What To Do When Sex Hurts: An Expert's Guide To More Comfortable Intimacy

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While you might think sex should be intimate, exciting and fun, the reality is, it can also be excruciatingly painful.

"Pain during intercourse is more common than you think," says Samah Arsanious, M.D., an obstetrician/gynecologist at Henry Ford Health System. "Up to 40% of women experience discomfort during sex at some point in their lives. Unfortunately, many are too scared or embarrassed to talk about sexual problems."

Frequently Asked Questions About Painful Sex

Pain during intercourse can be a temporary nuisance or a chronic problem. Either way, discomfort during sex can lead to depression, frustration and relationship problems. Here, Dr. Arsanious answers frequently asked questions about pain during intercourse — and how to alleviate it.

Q: What causes discomfort during intercourse?

Dr. Arsanious: Pain during sex can happen for a variety of reasons. It may be a sign of a gynecological problem, such as ovarian cysts, endometriosis or a hormonal imbalance. But it can also arise from a structural issue or even psychological or emotional concerns. Women may experience disinterest or discomfort with sex during different life stages, such as during pregnancy, after childbirth and when hormone levels change surrounding menopause.

Other culprits include:

  • Infections: Yeast infections, urinary tract infections, sexually transmitted infections and pelvic inflammatory disease can cause painful intercourse.
  • Insufficient lubrication: This may result from a hormonal imbalance (a drop in estrogen, for example) and not enough foreplay. Certain medications, such as antidepressants, high blood pressure medications and antihistamines, may also interfere with lubrication and affect sexual desire and arousal.
  • Trauma: Any injury or trauma, including injuries that happen due to an accident, during childbirth or after a gynecological surgery, can lead to discomfort during sex.
  • Inflammation: Inflammatory syndromes, such as inflammatory bowel disease, lichen sclerosus and Sjögren's syndrome, can make sex painful.
  • Cancer: Both cancer itself and its treatments can interfere with sexual desire and lubrication, which could result in discomfort during intercourse.

Q: What are some of the emotional factors that lead to painful sex?

Dr. Arsanious: Emotions and sexual activity are inextricably linked — and emotional factors can make sex more or less comfortable. Psychosocial influences, such as cultural norms, history of sexual or physical abuse, and relationship factors can make you feel tense during sexual activity. Similarly, anxiety, depression and low self-esteem can interfere with sexual desire and lead to discomfort during sex. Stress can also interfere with pleasurable sex since pelvic floor muscles tend to tighten in response to stress.

Q: How do you know if your sexual challenges are emotional or physical?

Dr. Arsanious: It's not easy. Painful sex often results from both physical and emotional factors. Emotional factors can cause you to tense up, which can lead to physical pain. To make matters more complex, if you experience pain with intercourse, you may be afraid of additional pain, which can make it difficult for you to relax and enjoy sex. You might even avoid sex altogether if you anticipate pain.

Q: Where do women experience the pain during sex?

Dr. Arsanious: You may sense pain in the vulva, the areas surrounding the opening of the vagina or inside the vagina. Perhaps the most common site for pain during sex is the perineum, the area between your pubic bone and tailbone. You also may feel pain in your lower back, pelvis, bladder or uterus.

Q: When should you see a healthcare provider if you're experiencing discomfort during sex?

Dr. Arsanious: If you're having persistent pain or recurrent challenges with intercourse, talk to your healthcare provider. The sooner you talk about it, the better equipped your doctor will be to address it. Your doctor will not only rule out gynecologic causes for your pain, but also help connect you with a healthcare professional who can address your problems. The most important thing to note is that painful intercourse is treatable. Signs you should see a physician include:

  • Pain with vaginal penetration
  • Marked pain during any genital contact
  • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of genital contact
  • Overactivity of pelvic floor muscles with or without genital contact

Q: What types of treatments are available for painful sex?

Dr. Arsanious: The available treatments depend on the cause of your pain. If you have a structural issue, we can take care of it with surgery. If it's hormonal, or you're going through menopause, we can prescribe estrogen or recommend lubricants. If you're suffering from vaginismus, where your muscles tighten during intercourse, we use something called vaginal dilators, which help train the vaginal muscles to relax.

Steps Toward More Comfortable Sex

Pain during intercourse can have a significant negative impact on a woman's health, self-esteem, relationships, quality of life and work productivity. Since most people
don't discuss their sex lives — good or bad — with their physicians, it's not uncommon for people to suffer in silence.

While you should always see a healthcare professional if you're experiencing pain during sex, there are also some self-help measures you can try at home to minimize discomfort during intercourse:

  1. Use lubricant. If you're experiencing dryness and pain, a water-soluble lubricant can help reduce irritation and sensitivity. Just steer clear of petroleum jelly, baby oil or mineral oil with condoms since they can cause the latex to break.
  2. Take your time. Don't try to rush sex. Instead, choose a time when you and your partner are relaxed and content, not stressed, tired or anxious.
  3. Communicate with your partner. Make sure your partner knows that sex can be painful. That way, you'll feel more comfortable pressing pause if necessary. Also, be clear about which activities you find pleasurable as well as which feel uncomfortable.
  4. Experiment. Get creative in the bedroom. If intercourse is painful, experiment with other sexual activities that don't cause discomfort. You can even play with nonsexual, but sensual, activities like massage.
  5. Relax. Set the stage for a pleasurable experience. Take a warm bath, light some candles, read an erotic novel. Do things that make you feel good and help put you into a sensual mood.

"Most important, always get help if you're experiencing pain during intercourse," Dr. Arsanious says. "You're not alone. Sexual discomfort is treatable. There's always something we can do to help."

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To find a doctor or psychologist at Henry Ford, visit henryford.com or call 1-800-436-7936.

Dr. Samah Arsanious is an obstetrician and gynecologist who sees patient at Henry Ford West Bloomfield Hospital.

Categories: FeelWell