‘Many women are taught they should put up with it’: What to do about painful sex

For women, opting out of sex is a simpler and less agonising option when sex gives more pain than pleasure. Painful sex is a taboo and awkward subject, especially as a relationship progresses and sex is supposed to get better with greater intimacy, understanding, and exploration. Suffering in silence and avoiding sex is not always the answer, as many of the causes of painful sex are treatable or manageable.

Sex therapist and hypnotherapist Helen Birch advises that if you are experiencing pain during sex, your doctor should be your first point of action, so they can rule out any medical needs. “Physical sexual pain is under-reported,” says Birch, “mainly because many women are taught from a young age that sex hurts and is something they should put up with.”

While painful sex is common, with research suggesting 75 per cent of women will experience sexual pain at some point, pain during intercourse is not normal, and should not be considered typical. For many women, pain may occur once or rarely, but for others pain may be persistent, causing them to stop having sex, or enduring it for the wrong reasons, and possibly not broaching the conversation with their doctor due to shame or stigma.

The taboo subject is rarely discussed in friendship circles for fear of the potential for shame and stigma

“Dyspareunia is the medical term for persistent or recurring pain that happens during sex,” says Birch. “It includes pain with intercourse that may be felt in the vaginal opening or deep inside the pelvis. It can range from mild discomfort to intense pain and can result in being dissatisfied with sex and a loss of interest in intimacy.”

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Causes of painful sex are varied and can include physical issues such as injury, inflammation, sexually transmitted infections and other infections, medical issues including more severe conditions such as endometriosis, recovery after childbirth or simply the sexual position. Psychological causes of painful sex are linked to anxiety, depression, stress, a fear of pain, lack of arousal, or guilt or shame about sex.

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Birch advises that vaginal dryness is a key indicator for painful sex and can be a cause of not only pain but also shame for many women. “This is because wetness is seen as a sign of sexual arousal and desire for a partner,” says Birch. “Vaginal dryness can be caused by a reduction in oestrogen, especially during the menopause or after childbirth. Medications such as antidepressants, antihistamines or contraception can all result in vaginal dryness. However, do not stop taking any medication without consulting with your doctor.”

When sex gives more pain than pleasure, our bodies and minds will react pre-empting possible pain and discomfort, creating anxiety and stress. “Anxiety around being intimate and lack of foreplay can also cause dryness,” says Birch. “While lube can be used to solve the problem, high-quality foreplay is still essential, first to ensure the whole of the body is in an aroused state and ready for penetration. Often it is more important to be so aroused physically and mentally to a point that you have a need for penetration rather than being ‘wet enough’.”

A major issue to overcoming sexual pain is fear of upsetting or disappointing a partner

Sexual health is worth prioritising as painful sex is likely to have a cause and when understood and managed, you can regain control over your sex life. The reluctance to discuss issues will only prolong the problem. Conditions such as vaginismus, the involuntary contraction of the pelvic floor muscles leading to painful intercourse, are not uncommon and can be managed. Vaginismus can be caused by fear, difficult or traumatic past sexual experiences, stress, anxiety, or conditioned body responses, all of which can be treated with support.

And yet, the stigma surrounding pain during sex is often a burden women carry due to societal expectations, isolating them from their partners as they carry the associated shame.

Imagine each step of the sexual encounter being enjoyable, easy, and pain free or reframing the experience by saying positive statements to yourself such as sex will be enjoyable

“A major issue to overcoming sexual pain is fear of upsetting or disappointing a partner,” says Birch. “This is prevalent in women who will put their partners pleasure and experience above their own sexual satisfaction and comfort. Exposure to porn can also explain why many people put up with painful sex. In porn, sex is often shown as rough, with little foreplay and women having little control of the sex. To many women, sex in porn looks painful and causes the body to go into a protective mode to prevent damage. The mind then creates a negative response pattern which links sex with unpleasant consequences. In order to protect your body from those unpleasant consequences, it now involuntary associates sex with pain.”

Birch explains that this creates a pain cycle called the “Fear Tension Pain Cycle”. “This theory suggests that fear causes the body to tense up and that tension increases the pain,” says Birch. “The increased pain then further increases the fear. Furthermore, fear triggers the fight or flight response which stops the production of sex hormones needed for arousal and directs blood away from sexual organs. It switches the body from feeling mode into thinking mode, and the body is waiting and anticipating pain.”

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It is possible to interrupt this cycle by reducing fear.

Birch recommends getting comfortable with good knowledge about how your body responds when sexually aroused. Practice self-exploration to understand how your body feels throughout the whole arousal process. Have a safe and consensual relationship with boundaries and consent and be open and honest with your partner. She also suggests challenging your old beliefs and cultural expectations surrounding sex.

Breaking the pain cycle can also be done through reducing tension. “Allow your arousal to build,” says Birch. “Build up the sexual craving until you are aching to be touched and only move forward with penetration when you feel fully aroused. Relaxation practices such as breathing techniques and visualisations can help. Imagine each step of the sexual encounter being enjoyable, easy, and pain free or reframing the experience by saying positive statements to yourself such as sex will be enjoyable.”

Painful sex is a common and widespread sexual problem, it is not simply a physical issue with the psychological ramifications of painful sex aggravating the problem. Yet, the taboo subject is rarely discussed in friendship circles for fear of the potential for shame and stigma.

But, if discussions about the definition of good sex, pleasure, and orgasms are possible, then perhaps it’s time to talk about and understand painful sex.