why sex could hurt
Approximately 20% of women experience pain during sex at some point in their lives, and this figure rises to 50% for women who are menopausal. If you are facing discomfort or pain during intercourse, know that you are not alone. Intimacy, connection, and pleasure should be the primary focus of sexual experiences. However, for many women, unwanted pain during sex can pose a significant challenge.
What Causes Painful Sex?
Let’s explore some reasons you might be experiencing pain. The most common cause of sexual pain is increased tone or tension in the pelvic floor muscles. Studies estimate that 60-80% of sexual pain is attributed to heightened pelvic floor muscle tone. Increased tension can arise without any identifiable medical explanation for the pain. Some examples include:
Vaginismus: An involuntary tightening of the pelvic floor muscles that makes penetration difficult or impossible, despite the desire for it.
Vulvodynia: Characterized by pain or discomfort around the vaginal opening without an identifiable cause. This condition can be linked to factors that cause the nerve endings around the vulva to become overly sensitive, resulting in discomfort or pain during touch, pressure, or penetration.
Your nervous system and your thoughts about sex play significant roles in pelvic floor tension. Chronic stress, anxiety, a strict conservative upbringing, and past traumatic experiences can all contribute to sexual pain.
Pelvic physiotherapy can help restore normal muscle tone, movement patterns, and neural pathways. Sexual pain has both physical (body) and psychological (thoughts and feelings) components. The aim of pelvic physiotherapy for sexual pain is to create a safe space where the body and brain can unlearn the ‘threat’ response associated with intimacy, facilitating the development of new pathways that transform pain into pleasure and fear into confidence.
Specific Medical Causes for Sexual Pain
It’s crucial to rule out any specific medical causes for symptoms of sexual pain, which may include:
Infectious causes, such as Yeast infections, bacterial vaginosis, herpes, STIs, or urinary tract infections affect millions of women annually.
Inflammatory causes, like Lichen sclerosus, Lichen planus, and autoimmune conditions.
Neoplastic conditions include Paget’s disease, Squamous cell carcinoma, and Vulvar intraepithelial neoplasia.
Neurologic causes, including post-herpetic neuralgia or nerve compression/injury.
Traumatic causes, like genital cutting, surgery, or birthing injuries, may lead to scar tissue and psychological distress.
Iatrogenic causes result from medical interventions, such as post-operative issues, chemotherapy, or radiation.
Hormonal changes occur during menopause, perimenopause, after childbirth, during breastfeeding, or due to amenorrhea. Pain is often due to a decline in estrogen, which can lead to thinning vaginal tissues, reduced elasticity, and vaginal dryness.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, affecting roughly 10% of women of reproductive age and associated with painful intercourse in up to 50% of cases.
Other Contributing Factors
Psychological factors: Stress, anxiety, past trauma, or relationship issues can contribute to tension in the pelvic floor muscles and reduce natural lubrication.
Medical conditions: Such as irritable bowel syndrome or interstitial cystitis.
When you experience pain, your body naturally reacts by tightening muscles as a protective response against further pain or injury. This reaction is entirely normal. For example, if you experience pain due to hormonal changes or an infection, your body may tense the pelvic floor muscles to avoid discomfort. Once the underlying issue is resolved, the muscles may return to their normal state, leading to a reduction in pain. However, sometimes the body retains that tension even after the primary issue has been addressed, creating a frustrating cycle of pain and tension. To break this cycle, it’s essential to address the root cause of the pain through medical management while also tackling the secondary pelvic floor muscle tension with pelvic physiotherapy.
Managing sexual pain requires a comprehensive approach, ideally involving a multidisciplinary team (MDT). This team-based approach ensures all aspects of your sexual health are properly addressed.