What To Do When Sex Hurts

Sex and pleasure are two experiences that should go together – just like some of the other best teams: movies and popcorn, vodka, and vermouth, for example. But sometimes for women, having intercourse – or attempting to – creates pain instead. It’s easy to understand why couples choose to think that if they just try harder, pleasure will emerge. So they may attempt to push past the pain, without realizing that that only makes the situation worse. That’s why today I want to tell you the most important things that I think you need to know about what happens when sex is paired with pain in a woman’s life.

The first thing I want you to know is that pain is always a message from your body. It’s a very clear and simple message – it’s saying STOP! When sex hurts, you need to stop. Don’t force it. If sex hurts, you need to see a physician or sex therapist, someone who is an expert in dealing with sexual pain conditions. If you have sex and pain, chances are very good that you have one of the two major conditions that I am going to familiarize you with today – vaginismus and vulvodynia.


Let’s start with vaginismus. This is an involuntary spasm of the muscles that surround the vaginal opening. By contracting these muscles, a barrier is formed so that intercourse is prevented. Vaginismus is the most common reason that couples are unable to consummate their marriages. Sometimes these couples have inadequate knowledge of sexual techniques and arousal techniques, and they may not even know that women need to be aroused and lubricated prior to penetration. Or they may be so excited about finally being able to “do it” that they go from a few kisses to intercourse with the very little preamble – even if they know better.

I’m sure you can understand that when a woman anticipates pain when she plans to have sex, her muscles may contract involuntarily, as a reflex reaction to her anxiety – just the way your abdominal muscles would contract if somebody throws a punch at you. The tension that is created by this involuntary spasm is painful in and of itself. So the next time the woman expects her partner is going to try to penetrate her, she’s going to tighten even further. The spasm will repeat and it will be even stronger, and this can create more pain. Thus, you have a vicious cycle where doing what seems natural, which is trying to do it right the next time, only creates a much more serious problem.

When sex is painful and a source of anxiety for one partner, it’s going to affect the other partner too. The prospect of failure, of rejection, the fear of hurting her, is going to get in a man’s way as well. He may begin to withdraw. Or he might learn to habitually release, to ejaculate, when his penis just touches her vaginal opening. Or he may not be able to maintain an erection when they do try to have sex again. In other words, the pain condition provokes a whole series of physical and emotional reactions to itself, to the vaginismus. And the longer the couple tries to handle the problems on their own, the more these difficulties pile up. That’s why I decided I wanted to share this topic about sexual pain. I know it’s not a pleasant topic, and it’s certainly not a very sexy one! But it’s really important for everyone to know that if pain occurs on penetration, you need to STOP and you need to see a specialist right away. If that’s the only think you take away from this article – if it’s all you remember – that’s enough. Please remember it.

Treatment for the couple usually takes a team approach, often involving a physician, a sex therapist, and a physical therapist who specializes in treating disorders of the pelvic floor muscles. This team will work with the couple and work with the woman to address both the initial concern – the vaginismus – and the sexual and relationship problems that arise from it.


The second condition I want you to know about is known as vulvodynia. This involves inflammation and pain around a woman’s external genitalia, that is, the vulva. Women with vulvodynia may feel shooting pain, itching, throbbing, rawness, burning pain, or stinging at specific “tender points” or all over. Some women have constant pain, while others have cyclical pain. With vulvodynia, any sort of genital touch may be painful, not just attempts at intercourse. Some women avoid all sexual contact – even kissing – because sexuality becomes associated with pain and distress. Their partners may stop approaching them – they may feel leery of getting close for fear of rejection. As is the case with vaginismus, there can be a domino affect, with layers of new problems arising out of the initial problem because the relationship itself takes on a whole new string of difficulties. This is why it’s so important to intervene early, not wait, and not try to solve the problem yourself with this disorder or any other pain disorder. You want to be able to work together with your health care practitioner in order to ensure your affectionate life and your erotic life do not suffer indefinitely.

Treatment and support for women with vulvodynia – and their partners – is essential. There are a lot of online organizations that are enormously helpful in providing educational support, connections with the community, and referrals to doctors and sex therapists. In fact, any woman who suspects that she has vulvodynia should make sure that the doctor that she sees is an expert in treating the condition, and you should ask about that before you even make the appointment.