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#SexColumn: Why does sex hurt and how to make it less painful

File image.

File image.

Published Apr 8, 2022


By Sharon Gordon

Johannesburg - Sex should not hurt. It should be a pleasurable experience even when it’s the first time. If I read one more book about a virgin experiencing extreme pain I’m going to find the author and tear out their heart! It just makes everyone fearful and if you’re ready physically and emotionally it is a wonderful experience.

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Having said that sex can be painful, and it is almost always because your body is not happy.

People experience pain during sex for many reasons. Figuring out why you may feel pain during sex can actually be very complicated to answer for a number of reasons:

- Definitions of what is pain versus what’s discomfort differ for people, and for researchers.

– Definitions of sex differ. When most people say “sex” they mean intercourse. For some people even sexual touching can cause pain, where for others it is only penetration that causes pain.

– Because we aren’t encouraged to speak openly about sex, it is likely that many people suffer in silence, so we may not know as much about sexual pain as we do about, for example, chronic back pain, or tooth pain.

The most important thing to know is that sex doesn’t have to hurt.

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Making sex comfortable may require creativity and patience, but most people can find a way to enjoy sex without pain.

When sex hurts it is often the result of a combination of factors, including physical and psychological ones. Something may happen in your body that hurts during sex, and then in the future you may anticipate the pain, which can amplify the experience next time.

Figuring out why sex is painful, and what to do about it, is a bit like solving a mystery. You’ll want to consider both the physical and psychological causes of pain during sex. This includes childhood trauma and sexual abuse. We’ve found that people with a strong religious upbringing can also be more vulnerable and fear sex.

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Once you’ve explored the possible reasons for pain during sex, you may want to explore some of the sex tips for eliminating or reducing pain during sex.

Sex shouldn't be painful (unless it's pain you choose to experience and enjoy which is a different story). If you're experiencing painful sex, there may be several factors that are contributing to the pain you feel.

These might be physical causes or psychological causes, usually it will be some combination of both. If you're trying to figure out where to start it can be helpful to consider some of the most common causes of painful sex.

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Physical causes of painful sex

Some causes of painful sex may be specific to women's or men's bodies, others are equal opportunity obstacles.

Here's an incomplete list of common causes of painful sex:

– Pelvic Inflammatory Disease

– Endometriosis

– Interstitial cystitis

– Vaginismus

– Vulvodynia

– Some sexually transmitted diseases

– Urinary infections

– Vaginal dryness

– Physical injury and chronic pain

– Women who have intercourse with a man with a very long penis can experience pain

– Some infections (like thrush) can cause soreness and itching

– Some sexually transmitted diseases

– Tight foreskin

Psychological Causes of painful sex

Often people think that a psychological cause is another way of saying "it's all in your head" which is another way of saying it isn't real.

Not true. Psychological causes of painful sex still result in very real pain, and very rarely can someone just "get over" a psychological reason for pain during sex.

For both men and women there are a variety of reasons why our minds may play a role in sex being painful, here are some of the more common causes:

– Coercive sexual experiences. Far too many women and men have experienced sexual assault or abuse.

– For many people their first experience with sex was something they did not choose. If you’ve never known sex that is consensual and pleasurable, it isn’t surprising that when you have sex (even when you choose to have it with a partner you like or love) your body doesn’t experience it as pleasurable. If you’re interested in learning more on this topic, I highly recommend the book The Survivor’s Guide to Sex which offers hope, support, and concrete guidance for people trying to create a positive sex life after experiencing sexual assault or abuse.

– Anticipating pain. If you experienced pain during sex (whether it was from a physical condition, or a wrong position), you may begin to anticipate pain the next time you have sex. If you’re expecting, it at least three things can happen.

* First, you aren’t going to be as tuned into what’s going on in your body, and you may find your arousal is lowered.

* Along with this, women may have less lubrication, which can cause a different kind of pain during sex.

* As well, the anticipation can actually make the pain feel more intense. For example, your body may be very tense, which may result in a different physical experience of pain or pleasure.

– Lack of interest in having sex. A very different situation than sexual assault is the time when you may not be in the mood to have sex, but your partner is.

Many of us will have sex even when we’re not 100% into it, and we do this for a variety of reasons.

One of the problems with doing this is that if you’re not that interested in having sex, it may result in pain.

For women, the most common reason for this is likely lack of vaginal lubrication (and there as many reasons for this). If you’re not psychologically aroused at least a little, and you don’t have a lot of vaginal lubrication, sex will most likely be uncomfortable or painful.

For men, if they are physically stimulated, they may have an erection and be able to engage in intercourse. But if they aren't turned on, it may take a lot longer to ejaculate than it normally would.

If there isn’t sufficient lubrication in this scenario the prolonged friction may cause pain.

Because sex can be painful for many reasons, and several factors could be causing the experience of pain during sex, finding the solution can be trial and error. It does require patience.

Not all of these suggestions will apply to everyone, but here are some steps to take.

Take notes. Try to figure out what’s going on. Ask yourself some questions:

– When did sex start to hurt (has it always hurt)?

– When does the pain begin (is it as you’re getting excited, only during penetration, related to orgasm)?

– Where do you feel the pain (is it in one specific area, or more general)?

– Are there still things you can do sexually that don’t cause pain?

Explore on your own. If you don’t regularly masturbate, now’s the time to start.

If you can masturbate without pain, that is both a helpful thing to know, but it can also provide you with much needed release while you figure out how to resume sex with your partner without it hurting.

Using masturbation to explore sexual pain is particularly good because you don’t have to worry about a partner poking you the wrong way. You can be as gentle (or as rough) as you want to be, and you’re always in control.

If penetration with your partner is painful, you may want to use a vibrator or dildo (with lots of lubricant) to explore penetration with masturbation, to discover if it feels the same or different.

Use plenty of lubrication

There are all sorts of reasons women experience vaginal dryness but using a personal lubricant can be an easy and effective way to treat this problem and eliminate a major cause of painful sex.

At Lola Montez, in store and online we stock a variety of lubricants. My favourite is Pjur, specifically the Repair Gel. It’s a bit pricy but worth every drop!

Communicate with your partner

It can be difficult to talk about sex at the best of times, even for couples who have been together for years.

When it comes to talking about a difficult sexual issue, the communication can get even trickier. But communication is key to resolving painful sex. Even if the cause is entirely physical, and will go away with treatment, it’s still important to talk with your partner about the pain you’re experiencing and figure out other ways for both of you to satisfy your sexual needs while you are getting treated.

This can be one of the positives of experiencing sexual pain, it can force couples to break down communication barriers and eventually lead to a better sex life than before the pain was experienced.

Experiment with different sexual positions. For some pain during sex happens as a result of pressure on particular parts of the body.

It may be putting pressure on certain joints hurt, or that penetration at a certain angle is painful.

Try exploring different sexual positions and see if this alleviates some of the pain.

Consult a doctor or other healthcare provider. I recently advise a man I know to see a doctor who specialises in sexual health. The doctor is a woman. His ego would not let him see a specialist and so his sex life will suffer. I don’t see how one hour of embarrassment compares to years of discomfort.

If you can, in most cases it is worth talking with your doctor about this.

Even if the problem clears up (or seems to clear up) pain during sex can be a symptom of other issues and knowing this can alert your doctor to other questions they may want to ask.

When I started out there were one or two people in South Africa who specialised in sexual health. There are many more now. If you’d like a reference email me on [email protected]

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