We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions remain anonymous. This week’s topic: why your vagina might be hurting during sex.
Q: I was having sex with my boyfriend the other day and while he was inside me my vagina started hurting a lot. Like a lot. I had to stop immediately because the pain was so bad, and I’m really worried there’s something wrong with me. A penis can’t, like, break your vagina, right?
A: No, a penis cannot break a vagina, but sex can definitely cause pain. Painful intercourse is called dyspareunia, and it’s actually extremely common — so common, in fact, that around 75 percent of all women will experience it some time in their lives. This pain can show up anywhere in your special region, including your labia, vagina, or pelvis, and also doesn’t have to happen right when you’re having it — pain before and after sex also counts as dyspareunia.
So what causes pain during sex? It can actually be a bunch of things — some totally easy to fix, and others a bit more involved. Let’s check out the main culprits.
Culprit #1: You’re Too Dry
As my eighth grade sex ed teacher once told me, “It’s the slippery juices that make sex feel good”. (I grew up in Berkeley.) As a tween, I was of course mortified, but now I know he’s totally right — vaginas need enough lubrication to make the rubbing of skin against skin (or condoms against skin, for those of us who play safe) feel good.
Unfortunately, around 40 percent of women living in the United States report not getting wet enough during sex, which makes vaginal dryness the second most common sexual challenge for us, behind low libido. I’ve written a whole article about reasons why your vagina might be dry, so if this is you, check them out.
If you’re experiencing a parched pussy, the first thing to try is obviously adding lubrication. There are a bunch of options on the market and there’s no shame in adding some synthetic juice to whatever your body is making naturally. Remember, slippery feels good!
Culprit #2: You’re Not Turned On Enough
While there are many culprits for vaginal dryness, one of them is just not being that into it, at least at that specific time. It actually takes between five and seven minutes from when your brain starts being turned on to when your vaginal tissue is slippery enough for penetration to feel great. So if your partner is just so excited that s/he’s not waiting long enough, there’s a good chance penetration will feel less than pleasant. If this is happening, ask your partner to engage in more foreplay and slow the f%&k down.
It’s also important to know what turns you on. Knowing what gets you going means knowing what’s going to get you ready for non-painful sex. Knowing what you like also means knowing what you don’t like, which means you can seek out experiences that actually turn you on, leading to better, hotter, un-painful sex!
Culprit #3: You Have A Genital Infection
Getting into the more serious culprits now, some vaginal infections can make sex less than comfy. The ones to look out for include genital herpes, trichomoniasis, and yeast infection. Depending on what you have, controlling or curing it can be very simple. Talk to your doctor to get tested and get treatment.
Culprit #4: You Have Endometriosis
Endometriosis is when your uterine tissue (called the endometrium) grows outside your uterus, where it has no business being. This condition, which affects around seven percent of humans with uteruses, can result in extremely painful cramps, and can also make sex hurt a lot.
Unfortunately, the only way to know if you have this disorder is through exploratory surgery. Fortunately, once you know this is the problem, you can often fix it. Pain medication can help manage pain symptoms. Hormone therapy can help keep your endometrial tissue in check. And if you’re really hurting, there are more intense options such as laparoscopic surgery, a hormone regime that puts your body into early menopause, or hysterectomy.
Culprit #5: You Have Pelvic Inflammatory Disease
Pelvic inflammatory disease, or PID, is when your reproductive organs get infected. This usually occurs from sexually transmitted bacteria like chlamydia or gonorrhea, although it can also happen from bacteria getting into you in other ways, like through the unclean insertion of an IUD. If you have PID, you may not have any symptoms, but if you do, they can include pelvic pain as well as pain during penetrative sex.
Luckily, PID is usually easily treated with antibiotics, so talk to your doctor if you think you may be experiencing this unpleasantness.
Culprit #6: You Have Interstitial Cystitis
Interstitial cystitis is when your bladder is chronically inflamed. Doctors don’t know why this happens to some people (or some women actually, because it’s mostly found in humans with female reproductive systems), but what we do know is that it can make sex super painful.
If you have interstitial cystitis, you can get your symptoms relieved — but you’ll need your doctor’s help. She can give you a cystoscopy to look in your bladder and may also stretch your bladder. If that doesn’t work, medication can help.
Culprit #7: You Have Ovarian Cysts
Lots of people get cysts on their ovaries at some point in their lives. While for many of us, these fluid filled pockets just show up and then go away without a peep, for some, ovarian cysts can be painful. A large cyst can cause abdominal and pelvic pain, and in addition to making sex feel very uncomfortable, can also result in needing to pee more frequently and nausea.
It’s important to know if you have a cyst because there are some potentially serious complications. If your cyst is large, it can actually move your ovary out of place, which can end up causing it to twist (called ovarian torsion), which is extremely painful. The cyst can also rupture, which is also extremely painful and can result in internal bleeding.
If you learn you have a cyst, often you’ll be told to wait “watchfully,” which I guess means do your best not to freak out and then go back to the doctor in a few months to see if the cyst has gone away or grown. If you get them a lot, you can consider hormonal birth control, since it reduces the risk of developing more cysts later. And if you have a large cyst, one that’s growing over time, or one that’s causing you pain, you can get it removed surgically.
Culprit #8: You Have Irritable Bowel Syndrome
Irritable bowel syndrome (IBS for short) is a common chronic condition wherein your large intestine feels not-good, often. Doctors don’t know what causes it, but what they do know is that if you have it, you can experience belly cramps and pain, bloating, constipation and diarrhea, and gas. Luckily, you can control your symptoms by changing your diet (goodbye gluten, sorry) or taking medications.
How does IBS relate to dyspareunia? It’s complicated, by which I mean to say doctors don’t really know, but they’ve found that when IBS symptoms are relieved in people who experience sex as painful, sex becomes less painful.
Culprit #9: You’re Experiencing An Ectopic Pregnancy
An ectopic pregnancy is when your egg is fertilized by a sperm but instead of implanting in your uterus, it goes somewhere else. This situation is extremely dangerous, both for you and your baby-to-be — the fetus won’t survive, and if you don’t get treatment, you can experience bleeding that can kill you.
Yikes! is right. How do you know if you have this serious situation? One of the first warning signs is pelvic pain coupled with light spotting. If you feel that and your pregnancy test comes back positive, you may be experiencing an ectopic pregnancy. Go to your doctor immediately for care. If you’ve caught it early enough, you can get an injection of methotrexate to dissolve the cells. Otherwise, you will need to get it surgically removed.
Culprit #10: You Have A Congenital Abnormality
We’re all built differently. Some people have congenital abnormalities like a not quite fully-formed vagina (called vaginal agenesis) or a hymen that covers your whole vaginal opening (called an imperforate hymen), both of which make putting a penis, hand, or toy up there pretty difficult if not impossible. Vaginal agenesis often requires vaginoplasty surgery to reform the vagina, and minor surgery can reconfigure the hymen to allow things to pass into the vaginal canal.
And for other people, size may be an issue. You can just be too small for what you want to put inside you! Sometimes this problem can be solved with lots and lots of lube, and there are certain sex positions that can be more comfortable for those with genital fit challenges — such as those that don’t result in the penis hitting the cervix, and those where you’re on top so you have more control over the situation. Otherwise, you may want to seek a partner whose parts you can more easily handle.
Culprit #11: You’re Dealing With A Mental Issue
The final culprit isn’t a physical one at all. Sometimes the pain we feel in our body comes from our mind, which doesn’t make it any less real. Some research shows that if you’re struggling with anxiety, depression, or fear, it can inhibit you from getting turned on enough to be slippery enough to feel good when you have sex. Also, there is some understanding within the health community that if you have a history of sexual abuse, it may contribute to pain during sex.
If any of this sounds like you, reach out and get help. Talk therapy can be extremely helpful in resolving any negative emotions you may have about sex, including fear of being intimate or being hurt and negative body image thoughts. Medication can manage anxiety and depression — although be aware, some antidepressants can lower your libido, which can in turn make it harder for you to self-lubricate, which can make sex more painful in a cruel feedback loop.
The Bottom Line
Sex is supposed to be fun and feel good! I’ll say that again: sex is supposed to FEEL GOOD. Seriously, thanks evolution for driving us toward sex by making it feel so delicious we’d make babies (and contraception for letting us have as much sex as we want without making babies). If you are feeling less than pleasant during your sexual activity, I urge you to figure out why.
In a recent survey, 30 percent of humans with uteruses reported that their last sexual encounter was painful. That’s a lot, but even one person feeling that way when she doesn’t have to is too much, in my opinion. Get care! Get better! And then get busy!
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