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Emily Jamea, Ph.D.<\/em>, is a sex therapist, author and podcast host. You can find her here each month to share her latest thoughts about sex.<\/em><\/p>\n Good sex only happens when there\u2019s mutual consent and mutual pleasure. But unfortunately, women often struggle to experience pleasure during sex and many actually experience significant discomfort and even pain. Sometimes, the pain can be so bad that intercourse isn\u2019t even possible. (What about people who enjoy the kinky mix of pleasure and pain? Sex shouldn\u2019t hurt unless you want it to. Period. Full stop.) <\/p>\n It\u2019s hard to say for sure how many women experience sexual pain, but the American College of Obstetrics and Gynecology estimates that three out of four women have pain during sex at some point during their lives. Sometimes the pain is temporary and sometimes, it\u2019s long-term. <\/p>\n There are many reasons women experience pain during sex. Genito\/pelvic pain\/penetration disorder is an umbrella term for several conditions that cause sexual pain. The two main conditions that cause sexual pain for women are vulvodynia and vaginismus. For some, the pain is mild, but for others, it can be severe. For instance, some women may be able to insert a tampon or tolerate a pelvic exam, but experience pain with sexual intercourse. For others, the pain may be so severe that they can\u2019t sit for long periods of time or even wear tight-fitting pants. Let\u2019s break it down. <\/p>\n Vulvodynia translates to pain in the vulva. (As a reminder, that\u2019s what you see if you\u2019re looking at the external genitalia.) When an area of the vulva becomes inflamed, it causes pain. Most of the time, there\u2019s a physiological reason for this kind of pain. <\/p>\n Vaginismus happens when there\u2019s an involuntary spasm of the pelvic floor muscles. The pelvic muscles are the ones you contract when you do a kegel exercise or when you\u2019re holding in gas. In most cases, vaginismus has a psychological component. Women are more likely to experience vaginismus when they were raised in a sex-negative home, within a rigid religious or spiritual environment, or when they have a history of sexual trauma. The spasm is the body\u2019s way of saying no <\/em>to something that is consciously or unconsciously scary. <\/p>\n There are, of course, other causes of sexual pain. Women who are not adequately lubricated, which commonly happens among post-menopausal women or during breastfeeding when estrogen is low, may experience too much friction, causing pain with intercourse. Women may also experience pain as they recover from giving birth (whether they had a vaginal birth or a C-section), especially if they tore or had an episiotomy.<\/p>\n Pain during sex isn\u2019t normal, but women are often given the message that pain is just part of the female condition. We\u2019re taught to expect pain the first time we have intercourse, and many women think that\u2019s just the way it always will be for them. <\/p>\n When I first started working as a sex and relationship therapist, my clients had seen an average of six medical professionals before landing in my office. Six! And those doctors weren\u2019t equipped with the knowledge to accurately diagnose, let alone treat, these conditions. Startling, right? If I had a dollar for every time a patient sobbed in my office, saying that her doctor had told her to \u201cjust relax,\u201d \u201chave a glass of wine\u201d or \u201ctry reading Cosmo to learn how to get more turned on,\u201d I\u2019d be rich. It was incredibly distressing for them. <\/p>\n Many of my clients came in complaining of low sexual desire, and it wasn\u2019t until I conducted a thorough assessment that I learned that the root of their concern was often that sex hurt. If something\u2019s painful, you\u2019re not going to want to do it. Women who experience sexual pain often also have reduced feelings of arousal, low sexual desire and conflict in their relationships. Partners are usually more lost than they are. <\/p>\n Fortunately, there\u2019s been a radical transformation in the accurate assessment and treatment of sexual pain. In most cases, a combination of pelvic floor physical therapy and psychotherapy works best. <\/p>\n Psychotherapy is particularly effective for women whose pain is caused by emotional or psychological issues. Sex therapists have specific techniques such as CBT, mindfulness and EMDR that can help alleviate the fear, anxiety and \u2014 in some cases \u2014 trauma surrounding your history of sexual pain. We\u2019re also trained to help clients actively participate in treatment so everyone\u2019s on the same page. Treatment is more effective when women feel like they\u2019re working as a team with their partners. <\/p>\n Hallelujah for pelvic floor physical therapists. These experts (who are finally growing in number) are trained to treat the physiological underpinnings of sexual pain. Interventions like biofeedback, electrical stimulation (e-stim) and manual manipulation work together to help women learn to relax and control the pelvic floor muscles. PSA: If you experience sexual pain, don\u2019t assume that simply doing kegel exercises is the answer. Strengthening a muscle that is already spastic can actually make your pain worse. Your PT may work with you to focus on learning to relax the muscle before transitioning to strengthening exercises. <\/p>\n In some cases, more aggressive treatments, conducted only by a healthcare provider (HCP), are needed. These include Botox injections to the pelvic floor muscles and in some cases, vestibulectomy, which is removal of the tissue that is inflamed.<\/p>\n If you experience pain with intercourse, don\u2019t be afraid to talk to your HCP. Pain is not something you should learn to tolerate. And if you\u2019re not satisfied with what your HCP suggests, reach out to a sex therapist. They can guide you to the right professionals for care. Don\u2019t forget that sexual pleasure is your birthright. Don\u2019t lose hope \u2014 options are available. <\/p>\n<\/div>\nWhy do so many women experience pain with intercourse, and what can we do about it?<\/h3>\n
Is pain during sex normal? <\/h3>\n