Painful sex: Why intercourse can hurt for women and tips to ease discomfort

PHOTO: Unsplash

Pain during sex is a common problem for women. Estimates as to how many suffer vary wildly, but according to the American College of Obstetricians and Gynaecologists, as many as 75 per cent of women could experience it at some point in their lives.

It’s a really miserable problem, too. Not just for the pain itself, which is bad enough, but because “pain down there” can cause unhappiness in relationships as resentment and blame builds.

Pain can result from a host of factors, experts say. Dryness is a common cause. Lack of lubrication can make sex uncomfortable, but also upsets the balance of healthy bacteria which can lead to infections that trigger pain and irritation.

Causes of painful sex range from clear pathology, such as congenital genital tract abnormalities, to acquired conditions like endometriosis, says Dr Lucy Lord, a Hong Kong-based gynaecologist and obstetrician.

Dr Lucy Lord.
PHOTO: Dr Lucy Lord

Endometriosis is a painful disorder that occurs when tissue similar to that which normally lines the inside of the uterus – the endometrium – grows outside the uterus.

Some women have symptoms that are difficult to diagnose, such as recurrent yeast infections or nerve entrapment syndromes. But by far the biggest group are those women for whom there is no apparent cause.

In addition, sexual pain, Lord says, can become a sort of self-fulfilling prophecy: if you experience pain during sex, you’ll become anxious about it, which will exacerbate the discomfort.

It can be tricky to identify the cause of female sexual pain. Hong Kong-based certified sex coach Sara Tang says she will often introduce some “detective work” into sessions “to find out the root cause, which can range from relationship issues to medication to embarrassment from negative conditioning in childhood”.

Sara Tang says many women suffer painful sex in silence.
PHOTO: Sarasense.com

Sometimes, she says, a woman feels so much pressure to please a partner that she agrees to intercourse without becoming adequately aroused or relaxed – and that’s bound to lead to pain.

Other times, she says, painful sex can be the result of injuries sustained during childbirth. Georgeann Sack, who wrote Kegels Are Not Going to Fix This, notes that “the perineum is located next to the entryway of the vagina, and 85 per cent of women tear their perineum during vaginal childbirth. This can cause painful intercourse for up to six months as the area heals.”

Neuroscientist and author Georgeann Sack.
PHOTO: 

Six months is a long time in a relationship, and a partner may feel they’ve been ousted not because sex is painful, but because of a new baby. It’s why, Sack says, communication is key: “Whatever the cause of painful sex, the key to maintaining intimacy is honesty. If sex hurts, tell your partner.” Otherwise, she says, you risk damaging your relationship as resentment mounts.

If you’ve experienced painful sex, or are venturing tentatively back to a sex life after a difficult delivery, sex toys can help. A woman may feel she has more control over things if she’s in charge of the toy.

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Cecile Gasnault, marketing director for sex toy manufacturer Smile Makers in Singapore, says the company speaks with sexologists who say they encourage patients to explore different ways to find pleasure.

“They take the focus away from vaginal penetration and invite their patients to be more externally focused … they recommend using toys for clitoral stimulation, or to explore erogenous zones on the body. The point is to realise that sex is not just about penetration, but about pleasure and intimacy and to help their patients find ways to enjoy themselves sexually.”

Reminding themselves of the pleasure that comes with sex by using a vibrator may help a woman shift the focus from the pain and end that self-fulfilling prophecy that Lord describes.

PHOTO: Pexels

There are, of course, physical ways to help treat painful sex. These might be straightforward if diagnosis is easy – an infection, for example, which is quickly addressed with medications, or lubrication if dryness (common during the menopause) is an issue. But there are also potential treatments which don’t get the attention they should.

Lord says one of the best ways to reverse vaginismus (when the vaginal muscles involuntarily or persistently contract whenever penetration is attempted), and difficulties during intercourse because of pain or the fear of sex, is using vaginal oestrogen. This, she explains, works well because it changes the vaginal anatomy and physiology, making the vagina larger, more stretchy and less sensitive to pain.

“Consider the changes in the vagina during pregnancy when oestrogen levels rise 20 to 30 times higher and the vagina can stretch to 10cm [four inches] to accommodate the passage of a baby,” Lord says.

Oestrogen is usually only prescribed for post-menopausal women and isn’t often considered for younger women, whose oestrogen levels may be have been arrested because they’re on the contraceptive pill. It works well but can take from three to six months to start having the desired effect.

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Being prepared to communicate in the bedroom is the key, and a really valuable first step, says Kristin Ziesing, a clinical psychologist and certified sex therapist. It will improve a sex life that might be troubled by pain, because a couple is able to talk their way around the issue to find out what works.

“It’s important to discuss what sexual desires each partner has and maintain curiosity about each other,” she adds. “When a woman engages in self-exploration and stimulation, she can also bring this knowledge to her partner so that he is more likely to please her sexually.”

Having the courage to talk about painful sex might lead to the best sex you’ve never had.

Sexperts’ top three tips to pain-free sex

1. Lubricate

“The leading cause of painful sex is vaginal dryness,” says Cecile Gasnault, marketing director for Smile Makers. “Therefore, anything that can help the body lubricate is recommended: outercourse – kisses, caresses, external stimulation, massage – and maintaining good hydration. The point is to realise that sex is not only about penetration, but about pleasure and intimacy and helping each other find ways to enjoy yourselves.”

2. Embrace pleasure

“Women need to know that sex should never be painful,” says Sara Tang, certified sex coach and educator. “Many women suffer in silence because we have been culturally conditioned to believe that losing our virginity is something that’s supposed to hurt, and that being a good lover is about making the other person feel good.”

3. Communicate

“Communication is key,” says Georgeann Sack, neuroscientist and author of Kegels Are Not Going to Fix This. “Whatever the cause of painful sex, the key to maintaining intimacy is honesty. If sex hurts, tell your partner. Do not try to push through the pain. Stop what you are doing and discuss what to do instead. It can be hard to do this; you’ll feel vulnerable and shy, but the alternatives – a damaged relationship and unhappiness – are much worse.”

This article was first published in South China Morning Post.