Ouch Sex Hurts - What do I do?
I’ve been there, and maybe you have too. You are having sex with your partner and a penis, finger or toy goes a little too far in and you recoil. Maybe you’ve felt an extreme burning sensation on your vulva during penetration, or perhaps you’ve felt a really strong cramp or pain after orgasm. About 3 in 4 women will experience painful intercourse at some point in their lifetime according to the American College of Obstetricians and Gynecologists. For some this pain will be short term and for others it may be recurring and chronic. Today on the blog I want to talk about some common reasons for painful intercourse (whether you are experiencing random sporadic pains, or more chronic and long term pain) and what to do about it.
First let’s talk about what’s going on:
It’s easy to forget that the vagina is a muscle, just like any other in the body, and that there is a complex bowl of muscles in the pelvis that take care of everything from urination to basically holding our body upright. There can be a lot going on in this area and while some of it may be directly related to our genitals - everything is so interconnected down there that it could be something totally unrelated. Also - your muscles in your downstairs region are prone to tension and knots just like any other part of your body. I’m sure we are all familiar with the tightness and lumps and bumps that can build up in the neck and back from stress and lack of movement. Your downstairs mix up is no different. Tension, tightness and knots can build up as well and when we bump into these tight muscles - well - it can hurt.
Some of the reasons you might be experiencing pain:
Not enough lubrication and a lack of presence during sex.
It takes 20 min for the vagina and surrounding erectile tissue to fully engorge and expand to be ready for a penis. If you aren’t warming up the oven you may experience pain. In addition if you are breastfeeding, pregnant or going through peri/menopause then your hormones are going to affect the sensitivity of your tissues and your ability to naturally lubricate. Lube is your friend, friend. Also - when we are distracted and not present during intercourse we may experience different pains. Essentially anything that keeps the body out of a completely relaxed and open state can cause the muscles of the vagina and pelvis to contract and therefore create the potential for pain during intercourse.
Medication
Various medications, including hormonal birth control and depression medications can affect your sex drive, lubrication and vulva/vaginal tissues.
Your Anatomy
We are all built a little differently. The length of your vagina canal, the placement of your clitoris and urethra and the shape and size of your organs and muscles down there can contribute to painful intercourse. It’s worth noting that this might change over time as we age so new pains may emerge as things shift and change shape. Some women may also experience tightness of the vaginal tissues or the hymen. The hymen is not, as many believe, a patch of skin covering the opening of the vagina. It’s actually a vestige (or leftover) of skin from when our organs are taking shape. Some women have almost no hymen, and for others it can still exist as a tight ring around the vaginal opening that can cause pain during intercourse or when inserting a tampon. In some cases surgery can support a women to address painful intercourse.
Changes to your Body after Delivery (Vagina or C-Section)
It’s no surprise that delivery can do a number on your vagina and vulva. Nearly half of all women who delivery will experience some form of pain during intercourse after childbirth and studies show it’s actually more common for women who had c-sections . From the obvious tears and scar tissue to the not so obvious strain on your muscles even a c-section can create - much has changed and it can take some adjustment. As mentioned above as well your hormonal changes in the postpartum period will affect your natural lubrication and the engorgement of your tissues. Side rant - I believe that painful sex after baby does not have to be a given - it’s a myth - like how we tell teenage girls it’s going to hurt the first time. It does not have to hurt if you do it right. Lots of warm up, lots of time, lots of lube, and lots of listening to your body go a long way. Masturbating first before starting intercourse also helps you get a lay of the changing land down there and the tools to tell your partner what to avoid and what has changed.
Chronic Pain In the Body and Dyspareunia
If you are diagnosed with or experience chronic pain (arthritis, fibromyalgia, back pain etc) this may impact your sexual experience as well. Even if your pain is not localized in the pelvis if you’ve experienced chronic pain in the body it can be a challenge to feel at home or relaxed in your body which can lead to painful intercourse. Dyspareunia is the medical term for chronic or persistent pain during intercourse. There are many diagnoses under this umbrella including vulvodynia, vaginismus. These diagnoses are typically a result of psychological and physical reactions to touch to the genitals which causes them to involuntarily contract and tighten therefore making intercourse painful or impossible. Finally painful intercourse can be a symptom of changes in reproductive organs such as endometriosis or ovarian cysts.
Menopause
Ah the ever changing female body. Over time the vagina walls and tissue thin and become more sensitive and natural lubrication changes. There is a saying - that if you don’t use it you lose it. These muscles can atrophy and become more stiff over time if they are not seeing regular use (one great reason to continue masturbating into our golden years).
Trauma
Last but certainly not least trauma, both emotional and physical, can create painful intercourse. When I speak of trauma I mean everything from a rape or sexualized assault to the thousand microagressions a day we experience (from someone staring at your boobs to long, to being cat called, to being shamed about how we dress). It does not often feel safe to walk around in the world as a woman, especially if you are trans, BIPOC, or LGTBQ2S+. This lack of safety that we feel in the body can make it really hard to relax into sex fully - even with a trusted partner. Any tension we are holding - concious or otherwise - in the body during sex can create painpoints, irritation and numbness in our sexual experience.
Actually one more - Shitty sex ed
What do I mean? Well most of us don’t really know our way around our own bodies - and neither do our partners, and most of us are really really bad at asking for what we need during sex. So if it hurts we don’t mention it - we just endure. We take pain as a given, or don’t allow ourselves the permission to request whatever changes we need actually have a great experience. No more ladies. No more. Get to know your bodies, learn together with partner and start talking!
No matter the reason for your pain, if it becomes ongoing it can start to create a imprint on your body. This imprint means that when you receive sexual input your body goes - oh but that sexy stuff hurts so let’s brace ourselves. In addition all the mixed feelings we can develop about our bodies (feeling broken or unworthy, feeling despair it will never get fixed, feeling mad our vagina is not cooperating) leave an imprint in our energy system. These imprints cause tension and knots and they make it harder for our sexual energy and for pleasure to move around freely in the body. Things get locked into the genitals and limit our sexual experience.
So what do we do about it (Can you do this in a bigger font/ heading?)
Acknowledge that pain is your body speaking to you. Whether you simply haven’t used enough lube today, something is going on with your ovaries, or a new traumatic experience is creating pain - your body is asking you to stop and pay attention. So stop. And pay attention. Ask her what she needs. She may tell you she needs music to relax, lube to help make things slide a little easier, or perhaps a trip to the doc to see what’s up.
Map your Pain Before you can really address painful intercourse we need to get really specific about what is hurting. If you can, map your pain. This means using your hands or a toy on your vulva and inside your vagina. Masturbate and bring yourself to arousal and then experiment to see if you can accurately describe a) the kind of sensation you are experiencing (burning, acute pinch, dull pain), and b) where (on your vulva, at the entrance of your vagina, your clitoris, and where inside). TIP - imagine your vagina is a clock - what time is the pain at, and is it at the front or deep back inside.
At home - Use Lube, and Get your Body RELAXED For certain challenges it is a matter of using more lube, adding more foreplay, going slow, and making sure your body is as relaxed as possible. Stimulating the senses with relaxing music, soft sheets, a warm bath ahead of time, yummy smells and tasty treats all help your body to relax into the present moment. Deep belly breaths will help you to release tension and land in the moment, eye gazing with your partner and even speaking affirmations out loud like “I am safe” can support your body to release any tension that is coming up.
Go see a Doc and Pelvic Floor PhysioIf pain is ongoing, acute or mysterious get to a doc as soon as you can. And make sure you also see a pelvic floor physio. Pelvic floor physiotherapists are experts in the muscles of the vagina, vulva, and pelvic floor - much more so than doctors. They are often better positioned to diagnose your pain (especially if you have done your pain mapping) and support you to do muscle release and strengthening. They will teach you exercises but also use their fingers to massage and release the muscles internally and externally just the way a physio would massage your achilles heal if you tore it.Talk to your doctor about alternative medications if your current medication is affecting your libido or creating painful intercourse. Note - If you have had a baby (vagina or c-section delivery) this is a must-do.
Learn Somatic Healing to release trauma and tensionFinally, there are healing modalities beyond surgery and medicine. Somatic (meaning of the body) Healing - works with the notion that we need to re-educate the way our brain talks to our muscles in order to make sure they are working optimally. It also works with the notion that emotions and traumatic experiences can get caught in the body - so that stress that’s causing you to hunch your shoulders creates knots and pain in the shoulders and changes how your body moves. The same can happen in the vagina, that trauma you experience can create knots and tension in the muscles that need to be released. This tension and trauma is released through a combination of physical touch - like someone would massage your back - and energy work. And you can learn to do it yourself on your own body. This is what I teach people - so if you want to learn more then hit me up.
The bottom line is that sex should be a pleasurable experience. I went through a year of chronic pain and infections and was nearly diagnosed with vulvodynia. When I started listening to my body and tuning into her needs I learned so much about myself and paved the path to pleasurable sex. Lack of knowledge about our bodies and understanding of how trauma and emotions affect the body can lead to unnecessary pain that we can eliminate. There are also solutions to more chronic conditions - we need the courage and persistence to find the right doctor or medical professional and the conviction that we too deserve to have orgams and intercourse that make us feel good. If your body is experiencing pain during intercourse and you want to talk more about it - then reach out. You can book a free 30 min consultation to chat about what’s happening and some next steps. And if you want to learn more about somatic healing and the techniques to clear pain and trauma from the body then hit me up as well. I’d love to teach you how.
You do not need to suffer alone. You are one conversation away from changing your life.
Much love as always.
Sofia