What's up down there?
Painful sex is a bit of a passion killer, no? Not to mention a major cause for concern. It can be triggered by anything from emotional issues to a more serious infection or hidden health condition, so it’s better to deal with it sharpish rather than grit your teeth and hope it will go away.
Known medically as dyspareunia, painful sex affects one in ten British women, according to a study by BJOG: An International Journal of Obstetrics and Gynaecology. That’s a lot of women suffering in silence. We spoke to the experts to decode your painful sex triggers.
Lack of arousal
‘If you’re not physically aroused, touch of any kind can be uncomfortable – especially if it’s somewhere sensitive, like your clitoris or the tip of your penis,’ says a spokesperson from the Brook Advisory Clinic. ‘Being well lubricated, relaxed and with lots of blood flow in the area (so penises get erect and vulvas swell) helps with this so put plenty of focus on foreplay’. Women especially need warming up before penetrative sex, both physically and emotionally. ‘If you’re not feeling turned on (mentally aroused) touch can be unpleasant – for example, being tickled when you’re feeling playful and silly is usually more fun than when you’re tired or angry!’ adds the Brook spokesperson, who suggests spending time enjoying foreplay to significantly improve your sexual pleasure. ‘There may be times when penetrative sex is not possible, but you can still have great sex without intercourse.’
Lack of lubrication
‘Lack of arousal can result in less vaginal lubrication, but many women simply do not produce enough vaginal lubrication, including younger women,’ explains Samantha Evans, sexual health expert, former nurse and co founder of luxury sex toy retailer Jo Divine. ‘Vaginal dryness is often linked to menopausal women, but younger women can be affected too due to the contraceptive pill, monthly hormonal changes, stress and anxiety.’ The use of lubricants can really help. Often GPs will prescribe a hormonal cream or pessary and many gynaecologists advocate using vaginal lubricants to help nourish the delicate tissues of the vagina. Your pharmacist can recommend over-the-counter lubes.
Painful sex due to injury
‘Painful sex can be a sign of damage from previous sex, such as tearing or soreness,’ explains a spokesperson from the Brook Advisory Clinic. You wouldn’t go running if you had a busted ankle, so sex after a particularly enthusiastic session, may have resulted in friction that has left you sore. Also: when was your last bikini wax? An ingrowing hair may be difficult to spot but you will sure as hell know about it if it’s down-there when you’re trying to get down to business.
You could have an STI
‘Stinging or burning during sex may be as a result of a sexually transmitted infection, especially if you also experience an unusual vaginal discharge, or an unusual odour,’ says Professor Ellis Downes, consultant obstetrician and gynaecologist and spokesperson for vSculpt. ‘If you have a new sexual partner and have had unprotected sex with him, and are experiencing these symptoms it would be a good idea to have it diagnosed and treated by your GP or at a sexual health clinic.’
STIs such as Chlamydia or gonorrhoea can have little to no symptoms but vaginal itching or burning, as well as painful sex, might be a sign that you are infected. Visit your GP or GUM clinic for a test. Treatments usually involve antibiotics but your doctor can recommend the next course of action.
You might have thrush
Vaginal thrush is a common yeast infection and symptoms include painful sex, itching and soreness around the vagina, stinging or burning when peeing and an odourless discharge. Three out of four women will suffer with thrush at some point in their lives, and it is often confused with other infections, such as bacterial vaginosis. You can pick up a DIY test in most pharmacies to determine whether you have thrush or BV, and your pharmacist will be able to recommend the next course of action. It is usually treated with antifungal cream, pessaries, pills or a combination.
He may be too big
‘Even if a woman is well lubricated and fully aroused, she may experience pain if a man inserts his penis too quickly or deeply, or if he’s particularly well-endowed’, says sexual health expert Samantha Evans. ‘The vagina relaxes as a woman warms up to having sex and opens more comfortably if the penis enters slowly. Guiding your partner in at your own pace can really help avoid any pain.’
She adds: ‘Often, having sex doggy style can be painful, so try backing onto the penis at your own pace. The same can be said when going on top. Do not allow your partner to pull you down onto their penis, but slowly lower yourself, controlling the speed and depth of insertion that is comfortable.’
You could be allergic
Many women experience an itching or burning sensation when they try new products, from changing their washing powder to using a new shampoo/ shower gel. Some vaginal lubricants can trigger allergic reactions leading to painful sex too, so be aware of what you are applying to the delicate skin of your genitals. Glycerin – often found in flavoured lubes – as well as parabens and aspartame can cause irritation. Similarly, alkali or acidic lubes can mess with the pH balance of your vagina and cause dryness and itching. Instead, switch to a water-based lube rather than a silicon-based one, such as Pjur. Another alternative is Sliquid, which is also glycerin- and paraben-free.
Latex products, such as condoms or sex toys, can cause an allergic reaction too – as well as some spermicidal creams – so check out Durex and other mainstream brands for their range of a latex-free condoms. There’s also a booming market for organic sex toys that are free from irritant phthalates. Check out Ethical Sex Toys for a range of options.
‘When using a sex toy it is important to clean it carefully after use to counter the proliferation of bacteria on it,’ says obstetrician and gynaecologist Professor Ellis Downes. ‘However some cleaning substances can irritate the vaginal lining so it is best to use hot water and natural soap.’
Painful sex may mean you have vaginismus
This is a condition whereby the muscles in or around the vagina tighten, making sex painful or impossible. It can be caused by a combination of physical and psychological issues. Physical causes can include urinary tract infections, sexually transmitted diseases, vulvodynia (persistent, unexplained pain in the vulva), skin conditions such as psoriasis or eczema, menopause, and birth trauma.
Psychological problems can be caused by emotional or sexual trauma. ‘A previous painful experience with sex might make it harder to feel aroused and enjoy touch,’ explains a spokesperson from Brook Advisory. ‘It can also make the muscles around the vagina and anus clench (to protect you from the pain you’re worried about) and make penetration difficult and more painful.’
With the appropriate medical intervention and counselling, this problem can be alleviated to enable penetrative sex. Treatment usually involves specialist counselling, pelvic floor exercises, biofeedback training with a women’s health physiotherapist and use of medical dilators or a vibrator/dildo to slowly encourage the vagina to relax and open.
Your diet could be at fault
Dietary irritants can be to blame for painful sex. Foods containing high levels of oxalates can trigger urethral irritation in women who are sensitive to them. When too much oxalate is absorbed into the blood stream via the gut, it combines with calcium to form sharp calcium-oxalate crystals which embed themselves into the delicate tissues in the body, causing damage and pain. Women who have irritable bowel syndrome (IBS) absorb too much oxalate due to the poor condition of their bowel. Sticking to a low oxalate diet for 3-6 months has been found to improve symptoms. A list of high oxalate food can be found on the Vulval Pain Society website and includes celery, coffee, rhubarb, spinach and strawberries.
You may have endometriosis
Painful sex is a common symptom for women with endometriosis, which affects two million women in the UK, making many avoid sex altogether. Up to 50% of women with endometriosis have cited painful intercourse, ranging from sharp, stabbing, needle-like pain to a deep ache. It can feel mild to intense, either during sexual intercourse or up to 24-48 hours postcoitally, or both.
As well as endometriosis (when the lining of the uterus grows outside the uterus or is thicker than normal), painful sex can also be caused by fibroids (growths of muscle and tissue inside the uterus) growing close to your vagina or cervix, irritable bowel syndrome and constipation.
As the symptoms of endometriosis are unpredicatable, there is no knowing when it may occur. Some women experience pain throughout the month whereas others only experience it at certain times of the month, probably related to their menstrual cycle.
There is no cure for endometriosis but there are treatments that can help with the pain – usually hormone therapy to lower your body’s oestrogen levels.
Painful sex when you’ve just given birth
It isn’t just chronic exhaustion that might mean you don’t fancy getting jiggy with your partner. There are a number of emotional and physical challenges after giving birth. ‘Childbirth is a formative experience for any woman, and for some it can be traumatic,’ says Dr Becky Spelman, psychologist and We-Vibe‘s relationship expert. ‘Insensitive care practitioners and/or a difficult or dangerous birth can give rise to a heightened fear of birth, pregnancy, and even sexuality itself. Women who have experienced a traumatic birth often struggle to re-engage with their sexual selves, even when they have recovered physically, and can experience pain with no obvious physical cause.
‘Sex can be painful after you have given birth for a number of reasons: bruising to the vaginal wall is a common reason,’ explains obstetrician and gynaecologist Professor Ellis Downes. ‘You may also have experienced a tear and this needs time to heal completely before you embark on sex again. If you have had a c-section you have had an operation and need time to allow the wound to heal completely. Doctors recommend at least six weeks but it is often longer. Once you do have sex again, start gently.’
Your relationship might be under strain
‘If a woman is experiencing emotional pain as a result of conflict within her relationship, that could also lead to painful sex,’ says Samantha Evans. ‘Many couples experience an emotional disconnect if one of them is unable to have sex, which in turn can increase the pain levels, thus creating a vicious circle. Consulting a couples’ counsellor or sex therapist may help.’
If you experience pain during or after sex, seek medical advice. You can still enjoy pleasurable sexual activity without intercourse by incorporating the use of lubricant, such as YES, and slim vibrators, such as the range at Jo Devine.
You could have a hidden health condition
Often painful sex is a sign of a more unusual, difficult to diagnose health issue. Samantha Evans outlines some of the lesser known conditions that could be causing you discomfort during sex.
Lichen Sclerosus is a common condition, generally affecting postmenopausal women. It is thought to be linked to an overactive immune system, however the cause is not completely known. It is not an STI and cannot be contracted during sex.
It generally affects the vulva and around the clitoris and symptoms include itchy white patches of skin that start forming together to create a larger patch, red blood blisters caused by thinning of the skin and, ultimately, painful sex.
The main treatment for Lichen Sclerosus, also known as LS, is a steroid or cortisone cream or ointment to control symptoms. Avoiding fragranced products and wearing loose fitting clothing can ease symptoms.
Vestibulodynia (provoked pain)
This condition is characterised by burning pain around the entrance of the vagina when touched and is thought to affect 12-15% of women of childbearing age. It often occurs through light touch such as inserting a tampon or sexual intercourse and generally has no other symptoms at other times.
Research by Reed found that women who have this condition are 2-3 times more likely to have more than one chronic pain condition, including IBS, fibromyalgia (musculoskeletal pain) and interstitial cystitis (bladder pain). Treatment for this condition includes pelvic floor exercises, biofeedback therapy, low oxalate diet, counselling and sometimes surgery to remove the glands at the entrance of the vagina.
Vulvodynia (unprovoked pain)
This is different to vestibulodynia in that it occurs spontaneously, the pain felt is often burning and sore in nature, there is no itching sensation and again it can be focused around the vulva or generalised.
The intensity of pain can vary from mild discomfort to a severe constant pain, making even sitting down uncomfortable. Usually continuous, the pain can affect sleep patterns and day to day activities. Often the pain isn’t localised to the vulval area but can be experienced in the anus when having a bowel movement and in the bladder when you pee. Unprovoked vulvodynia can impact upon sexual activity during foreplay and make penetration painful.
For a small minority of women, the cause can be related to back pain as a result of nerve compression or a slipped disc triggering referred pain to the vulval area. However, for the majority of women, the cause is idiopathic meaning there is no known reason for the condition.
Treatment can consist of taking tricyclic antidepressant tablets for a period of 3-6 months. Taken in tablet form, staring with a low dose, then increasing every few days until the pain decreases or subsides. Using natural lube, such as YES organic lubricants, during sex can help, as can applying aqueous cream to soothe the area.
If you are experiencing painful sex on a regular basis, always consult your doctor.