Welcome to The V, our weeklong series devoted to all things sex and reproductive health. This is a safe space free from "taboos," because there's no reason women should feel awkward talking about their bodies. That said, we'll be clearing up any misinformation on the subject, starting with this huge misnomer: The "V" in this case doesn't refer to the vagina, but the vulva, which is the anatomically correct term for external female genitalia (including the opening of the vagina). Stay tuned all week for need-to-know guides on birth control, tips for taking your orgasm to the next level, real-life stories about endometriosis, and everything in between.
Original Illustration by Lauren Johnstone
I think we can all agree that even when it's amazing, sex is… weird. It's body parts and gooey textures and intense chemical reactions, not to mention that it's one of the most emotionally vulnerable situations you can put yourself in. So when something goes not quite right during sex, like pain, things can get extra weird.
Do you experience regular pain with sex? You are so not alone. According to estimations from The American College of Obstetricians and Gynecologists, nearly 75% of women will experience painful sex in their lives, either temporarily or long term. (By the way, we know that there are just as many—if not more—definitions of "sex" as there are human sexual identities, which is to say, a lot. But since so many women's pain comes specifically from penetration, that's mostly what we're going to talk about here. I also hate the word "penetration," so I'm going to try not to use it.)
75 is a sky-high percentage, but most women never talk about their experiences with painful sex—and there are many complicated reasons for that. One of them, says Felicia Clark, a body image coach and teacher of Tantric sexual healing, is simply because "one of the unwritten rules of a committed long-term relationship is to tolerate bad sex." As Clark puts it, "Just as women are pressured to fake orgasms, women are expected to pretend to like painful sex in order to support the male ego." When sexual fulfillment doesn't happen, blame is so often placed on the woman, even though most people (of all genders and sexes) are pretty uneducated about what it takes to please a partner.
Unfortunately, painful sex is often misunderstood by the medical community as well. "I believe so few women talk about it because many of them have been to countless physicians who were unable to treat their pain," says Lisa Valle, a board-certified OB/GYN who runs a practice solely devoted to female sexual dysfunction. "A typical patient I see in my office has seen approximately 10 to 15 health professionals from various specialties prior to coming to see me." Valle says that because many physicians are not taught about female sexual health concerns in med school, they're not able to treat many patients appropriately.
The truth is that there are dozens of specific causes of painful sex, from niche medical conditions to emotional factors. But today, we're just going to talk about the most common ones. We're not trying to get all WebMD on you—consult an OB/GYN you trust before moving forward with any sort of treatment. But to get you started with a bit of information, read on to discover seven common reasons women experience pain with sex (and what you can do about them).
Common Causes of Painful Sex (and How to Treat Them)
If You Have Endometriosis…
Endometriosis is a disorder that causes the tissue that normally lines the inside of your uterus to grow outside the uterus… which does not feel good, to say the least. The condition "most commonly presents as recurrent painful premenstrual or menstrual pain," says Valle. Sex with deep penetration (ugh, okay, I guess I'm going to have to use this word a few more times) can make the pain worse.
To help with the painful sex part of endometriosis specifically, Valle recommends switching up your positions to avoid too-deep penetration. "This might entail some experimentation since every woman with endometriosis presents differently," says Valle. "Shallow sex and side-to-side or doggy style might be preferred."
Avoiding sex when pain is worse during times in your cycle might also be a good idea. "A journal of her pain would be helpful to determine this," Valle suggests.
If You Have Skin Issues Down There…
There are tons of different types of dermatologic conditions that can occur in and around the vulva, so you'll definitely want to hit up your OB/GYN if you think this might apply to you. In terms of how they affect your ability to enjoy sex, some are worse than others. "Lichen sclerosis of the vulva is one vulvar condition that alters the architecture of the vulva, which can ultimately cause sexual pain if left untreated," Valle explains. Vulvodynia is another example, a condition that causes chronic vulvar pain for seemingly no reason.
Treatments of these sorts of conditions can vary, so it's super important to get an accurate diagnosis. But topical steroids are often prescribed. Sometimes so are vaginal dilators, which work to widen the entrance of the vagina (which is not as terrifying as it sounds). And sometimes it's recommended that patients avoid wearing tight, irritating fabrics and scented toilet paper and tampons. But again, a specific diagnosis is key.
If You're Going Through Hormonal Changes or Menopause…
Hormonal changes in the body (like the lowering of estrogen levels) can have a huge impact on a woman's ability to enjoy sex. This can occur as women age, breastfeed, go through menopause, take certain medications, or experience other reproductive health issues, Clark says. "The absence of estrogen has direct effect to the vulva, vagina, and lower urinary tract to make those tissues more thin and fragile," explains gynecologist Barb DePree, MD. This can lead to dryness, burning, urinary tract symptoms, decreased lubrication, and pain with intercourse.
While prescription hormone treatments are an option, there are also things you can do at home, like using a lubricant or vaginal moisturizer during sex (DePree is a fan of Replens Silky Smooth, $15). "Whenever you reduce friction, you may also reduce pain," she says. There is also a number of all-natural lubes on the market, like Province Apothecary Sex Oil ($28) and Coco La Vie ($48).
If You Have Pelvic Floor Dysfunction…
Involuntary spasming of the pelvic floor can be a sign of a sexual health condition like Vaginismus. According to Sherry Ross, MD, OB/GYN, and author of She-ology, "Vaginismus is a condition where the muscles of the vagina contract involuntarily, tighten, or spasm, causing vaginal pain, sexual discomfort, burning, and penetration problems." (You can read way more about the condition here.)
Both physical and emotional factors can cause pelvic floor dysfunction, so working with a skilled pelvic floor physical therapist, as well as a mental health therapist, can be super helpful.
If You Just Had a Baby…
If life were fair, a woman's vaginal pain would end after the trauma of childbirth, but of course, there has to be a long, painful recovery process. According to Laurel Steinberg, Ph.D., sexologist, and professor of psychology at Columbia University, "Before giving birth, many women have an episiotomy to sew tears or incisions made in the vagina to facilitate the birth process." These cuts and tears need time to heal—usually four to six weeks. To be safe, just try to suck it up and wait until your OB/GYN gives you the green light to ensure sex doesn't feel… 0/10.
If You're Dealing With Relationship Strife (or Inadequate Foreplay)…
Sometimes painful sex comes not from a medical condition, but from a straight-up bad connection. "Relationship strife can lead to a lack of becoming sexually excited with a partner, resulting in a lack of genital engorgement and lubrication," says Steinberg. (Engorgement: That's another word that gives me the creeps. Does this mean I'm a prude?)
Not to mention, a lot of partners just don't understand exactly how much foreplay is needed for a woman to feel physically ready for sex. "They just stimulate the breasts and sex organs for a short time before penetration. … The 'non-readiness' for sex can be painful," says Clark. Plus, a lot of dudes, in particular, might think (even subconsciously) that rough, painful sex is normal.
To remedy all of these situations, slowing down the foreplay process is crucial. Which can be easier said than done. So our experts recommend possibly stepping outside your comfort zone and signing up for a Tantric sex workshop in your town. (Try it once—you and your partner might really dig it.)
If You Have Anxiety, Depression, or PTSD…
Our experts agree that mental health can majorly impact whether sex is painful or not. "Depression can cause a reduced libido or psychogenic pain in any part of the body, including the vagina, and anxiety can cause a reduced libido, vaginismus, or dyspareunia [that's just a fancy word for painful sex]," says Steinberg. Physical and talk therapy with doctors who specialize in female sexual health issues can help you work through some of this stuff.
In addition, memories of past sexual trauma can also make sex painful. "When a [partner] does something sexually to trigger that memory, or he [or she] was the cause of the trauma, a woman's body can 'close,'" Clark explains, "whereby lubrication, openness, and receptivity won't happen." In cases like this, holistic energy and healing exercises can be helpful. Clark recommends the use of yoni eggs ($25), semi-precious stones worn inside the vagina to strengthen the pelvic floor, as well as bring sexual healing and balance.
This story was originally published on June 29, 2017.