Painful Sex Is Physical & Psychological. Here’s How We Stop It

We often talk about sex in terms of pleasure. For many people, though, it’s also about unwanted pain. According to The American Gynecological Society, 75% of women have experienced pain during sexual intercourse at some time during their life, while a 2015 study found that about 30% of women and 5% of men experienced pain the most recent time they had intercourse. That pain can range from a brief “ouch” when a position isn’t quite right to deep, stabbing pains throughout penetration. So why are so many people hurting when they shouldn’t be?

While the cause of pain may vary from person to person, sex coach Myisha Battle tells Bustle that there are societal reasons why so many women are in pain during sex so frequently. “Our culture gives us the message that pain during sex is normal for women,” Battle says.

Battle is referring to the deeply rooted cultural narratives that have led us to believe that sex should hurt — at least a little bit — for women. These issues are tied up closely with both biology and gender issues: Most people experiencing pain during sex are cisgender women having vaginal intercourse with cisgender men — the study cited above clearly illustrates how unbalanced the experience of pain during sex is. And that’s not just because there’s a penis and a vagina involved.

Americans are taught from a young age — through movies, books, and even messages from our peers and parents — that boys and men just want sex all the time, and it’s the job of girls and women to be the gatekeepers. The only way she’s able to do that, it’s implied, is because she doesn’t want it as much as he does. Sex is something she does for others — for procreation, for her husband — but never for her own pleasure. Good girls not only don’t “give it up”; they don’t even want to give it up.

If that sounds a little bit outdated, that’s because it is. This narrative (and its relationship to rape culture) isn’t as strong as it once was — but that doesn’t mean it’s disappeared completely. While some parts of society now recognize, for example, that we were wrong to cast Monica Lewinsky as the villain of the Clinton impeachment scandal in the ‘90s, people still blame teenage girls for “seducing” older, men. You can also look to the fact that many people still think it’s funny to joke about dads “protecting” their teenage daughters from dates with age-appropriate boys. Both examples highlight the fact that a girl or woman’s sexuality is never her own — and certainly not hers to get pleasure from — from childhood through marriage.

A related narrative is that a girl’s first time having intercourse will and should be painful. Girls are told stories of bleeding, stabbing pain, gritting their teeth through the pain. This image is not only false, it sets girls up for a sex life that normalizes pain. Rather than teaching young people about how arousal affects the vulva and vagina — like the need for time spent warming up before penetration, a focus on enough lubrication, and the fact that the vagina lengthens when aroused — we just tell girls to essentially grin and bear it.

We don’t give boys the tools to make the experience more pleasurable for their partners, either. Young men enter into intercourse with a pretty good idea of what feels good for them and only dim ideas — or ideas gleaned from porn, where the pre-penetration stuff is often cut out — about how to make sure their partner is properly aroused. Basically, we’re setting everyone up for failure, and girls for unnecessary pain.

Another message that the painful-first-time narrative sends is that while it will hurt at first, if you push through the pain it will start to feel better. By making that a “normal” part of a person's first time having penetrative intercourse, our culture is sending a message that if sex continues to hurt after that first time, then it’s just part of the process.

With the right sexual skills to make sure that both partners are turned on and ready before penetration, there’s no reason for sex to hurt — ever. (Unless you’re practicing BDSM, which is a different conversation.) And while some people may find that the “push through the pain” method works for them, for others, it’s the worst move to make.

“The last thing you want to do if you have a partner who’s experiencing pain during sex is tell them that it’s not a big deal, that if they keep going it will go away, or that the pain will eventually subside because the pleasure will kick in,” Battle says. “That’s usually not the case. Pain is a warning — it’s an alarm bell. It’s a moment to pause and check in, not to continue on.”

But cultural narratives don’t always explain individual situations. Dr. Lauren Streicher, M.D., the founder and medical director of the Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for Sexual Health, tells Bustle that many of her patients come to her because of pain during sex. Her job, as a physician, is to fix the physical side of the problem. But she also encourages her patients to “have a frank discussion” with their partners about what’s going on — which may be easier said than done.

“Part of what women struggle with is not only the pain itself, but partner issues,” Dr. Streicher says. “Women think, ‘I don’t want him to be upset, so I’m just going to grit my teeth and bear it.’”

To help patients work though both the physical contributors to pain during sex, Dr. Streicher recommends a visit to a pelvic health specialist. And for the psychological parts, she refers patients to a sex therapist. Or, if there are none in a patient’s area, she recommends talking to a therapist who is trained in sexual issues. A good place to start looking is the American Association of Sexuality Educators, Counselors and Therapists (AASECT), which has a tool for finding qualified providers around the country.

Dr. Streicher also recommends taking penis-in-vagina sex (PIV) off the table — at least for a little while. “I always say, ‘You can have sex. You just can’t have intercourse,’” Dr. Streicher says. She encourages patients to try out sex acts that don’t lead to pain, like mutual masturbation or oral sex, as they work toward solving the underlying problem causing the pain. Dr. Streicher also recommends Ohnut, a set of rubber rings that can be customized to control depth of penetration. For people who are experiencing pain with deep penetration, the Ohnut can help partners ease into penetrative sex. That in combination with the right lube can help couples stay intimate even as they work to solve problems with painful sex.

But while it’s always important to help individuals, that massive percentage of women who experience pain during sex isn’t going to go down until we change our narratives about pain during sex. While pain during sex technically is “normal” — in that the it has happened to the majority of women — it’s not a reality we have to accept. As a culture and as individuals, it's on us to reject that narrative.

Studies cited:

American Gynecological Society. (2017) When Sex Is Painful. https://www.acog.org/-/media/For-Patients/faq020.pdf

Herbenick, D., et al. (2015) Pain experienced during vaginal and anal intercourse with other-sex partners: findings from a nationally representative probability study in the United States. Journal of Sexual Medicine. https://www.ncbi.nlm.nih.gov/pubmed/25648245

Experts:

Myisha Battle, sex coach, http://www.myishabattle.com/

Dr. Lauren Streicher, MD, Medical Director of The Northwestern Medicine Center for Menopause and The Northwestern Medicine Center for Sexual Health https://www.drstreicher.com/