7 reasons you’re experiencing painful sex—and how to make it feel better

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  • Vaginal dryness: One reason you might feel pain as a partner puts their penis, fingers, or a sex toy into your vagina is because there’s not enough natural or synthetic lubricant. Vaginas get dryer for several reasons, though one of the most common is menopause. “When someone goes through menopause the vaginal tissue gets thin and sensitive, their labia decrease in size, their vagina feels tighter and dryer,” Nicole Bullock, DO, FACOG, an OB/GYN with Abilene Physician Group in Texas, tells Health. “Inserting anything vaginally is going to become an issue.”

 

  • Vaginismus: Vaginismus is a little-known condition that causes vaginal muscles to clench and tighten, especially when someone tries to put anything inside — a penis, sex toy, or even a tampon. Sometimes, the muscles spasms characteristic of vaginismus can be related to past sexual abuse or trauma or emotions around sex like fear and shame, Dr. Minkin says. But other times vaginismus happens even without past trauma or after having worked through trauma in therapy.

 

  • Tilted uterus: If the pain you feel during sex seems to happen only in certain sexual positions, it’s possible that you have a tilted uterus. Between 20 and 30 percent of people assigned female at birth have a uterus and cervix that tilt backward toward their spine rather than forward toward the belly like usual. Usually, a tilted uterus and cervix causes no problems and most people don’t even know their uterus is tilted unless a gynecologist tells them so, according to Dr. Bullock. But sometimes certain sexual positions can be uncomfortable or painful for people who have a tilted uterus because the penis or sex toy hits their cervix.
  • Endometriosis: Endometriosis is a strange and complicated disease that causes tissue like that which lines the uterus to grow outside the uterus. That tissue can then swell and bleed each month just like the ones inside the uterus and can cause inflammation, lesions, and scar tissue inside the pelvic area. Some people who have endometriosis have chronic pain, some have pain only around their periods, and some have pain with sex or with bowel movements, Dr. Bullock says. Endometriosis causes painful sex if the endometrial-like tissue has grown onto the lower part of a person’s uterus, near the cervix and vagina, Dr. Gupta says.
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  • Vaginal septum: Young women and people assigned female at birth who feel a lot of pain when they start having sex might have a vertical or complete vaginal septum. The condition is also known as a “double vagina” because a wall of tissue runs vertically up the vaginal canal, separating the vagina into two categories and creating a barrier that fingers, sex toys, penises, and even tampons might not be able to pass through. Most people who have a vaginal septum won’t know until they try to use a tampon or have sex for the first time, Dr. Bonder says.

 

  • Tight pelvic floor muscles: Pelvic floor dysfunction isn’t always a result of vaginismus. Conditions that make people prone to tightening other muscles, like anxiety and temporomandibular joint syndrome (TMJ, which causes jaw clenching) can also cause clenching in the pelvic floor, Dr. Bonder says. “Pelvic floor muscles, which surround the vagina and control urination, defecation, and sexual function, should relax during intercourse,” she says. Any tightening of those muscles during sex can cause pain.
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  • Fibroids: Fibroids are growths in your uterus, Dr. Gupta says. They’re very common and usually show up around ages 30-40, though they are more likely to grow earlier in Black women. Usually, fibroids aren’t cancerous or dangerous in any other way, but they can cause pain during sex and affect a person’s period or ability to get and stay pregnant.

 

The #1 thing you can do to work through painful sex: talk about it

“Communication is the key for just about all of these issues,” Dr. Minkin says. “There is a lot of research showing that if a woman is uncomfortable with sex, she will naturally want to have sex less (who would want to have sex if it hurts!)” It sounds obvious, but communication is important—communication with the people you have sex with, but also communication with your doctor.

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“If you can communicate with your partner and seek appropriate medical help, you’ll feel a lot better and have a much better relationship,” Dr. Minkin says.

In communicating with your doctor and your partner, it’s also important to normalize these moments of pain, instead of feeling shame or embarrassment when something in your sex life goes south. That way, you can learn from those moments, and focus on what makes your body feel good.

Dr. Chavez suggests using the concept of a “positive sandwich” when talking through something that hurts. “With the positive sandwich, you talk about what’s going wrong and also what’s working well, what you appreciate. The ego is fragile when it comes to sexuality.” A positive sandwich keeps everything from being doom-and-gloom. “Be very direct,” Dr. Chavez says. “Say ‘I need more of this. This feels good.'”

Some products can also be helpful. Lube is great all the time, for everyone, even if you have plenty of natural lubrication. So, especially if you have pain sometimes because of dryness, get some lube. Something like an arousal gel can also intensify pleasure and help keep you grounded in your body.

 

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