Sex is a good time. At least it should be. Around 75 percent of people with vaginas will experience pain with sex at least once in their life, but 7-22 percent of women will suffer persistent discomfort. It’s normal to expect some occasional trouble easing into sex if you’re stressed out or you’re not lubricated enough. But if sex continues to hurt — and adequate time is devoted to arousal — it’s time to check with your doctor.
“Something that is happening over and over, or is worsening, definitely requires a look see,” says Dr. Alyssa Dweck, a gynecologist who specializes in sexual wellness and is co-author of “The Complete A to Z for your V.”
There isn’t just one type of pain with sex. Conditions like vaginismus — when the opening of the vagina involuntary contracts — can make sex painful if not impossible. If you’re born with a retroverted uterus — meaning it’s tilted backward instead of straight — you can also experience pain during certain sexual positions. Since everyone’s experience is different, identifying your symptoms can be the key to resolving the problem. If you’re having painful sex, here are a list of some treatable conditions to consider asking your doctor about.
If any part of your vulva — the labia, clitoris, and vaginal opening — chronically burns, stings, or feels raw during sex, manual stimulation, or even during long periods of sitting, you could have vulvodynia. While there is no definitive cause for the condition, it is treatable with pelvic floor therapy, cognitive behavioral therapy, antidepressants, pain medication, topical anesthetics, or nerve-blocking medication. If none of this works, surgical removal of the painful tissue is another possible option.
Pelvic floor tension
If sex hurts more often than not, you might start “muscle guarding,” says says Dr. Anna Reinert, a fellow in minimally-invasive gynecological surgery and chronic pain at Dignity Health in Phoenix. Muscle guarding is when you unconsciously tense your muscles, often as a protective mechanism against further trauma. If you experience pain that continues post sex, this can be a sign of pelvic muscle tension.
“If women have pain not just with sex, but pain that lasts afterwards, for hours or days, that’s usually suggestive of a pelvic floor muscle issue,” says Dr. Reinert.
Another tell-tale sign of a pelvic floor spasm is difficulty emptying the bladder. “Patients describe sitting down on a toilet and they can’t pee right away. It takes a while or they have to lean forward or push,” says Dr. Reinert.
Unfortunately, most gynecologists aren’t specialized in pelvic floor disorders, so the condition can go unnoticed in a routine pelvic exam, lamented Dr. Reinert. If you are experiencing symptoms, bring the issue up with your OBGYN and consult the International Pelvic Pain Society to find a pelvic floor therapist who specializes in pelvic pain.
Women with endometriosis are nine times more likely than the general population to experience pain with sex. The inflammatory condition occurs when tissue similar to what lines the uterus grows elsewhere, usually showing up on pelvic organs like the bowel, bladder, or ovaries. Sex can irritate endometrial tissue, which can worsen pain and inflammation.
Treatments for endometriosis vary from hormonal medication and surgery to dietary changes and acupuncture. While surgical removal of endometrial tissue can help, pain can continue after treatment. Want tips on how to have better sex while living with endometriosis? We have you covered.
Cysts and fibroids
Ovarian cysts are fluid-filled sacs that routinely come and go with the menstrual cycle. Problems arise when they get too large or become an endometrioma — painful cysts filled with tissue and blood. Those with polycystic ovarian syndrome can also develop a lot of little cysts. It’s often painful when a penis (or toy) hits any of these cysts during sex, which can cause them to leak fluid.
Fibroids — non-cancerous growths in the muscle of the uterus — can also lead to an uncomfortable sexual experience. Up to 50 percent of females develop fibroids at some point in their life. Often they go unnoticed, but they can become painful during sex if they grow near the vagina.
A pelvic exam or an an ultrasound can diagnose both cysts and fibroids, which can be treated with medication or surgery.
Yeast and bacterial infections can inflame the walls of the vagina, making sex uncomfortable. Sexually transmitted infections like chlamydia and gonorrhea can do the same thing. If left untreated, STIs can lead to pelvic inflammatory disease, an infection of the uterus, fallopian tubes, and nearby pelvic structures. This scarring can lead to chronic pelvic pain and pain during sex, writes Dr. Dweck in “The Complete A to Z for your V.” Treatments include antibiotics or surgery.
What to ask your doctor
Very rarely do doctors ask about about the quality of your sex life during a routine visit. If you’re experiencing persistent pain with sex, don’t wait for your OBGYN to bring it up. Head to your annual check-up with a list of your symptoms.
Even better, make a separate appointment dedicated to discussing your sexual health. “It’s not always just a simple straightforward, one-word answer for painful sex,” says Dr. Dweck. ”It’s something that requires a lit bit more of an in-depth conversation.”