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Women's Health

Why sex hurts sometimes – and what to do about it

Fri 15th May, 2020

Kate Iselin

The sex we have in real life is rarely like the love scenes we see in films.

The lighting isn't anywhere near as good, we don't all end up with perfectly-tousled hair afterwards, and sex doesn't always feel as great as it looks on-screen.

Sometimes, it can even be really painful.

We don't talk a lot about painful sex, but that doesn't mean it doesn't happen. One study found that one in five Australian women have experienced pain during sex. This is a high number, but the one reassuring thing to take away from it is that those who experience painful sex aren't alone. So painful sex might be common—but it doesn't have to be normal.

Pain during sex—specifically, during vaginal intercourse—is also called "dyspareunia". It can be categorised into two different types: superficial pain, which occurs around the entrance to the vagina or on the skin of your vulva, and deep pain, which occurs further inside your body.

Superficial pain might feel like a burning, itching, or stinging sensation, and it can have a number of different causes.

Infections like thrush, bacterial vaginosis, trichomoniasis, genital herpes, and urinary tract infections—the dreaded UTIs—can have symptoms of pain on your vulva or inside your vagina. And, maybe surprisingly, parts of our personal hygiene routine can also irritate the vulva: soap, moisturiser, tanning lotion, and waxing products can react negatively with our skin, and things like laundry detergent and even tight, synthetic clothing can cause painful reactions.

Condoms and lubricant can also be to blame.

Many condoms and dental dams are made of Latex, but a small part of the population can be allergic to Latex and experience pain and swelling when it comes in contact with their skin. Condoms made of lambskin, polyurethane (plastic), or polyisoprene (rubber) are a great alternative for anyone who can't use Latex. And when it comes to lubricant, it might be a good idea to ditch anything that's scented, flavoured, or provides warming or cooling sensations, as these kinds of lubes sometimes include additives that can react negatively with sensitive skin. Stick to water- or silicone-based lubes without additives where possible.

The good news is that most of these things—STIs, skin irritation, and allergies—are pretty easy to have diagnosed, and simple to treat and manage. Deeper pain, however, can be more complex.

Sexual health therapist and author of "Sex Down Under", Matty Silver, took us through some of the more common causes of deeper pain during sex. Deep pain occurs further inside your body—at the top of the vagina, at the cervix, and around the pelvic floor—and can sometimes feel like burning, tightness, tearing, aching, or cramping similar to what you might experience during your period.

Silver says there can be a number of things behind it: having sex too soon after surgery or childbirth can cause injury and pain, as can having sex with an active infection or STI. Pelvic inflammatory disease (PID) can also be a culprit, and is caused if an infection is left untreated or unnoticed and spreads to the uterus and ovaries.

But Silver also mentioned two conditions that pop up a lot when talking about pain during sex: vaginismus and vulvodynia. “I must have seen at least two hundred clients with mainly vaginismus,” she said.

Vaginismus occurs when your pelvic floor muscles tighten to the point where it's painful, and sometimes impossible, to have penetrative sex or even insert a tampon.

Vulvodynia, on the other hand, is chronic pain that occurs on the vulva and around the entrance to the vagina. Like many reproductive health conditions, vaginismus and vulvodynia aren't things we talk about every day, but that doesn't make them any less real.

Vulvodynia, like some other chronic pain conditions, is said to occur more frequently in women who've experienced physical or sexual trauma in the past; and vaginismus can also be triggered by traumatic or difficult experiences with sex, childbirth, or medical procedures. But neither of these conditions are all in your head.

“When a woman has vaginismus it can feel as if her partner is running into a solid wall when they try to enter her. The vagina is perfectly normal and capable of intercourse without pain in these women, as long as the pelvic floor stays relaxed,” says Silver, emphasising, “It is the pelvic floor spasm, and resulting compression of the vagina, that causes the pain and obstruction, not problems with the vagina itself.”

Both vulvodynia and vaginismus can be treated, although the treatment—as those who live with either condition would agree—isn't as simple as 'just relaxing'. Silver regularly refers her clients to specialists and physiotherapists, who can coach them through pelvic floor exercises that retrain their muscles, and notes that a pelvic floor physiotherapist, or continence nurse, can be of "enormous help" to clients.

There are so many potential causes of painful sex, and it can be extremely difficult to figure out for yourself what is causing your specific pain. We recommend speaking to your GP if you're experiencing any regular pain during sex, and take heart in Silver's advice that treatment need not be complicated or painful.