Painful Sex: Understanding Why Painful Penetration Occurs & What Can Help
Photo by Matthew Henry on Unsplash
10 minute read
Pain during penetrative sex (sometimes referred to by the umbrella term dyspareunia) or the fear of painful penetration can impact anyone, in diverse ways with numerous different contributing factors. While painful sex can impact anyone, painful penetration disproportionately affects people with vulvas experiencing or attempting vaginal penetration.
Pain that prevents people from having satisfying sex lives, that can impact relationships, leave people feeling broken or abnormal is common, yet sex shouldn’t hurt and pain is often an indicator that something is going on and needs to be acknowedlged. People who experience pain during penetrative sex are often told by friends, partners, GPs or health professionals to have a drink and endure it until it passes. These suggestions are abhorrently dismissive and are way more likely to exacerbate pain and heighten dread of any form of sex.
Despite common beliefs, it’s not sexual pain that destroys relationships, its resentment, the absence of support, unfair expectations and not knowing how to adapt to make space for pain within relationships. When all people involved are on board and actively supporting a partner who is dealing with pain or fear of pain, positive outcomes are possible.
What Contributes To Painful Sex?
Attempting penetration when you’re not completely aroused - It can take most people anywhere from 15-60+ minutes for complete mental and physical arousal.
Not using enough lube because you expect that you/your partner(s) to be well lubricated after a few minutes.
Hormonal changes such as menopause or those using testosterone HRT - increases the risk of atrophy (thinning of vaginal tissue and reduced elasticity, decreased lubrication production). Check out Buck Angels guide for trans masc folx.
Infections such as thrush, UTIs, bacterial vaginitis.
Vulva skin conditions or irritation.
Inflammation, autoimmune conditions or other conditions such as endometriosis, adenomyosis, pelvic inflammatory disease, ovarian cysts or other illnesses that contribute to physical changes that may result in painful penetration.
Fear and anxiety around having penetrative sex which may in turn lead to bracing or tensing your body. Attempting to penetrate a tense pelvic floor muscles can hurt and may result in automatic or involuntary contractions of the pelvic floors in anticipation of pain and to protect or shut off the vaginal entrance (this pain condition is called vaginismus).
Pressure or expectations to follow the social script that defines sex as penetration rather than focusing on a range of sexual activities (that may or may not include penetration) that centre pleasure - tolerating sex you don’t enjoy, that isn’t pleasurable or that hurts increases likelihood of pain.
We live in a culture that socialises people to believe that painful sex is something to tolerate, endure or get through until it stops hurting (rarely) or until a partner ejaculates and sex is over, which can create or exacerbate painful penetration, fear and avoidance of sex and other forms of intimacy that could lead to sex.
If you’re stressed and your body is experiencing sympathetic nervous system activation, its primary goal is survival (regardless of whether its an actual life or death situation, your body might experience a stress response when encountering any stressor) and thus does not have the resources or ability to send blood towards the genitals or become erect, to notice pleasure or to build arousal at that time. Because of this survival response, you’re also more likely to hold tension in your body, further contributing to pain.
Pushing yourself to be sexual when you don’t feel like it or having bad and unsatisfying sex - It’s ok to say no to sex when you don’t feel like it and it’s important to honour this boundary. Having sex when you don’t want it will often exacerbate painful penetration, fear and avoidance.
Groin or pelvic injury or following pelvic, genital, abdominal or rectal surgery.
Pain or discomfort of the vulva without any clear or identifiable cause is called Vulvodynia and can have multiple contributing factors such as hypersensitive nerve fibers that send pain messages to the brain that are disproportionate in response to light touch.
Understanding And Tracking Painful Penetration
Learning about your pain experience and monitoring it, including exploring language to describe your experience, keeping a journal when you experience the pain and any relevant info and getting a pelvic exam can be helpful in accessing a diagnosis and seeking support and is useful in creating a pain management plan.
Write down words that best describe the pain. Is it deep? shallow? sharp? dull? cutting? burning? aching? throbbing? shooting? numbing? tightness? itching? cramping? stabbing? stinging? hot? cold?
Keep a daily journal to track the pain. Include any factors that exacerbate the pain. Are there times when the pain isn’t as bad? Are there any exceptions to the norm when you don’t experience pain? What have you noticed helps to reduce your pain? Rank your pain out of 10 each day, where 0 is no pain and 10 is the most extreme pain you’ve ever experienced, and notice if that number shifts.
Understand and break the Cycle Of Pain. Painful penetration becomes a cycle where an initial painful sexual experience or a belief that sex will hurt means your mind and body will anticipate pain. If you’re worried that sex will hurt, or you’re trying to prepare for pain, your body will automatically brace and tense. Attempting to penetrate against a tense pelvic floor is painful and this experience of pain reinforces the belief that sex will hurt. Next time your body encounters the same situation or is anticipating penetration, it remembers the experience was unpleasant and will automatically tense up. This may occur well before you even begin sex, when a partner kisses or touches you. If you continue to ignore your body’s fear response and attempt penetrative sex or push through the pain, you may find your fear increases and you avoid sex or anything that could lead to sex.
Cycle Of Pain by HopeAndHer.com
Do a vulva self-examination or do an online pelvic pain assessment.
Get on top of pain and connect with health professionals. Unaddressed pain that becomes prolonged or ongoing can develop into chronic pain and can be more challenging time manage as time goes on. This is often because nerves become hypersensitive or over stimulated for extended periods of time.
Getting a pelvic examination with a sexual health GP or a gynaecologist is important. If health professionals dismiss your pain, try to convince you that your pain is in your head get a second or third opinion. Many folx spend years waiting for a diagnosis or a professional to affirm their experiences as real, valid and offers the support they need. Sexologist Tanya Koens wrote that a colleague of hers conducted a thesis on sexual pain experiences and found some women sought up to 18 practitioners before finding support and an accurate diagnosis or pain management plan. Check out Dr Alice Huker’s Guide to seeking professional medical support for painful sex.
A pelvic floor Physio can also be a great support pathway to dealing with pelvic floor tightness or weakness that might contribute to painful penetration and teach you exercises or stretches to relax or retrain your body.
Seek out sexual support with a sexologist to explore, unpack and make space for fears and anxiety around sex, reframe your beliefs that might be behind the fear, learn about how your body works, examine what “real sex” means to you, challenge your expectations that you “should” tolerate or endure painful sex and begin to reduce the impact of painful sex has on your relationship.
Approaches To Dealing With Painful Penetration
Slow sexual encounters down and increase your time to arousal. Given that it can take anywhere between 15mins and 60 minutes or longer to be mental aroused (how aroused you feel) and physically aroused (lubricated, erect), prioritise time to get turned on before you attempt any penetration.
Pain and fear are messengers and the body’s way of telling you something isn’t right. Do your best to acknowledge these messages rather than pushing through or ignoring them - When a partner invites you to be sexual or as you’re beginning a sexual encounter, pay attention to what’s going on in your body. Are you suddenly feeling tense or nervous? Do you notice any desire to pull away? Do you notice any thoughts and feelings that might indicate you don’t want to have sex? Notice and listen. Pushing against or ignoring these signals increases the chances of experiencing pain, decreases satisfaction and enjoyment in future sexual encounters.
Pay attention and notice when you’re catastrophising, problem-solving, being judgemental or criticising. Recognise your mind is probably doing these things in order to prepare, plan or problem-solve for the worst-case scenario. Catastrophising and criticising exacerbate distress and fear which can further worsen the pain. Non-judgementally name what you’re doing as trying to prepare for the worst and gently shift your attention away to focus on sounds around you or notice other sensations in your body, like tension you’re holding onto and focus on releasing it.
Finding Pleasure Despite Pain
Many people who experience some form of pain while attempting to have sexual encounters can still have a pleasurable sex life. Sometimes pleasurable sex is what supports folx with pain to heal and reconnect with their bodies and their relationships.
Prioritising pleasure can be a coping strategy and creates hope in what can at times feel like a hopeless situation. Explore what feels good, both in your every day and during sexual encounters, on your own and with a partner. Keep listening to your body because in the same way that it will let you know when it doesn’t want something, it’ll let you know when something feels good. Explore types of touch, sensations and positions during solo and partnered sex. Slow down and pay attention to pleasure using mindfulness practice to shift your attention away from distracting or unhelpful thoughts towards pleasurable bodily sensations.
Take the pressure off penetration and focus on pleasure. When it comes to sex, focus on what feels good rather than following the script that says sex should look a certain way. While a social definition of sex defines penetration as the main course or central act, sex without penetration is as valid and worthy as penetrative sex. You have the ability to define sex for yourself however you want to. When this definition centres your pleasure, you’re increasing your opportunities for satisfying sexual encounters that you’re more likely to build arousal, increase desire and feel connected with yourself and/or your sexual partner(s).
The Role Of A Partner
Painful penetration or fear of penetration does not occur in isolation. It’s not only the responsibility of the person thats experiencing pain. If one partner is dealing with painful penetration or a fear of penetration then its likely to impact all people in that relationship. Partners can play a bigger role in painful sex outcomes than they may realise. Read this ABC life article to learn more about what people can do to support a partner living with pain.
Having a partner who experiences painful sex can be challenging and it may be difficult to be supportive if you’ve never been taught how. It’s ok to be frustrated, angry, upset, confused, whatever you’re feeling, its ok and you’re allowed to feel that way. Make space for those feelings, talk about them and learn to self-soothe rather than bottling them up or directing them at your partner.
Learn about your partners pain condition, ask questions, go to medical appointments, have empathy and undertstand what your partner is going through. Explore things you can each do when pain is present or when they’re distressed by the pain to enhance connection, closeness and move towards productive and positive outcomes.
Many people who experience painful penetration still can and want to be sexual. Its ok if you can’t have vaginal penetration, there are other ways to maintain regular sexual encounters together. Explore other types of sex that you can have instead. If your partner isn’t up for sex or the pain makes it difficult to explore other sexual activities, do something else that allows you to connect and enjoy each others company. Have a cuddle, cook dinner together, go for a walk, have a shower together, massage each other, watch a movie, whatever helps you feel connected.
Be your own pleasure advocate. Find other ways to meet your sexual needs if you can’t have penetrative sex. Placing pressure on your partner, expecting them to “fix themselves”, beliving that their pain is an excuse to avoid sex or expecting your partner to endure pain or discomfort for the sake of your sexual needs is harmful. Nobody is entitled to penetrative sex. Nobody is obligated to have sex when they don’t want to or when it hurts for the sake fo their relationship. It’s ok if penetrative sex is something you miss or you want to work towards. It’s ok to express your needs and ask for what you want even if its not available at the time. Focus on what’s possible and pleasurable right now. Remind yourself it takes time to address, manage and unlearn painful sex. Seeking support early, connect with professionals and seeing yourself as a team against the pain rather than against each other paves the way for positive and hopeful outcomes.
