When we talk about penetrative sex we hear about pleasure and amazing mind blowing orgasms. We picture intimate steamy scenes from movies, perfect bodies and exciting climaxes. Sex is spoken and portrayed as this perfect ‘act of love’, but the reality is that for a lot of women sex is difficult. It’s painful, unenjoyable and frankly imperfect. It is ok to feel like this, life isn’t a rehearsed movie script and sex isn’t always pleasurable. However at what point do we recognise that painful sex is actually a problem?

‘Sex shouldn’t be painful.’

You’re right, it shouldn’t be. However there are unfortunately many reasons as to why sex can be so painful for some. These reasonings differ in severity but each could be a culprit behind your discomfort and it’s so important to speak up about these problems and share. You’ll find by doing so that you’re actually not the only one!

1. Endometriosis

Endometriosis is a chronic condition where tissue similar to the lining of the womb (endometrium) grows in other places outside of the womb. This is most commonly in areas such as the ovaries and fallopian tubes, however can extend far beyond the reproductive region into places such as the bowel, and in rarer cases, the lungs. 

Women with endometriosis may have different levels of pain during sex, depending on the location of where their endometriosis is growing. The type of pain can also differ from person to person with some describing it as a deep widespread aching, and others perhaps experiencing sharp and stabbing pains. Nevertheless, penetration in general is sadly painful if too deep, and thrusting can pull and push at the growths. A lot of anxiety can arise through this, both with anxiety around speaking about sex with a partner or anxiety around wanting to have sex again for fear of pain. In turn, this can often make pain worse and could trigger other problems such as vaginismus. 

2. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease can cause deep pain felt within the pelvis during sex. Typical symptoms can include an abnormal vaginal discharge, a fever, feeling or being sick, abnormal bleeding, heavy/painful periods and low abdominal pain. It is caused by a bacterial infection spreading from the vaginal canal/cervix into the womb and can be known to be caused by STI’s, and even contraceptive devices such as IUDs. Usually a course of antibiotics would need to be prescribed in order to resolve PID, however if not treated quickly can lead to more serious and long-term problems. Always go to your doctor and never be embarrassed about discussing more ‘private’ matters with them, they are there to help you!

3. Ovarian Cysts & Fibroids

Cysts: Ovarian cysts are fluid filled sacs on the ovary, and most tend to go away on their own in a few months without needing treatment. They don’t always cause noticeable symptoms, but can cause pelvic pain during sex which can range from a dull heavy sensation, to sudden severe or sharp pain.

Fibroids: Fibroids are non-cancerous growths that develop in or around the womb. These can differ and grow either within the muscle wall of the womb, outside the wall of the womb, or in the muscle layer beneath the womb’s inner lining. They do not need to be treated if they are not causing symptoms and over time can shrink and disappear without treatment. In some cases they can cause pain during sex. A simple ultrasound will be able to tell you if you have any lurking!

4. Vaginismus

Vaginismus was given deserved attention in the well watched Netflix documentary ‘Sex Education’ where we met Lily, a fanatic of all things alien sex and quite frankly the best one-liners. For context, vaginismus is a chronic spasm or contraction of the vaginal muscles upon insertion or penetration. There is no known cause for vaginismus but it is said that perhaps a previous traumatic experience or fear of penetration can be linked. 

The use of dilators can really help with symptoms, as Lily used in the show. Dilators can be used with your own control, and are cone shaped instruments that you insert vaginally. You start off with a small size and gradually work your way up to a larger size. This trains the muscles and the skin to get used to touch, stretching and handling insertion. 

Talking therapies have also been effective in helping vaginismus symptoms, tackling the more psychological aspect and getting to the root cause of why or where it started.

5. Vulvodynia

A condition that many of you may not have heard of, but vulvodynia is surprisingly common! Unfortunately because of the complexity of the condition, it can be hard to diagnose and equally hard to understand (seems to be a common theme with these women health conditions….) Vulvodynia is the persistent, unexplained pain in or around the vulva and has no known cause. It’s related to nerve pain and can be triggered upon touch, penetration or even flare from tight underwear. Sometimes vulvodynia can be triggered from a traumatic experience (childbirth, injury) but a lot of the time the cause is unknown. 

Vulvodynia is usually diagnosed when other conditions have been ruled out, hence the longer diagnosis time and the complexity behind the diagnosis. 

Antidepressants, cooling/numbing packs, numbing gels are all things that can be prescribed to help with vulvodynia symptoms.

6. Vulval Dermatitis

General irritation around the skin of the vulva, such as dermatitis, can make sex extremely uncomfortable and painful. Tearing, splitting, itching and dryness can all contribute to a pretty unenjoyable sexual experience. Dermatitis is not spoken about often, but can be extremely common! It is so important to look after your vulval skin by avoiding harsh chemicals in bath products, laundry products and period products. Allow your vulva to breathe, use natural intimate moisturisers to keep the skin hydrated, and do not over wash! Wearing cotton underwear is extremely important as certain materials such as nylon/polyester/lace can cause further irritation and aggravate symptoms.

Sex shouldn’t have to be painful, and is something we all deserve to enjoy (yes shock, girls do enjoy sex too!). There is nothing to be embarrassed about when admitting that you may have a problem when it comes to sex. The more we talk openly, the more we find common ground with others and can share different tips with each other to help ourselves. Gynaecologists can be absolutely amazing and provide the best support, and it’s fine to see a few different professionals until you find somebody to fully trust. It’s certainly been a hell of a journey for me, and still is, but through a combination of support from my lovely followers and my gyno, I am sure I can find my answers!