Pain with Sex
Pain with sex is common, but it is not normal.
Insertional Pain
The most common cause of pain during and after sex is. . . NOT ENOUGH LUBE!!
A coworker told me, “Lube is like therapy. Everyone needs a little and you can rarely have too much.” Truer words have never been spoken my friends.
Think of the skin at the vaginal opening like the skin on the back of your hand. It’s relatively delicate and has NO LUBRICATING GLANDS. There is nothing to lubricate the vaginal opening, even if you feel like you are “ready enough” or “wet enough” for sex, you still need lubricant on the outside. Without enough lubricant you can experience pain with insertion, pain during sex, and irritation/burning after sex. Have you gone to pee after sex and thought, “ouch! I hope that’s not a UTI.”? That’s not a UTI, it’s micro tears at the vaginal opening (from dry friction), and when urine hits those tears. . . ouch.
Deep penetration pain can be due to the size or shape of your partner, or your position. If you have deep penetration pain no matter what position you switch too, then it’s time to talk to someone.
Other causes of pain with sex that can be diagnosed by a healthcare provider:
Vaginal infection or STI: These infections can be very inflammatory. Sometimes the only sign of an infection is pain or bleeding with sex. Vaginal infections, like yeast and bacteria, are not sexually transmitted and are incredibly common. Testing for STIs and vaginal infections is typically quick, easy, and well covered by insurance (so just knock it out).
Ovarian cyst: Diagnosed with ultrasound and managed with a “watch and wait” approach or medication, rarely surgery is needed.
Endometriosis: Pain with sex is a common red flag for endometriosis. Typically, people with endometriosis have ALWAYS had pain with sex, not just a rare occurrence from time to time.
Musculoskeletal Imbalance: The pelvic floor is made up of quite a few muscles, and just like any other muscle in your body, they can cause pain if they become imbalanced. If any type of penetration, touch, or exam is painful (or intolerable), you may benefit from Pelvic Floor Physical Therapy.
Birth Control: Yup. Some forms of birth control can thicken cervical mucus, making you feel more “dry” during sex. Often this can be managed with over the counter lubrication. But sometimes a patient will require a prescription vaginal cream, or even a different birth control.
Sex should be enjoyable, not painful. If you have pain with sex and it is effecting your relationship or dating, it’s time to get it sorted. This is not an embarrassing topic, and you’re not alone. Please bring this up to your healthcare provider because we are here to help. :)
**Disclaimer: This post focuses on women who have pain with vaginal sex (penis or toy inserted into vagina). I focus on this type of pain because it is the most commonly reported, but we will discuss pain that men experience and other similar topics in future posts. I will also post more specific content on exactly what lubricants I recommend.
