It can feel scary and isolating when sex doesn’t feel good, but you’re not alone if your vagina’s not playing ball. A British survey, published in 2017, found that nearly one in 10 women experience painful sex (dyspareunia).
“Many women are almost conditioned to a less gratifying sex life and they see painful sex as part of it,” says Dr. Remziye Kunelaki, lead psychosexual therapist from sexual health clinic 56 Dean Street in London. “I think the biggest mistake they can make is doing nothing about it and putting up with the pain silently.”
Dr. Kunelaki is one of three experts I’ve asked to help unpack some of the most common unwanted sensations that women experience during sex. She’s joined by vice-president for education of the Royal College of Obstetricians and Gynecologists Prof. Janice Rymer and Dr. Leila Frodsham, who runs a psychosexual dysfunction specialists clinic at Guy's and St Thomas' NHS Foundation Trust and is a spokesperson for the Institute of Psychosexual Medicine.
Ultimately, whatever pain you’re experiencing there’s almost definitely a solution out there, though it can take time to work it out. If you’re not getting decent support from your doctor, Frodsham recommends trying your local sexual health clinic or visiting the websites of gynecology training organizations as they’ll often have referral links to specialists.
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It burns when penetration is involved
The first thing to consider is whether you have an infection. STIs like genital herpes, gonorrhea, and chlamydia can cause burning during and after sex. “Getting an STI is not something to worry about but its treatment should be prioritized,” says Kunelaki. She says that vaginal thrush—a fungal infection that 75 percent of women experience in their lifetime—can also cause burning (as well as lumpy discharge). Head to the GP or your sexual health clinic, get checked out, and send a vaginal swab off to get tested.
Once you’ve ruled out infection, it’s time to consider other causes. The skin of your vulva and vaginal walls can be affected by the same dermatological issues as other parts of your body. For example, lichen sclerosus, a rash that can appear elsewhere on your body, can cause sex pain if you get it on your vulva.
More commonly, your vaginal walls can get irritated by chemicals. All the experts I spoke to suggested that if you’re experiencing burning during sex you should ditch potential allergens ASAP. This means throwing out fragranced shower gels, switching to natural lubricants, and ditching chemically bleached tampons and sanitary pads.
“I frequently see women who are so allergic to sanitary towels that they have the red outline of one on their vulva when they see me,” says Frodsham. She suggests that her patients use cotton or bamboo options instead. She also recommends sex pain sufferers try using olive oil to wash (other experts recommend emollient washes) and that anyone with irritation or dryness should try massaging their vagina (especially the inside back wall) with coconut oil twice a day.
“There seems to be something about doing massage there that really helps with pain—and it moisturizes it as well,” she says. “That means you also don’t need to mess around with lubes when it comes to sex, which psychosexually is quite an important thing,” particularly if you’re already stressed out about sex. Oil and latex condoms don’t mix, so if you’re going to try this then switch to a different form of contraception.
Vulvodynia (or chronic pain of the vulva) can also cause a burning sensation during both penetrative and non-penetrative sex. If you suspect it might be the cause of your sex pain, it’s worth talking to your gynecologist.
I’m not getting wet enough (and it’s making sex painful)
The 2017 dyspareunia study found that sex pain is strongly linked to dryness. If being penetrated feels a bit like your partner is trying to sand down your vagina, you might be too dry. On a basic level this means asking yourself two questions: 1) Am I giving myself enough time to warm up before we do penetrative stuff? ( “Sometimes it might be a case of thinking that you are ready for penetration but that might not be true physiologically ,” says Kunelaki), and 2) Am I using enough of the right lube? For example, Dr Frodsham says that KY Jelly is actually not great for sex because “it gets more sticky the more you have sex, so it can actually exacerbate sexual pain.”
It’s also good to investigate the cause of the dryness. The experts I spoke to said it could be irritation from recurring infections or allergens, or it could be caused by dropping estrogen and rising progesterone levels. Estrogen levels drop during menopause and breastfeeding, as well for those on the progesterone-only or mini-pill and those suffering from anorexia. This can cause long-term dryness. Frodsham suggests using an estrogen pessary or topical cream to increase moisture, and to consider swapping contraception. She recommends one with local hormones like Mirena or Jaydess IUD, rather than the implant, and a combined pill over the progesterone-only or mini-pill.
It burns when I pee after sex
This is another problem where infection, allergens, or dryness could be to blame for irritating your vaginal skin. It could be that the friction during sex might have left you with little tears around the vagina. “Obviously that’s going to hurt,” says Rymer. “They particularly appear at the back of the vagina. It’s a common area that people get a breakdown of skin and you can get a little cut there and that can be very painful.” She adds that this kind of pain could also be a symptom of a urinary tract infection. If you suspect that’s the case she recommends going to the doctor and getting a urine sample sent off to the lab—that way you can get it cultured and treat the bug properly.
I have lower abdominal pain or cramping after sex
“Is something going on in the pelvis? Is it endometriosis?” are the questions that Rymer says she’d ask herself if someone came to her with this kind of pain. Endometriosis is a condition where the tissue that lines the womb is found outside of the womb. It can cause painful periods and deep pain after sex because the movements pull on the endometriotic tissue.
Rymer adds: “Someone might have a cyst [a fluid-filled sac] that’s sitting there when you have intercourse that makes it uncomfortable. You might have a fibroid [a non-cancerous growth near your vagina or cervix] in an odd position.” Basically, if you’re experiencing lower abdominal pain, it’s definitely worth asking your doctor to book you in for a pelvic scan.
Another condition that can cause deep pain after sex is pelvic inflammatory disorder. It’s caused by a bacterial infection (like gonorrhea or chlamydia) that can travel from the vagina or the cervix to the reproductive organs. It causes aching across the pelvis that can get worse after and during sex. “The symptoms of PID are usually abdominal pain, painful sex, heavy periods, and discharge,” says Dr Kunelaki. “It’s simple to treat with a two-week course of antibiotics.”
If you’re feeling pain deep inside you during sex, again endometriosis or PID might be the cause, but not always. “Sometimes it’s just that the ovary has been hit,” says Dr Rymer. Your uterus may be naturally tipped backwards (a.k.a. retroverted), or scar tissue from previous infections like PID could also have fixed it in this position, meaning that it can hurt if it gets hit during sex. Irritable bowel syndrome can also cause stomach ache-like sensations during sex.
It feels like their penis or my toy or strap-on won't fit inside of me
Vaginismus could be to blame. The psychosexual condition causes the muscles around the vagina to constrict without your control. It can be triggered by all sorts of things: previous sexual trauma, mental health problems, and even fear of sex pain from another condition. “Any woman who has had sexual pain, but invariably those with lichen sclerosus, can develop a vicious cycle of vaginismus (pelvic floor contractions) which causes pain after their condition has been treated,” says Frodsham.
Therapy can help ease symptoms, as can sharing stories as part of a community like the Vaginismus Network. Kunelaki says mindfulness and breathing exercises can ease pain symptoms: “Any activity that will slow you down and allow you to be in the moment rather than remain preoccupied with worries will be helpful.” You can also get vaginal dilators that are like a Russian doll of dildos, building up from tampon-sized to penis-sized, which Rymer says “get you used to having something in the vagina.” Frodsham recommends massaging the space between the anus and the vulva with coconut oil to relax the muscles that contract when vaginismus is experienced. She says women's health physios now favor this kind of perineal massage over dilators.
It feels like I need to pee during penetration
Kunelaki says that if you keep needing to pause the action to dash to the bathroom, it might simply be because during sex there is pressure on your bladder from your sexual activity. “Your vagina and your bladder are located anatomically very close,” she says. “It is advisable to empty your bladder before and after having penetrative sex.” Of course, you might also just be about to squirt, in which case it’s worth reading this.