and scar tissue inside the pelvic area. Some people who have endometriosis have chronic pain, some have pain only around their periods, and some have pain with sex or with bowel movements, Dr. Bullock says. Endometriosis causes painful sex if the endometrial-like tissue has grown onto the lower part of a person's uterus, near the cervix and vagina, Dr. Gupta says.

What can help: "While there is no cure for endometriosis, some symptoms can be treated through surgery or hormonal birth control, which can help cut down on the pain and bleeding you may experience during your period and sex," Dr. Gupta says. Typically, a doctor will suggest surgery to remove some of the endometrial-like tissue and the scar tissue it creates, and birth control can stop the invading tissue from swelling and bleeding.