Painful sex sounds like an intuitive enough thing to pinpoint and put a stop to, but the truth is that putting into words the pain commonly experienced during penetrative sex can be tricky. What's "normal" in a culture which devalues women's pain so routinely that we're taught to expect pain during intercourse? How do you know if something is serious enough to talk to a physician or therapist about? Does your partner even care? How experts define sexual pain can be useful information to know, so you can broach the subject with some concrete language.
"Your level of arousal affects whether something feels pleasurable or painful," licensed marriage and family therapist Jill Whitney tells Bustle. "Some kinds of rougher touch like pinching or spanking that might feel awesome when you're intensely aroused can hurt when you're not. This can confuse a partner who knows you liked it last time and doesn't see why you wouldn't now — but that's just the way bodies work."
If you find yourself white-knuckling through sex because it seems too daunting to express what you're feeling, here are a few specific ways experts define sexual pain.
1Pain Includes Discomfort, Sensitivity, Or Irritation, Even From Non-Sexual Penetration
Arielle Egozi, founding member of Women of Sex Tech, tells Bustle that she defines sexual pain as "any kind of discomfort, sensitivity, or sharp irritation anywhere near, on, or inside the genital region." As a sufferer of vulvodynia, Egozi tells Bustle she feels "a burning sensation on my vulva, as if my flesh was open and raw, whenever I'm penetrated," even from something as simple as inserting a tampon.
"Unfortunately, almost no research has been done for vulva-owners that experience pain, and so many doctors may dismiss symptoms if there are no visible signs of concern," Egozi says. "Do your best to find the adjectives and metaphors that express what you're feeling, and know that 75 percent of self-identified women will have painful sex in their lifetime, so you are never alone."
She even points to companies like Ohnut who are creating wearable devices to help people experience less painful penetrative sex and open the conversation around sexual pain.
2The Definition Is Changing In The Medical Community
Licensed marriage and family therapist Alana Ogilvie tells Bustle that the definition of sexual pain is actually changing in the medical community in some pretty encouraging ways. "There's been a really big push to reclassify pain you feel in your pelvic area and genitals as a pain syndrome and not as a sexual dysfunction," she says. "That's one of the reasons we now use 'genito-pelvic pain/penetration disorder' to talk about pain that someone may feel in their pelvis and genitals."
An outsized focus is often placed on the emotional causes of painful sex, which makes sense considering it's a site of so much trauma for women. But pain during sex has a variety of physiological reasons, too, including an infection, an overgrowth of nerve-endings, or a muscle condition, according to Ogilvie.
"Pain during and after sex can feel like tightness, pressure in your abdomen, burning, stinging or throbbing sensations, strained muscles, or a strong desire to urinate," she says. "I'd make the argument that experiencing any kind of pain in that region of your body isn't 'normal' and could be a sign of something serious, or even something seemingly innocuous like a tear on the vaginal wall (which, if aggravated, could get worse and then lead to infection)."
3It's Not Something You Need To Justify To A Partner
"The first step is figuring out what's going on," Whitney says. "What, exactly, hurts? Is your partner's touch too intense? Is penetration too hard or at an uncomfortable angle? Do you need more lube? Are you not fully ready? Women sometimes say they're ready for penetration when they're only partially aroused, maybe because their partner is eager or because they feel they're taking 'too long' to get really ready. But there's no such thing as 'too long'; there's only the amount of time and kinds of touch that you need on this particular occasion."
She also emphasizes rolling with your body's needs, so to speak. What felt good in one sexual encounter may not feel good in another, and it's important to know that kind of inconsistency is normal.
Most importantly, it's the job of anyone having sex with you to care about your experience. Needing to justify your pain to a sex partner is a huge red flag. "A partner who dismisses your pain by saying it 'shouldn't' hurt or it 'didn't hurt last time' is not treating you with respect," Whitney says. "Your experience of pain is legitimate, whether it makes sense to your partner or not. A caring partner will get curious with you about how to change things so you feel pleasure and not pain. Both people's enjoyment is the whole point of sex, after all."
4Think About The Factors Leading Up To The Pain
People who excessively Google their symptoms tend not to be a doctor's favorite patient. But given the well-documented cases of poor care women especially receive, it's important to empower yourself with knowledge about your own body.
"Dyspareunia, which is pain during intercourse or penetration, can be caused by an allergic reaction, vaginal dryness, an infection, health conditions, and even mental health concerns," Dalychia and Rafaella, the founders of Afrosexology, tell Bustle. "So the very first step in defining sexual pain is to tune in to your body and think about the possible factors leading up to the pain. Recognizing and addressing pain may be new territory for people with vaginas because the overall message is that sex with penetration should be and will be painful."
5Pain After Sex May Mean Orgasm-Induced Headaches & Post-Orgasmic Illness Syndrome
Post-sex pain takes a few different forms, according to licensed psychologist Nicole Prause, including orgasm-induced headaches, abrasions, pelvic decongestion (better known as "blue balls"), cervical bruising, and something called "post-orgasmic illness syndrome," in which sufferers manifest flu-like aches and pains after sex.
In the case of orgasm-induced headaches, "we do not know exactly how common they are or the exact mechanism, but some people resort to taking medications before sex because it happens to them every time," Prause tells Bustle.
Damage to the vulva sustained during sex is a pretty common source of post-sex pain. "Every woman develops tears in her vulva during intercourse," Prause says. "High-friction intercourse, due to, for example, a large phallus or insufficient lubrication, increases the amount and severity of these tears. They can become visible and bleed, but are often invisible to the naked eye or only appear as a redness. The tears might be noticed during first urination after intercourse."
Pelvic decongestion, meanwhile, describes the pain that can happen when you're super aroused during sex, but don't orgasm. "A primary function of orgasm is to help decongest the pelvis, or allow the blood to run back out of the vaginal walls," Prause says. "This fullness distends the genital areas and can be experienced as painful over a longer period. Masturbation is your friend here, as the only reported cases were resolved by orgasm."
Finally, if you like cervical stimulation during sex, or if your partner is simply using a phallus that is longer than your vaginal canal to penetrate you, then you might sustain cervical bruising that you don't notice right away.
"Repeatedly hitting the cervix will bruise it, but sexual arousal makes us less sensitive to pain," Prause says. "Once the sexual arousal dissipates, deep injuries inflicted during sex may be perceived as 'new,' when really the person is just becoming aware of it for the first time."
Dealing with sexual pain for the first time can feel scary at first, but you can use these definitions to gauge your own pain, explain it to others, and work towards a solution with your support network.
