Sex is not supposed to hurt. Whatever your sexual preferences, 1 in 5 women experience painful sex at some point in their lifetime. This is not always related to pregnancy or childbirth (but often is), and can affect women of any age. I would strongly encourage anyone who experiences painful sex to seek individualised advice from your GP or pelvic health physiotherapist (look no further, I’m ya gal). Let’s get the “red flags” out of the way; if you have unexplained bleeding or spotting, constant abdominal pain, burning or stinging when you wee, please go and see your doctor, and come back to this blog once they’re happy.
At the worst end of the symptom spectrum, there is a condition called vaginismus. You may have heard this term before; there was a 2020 Netflix drama called “Unorthodox” (loved it) where the main character suffered from this. A complete inability to tolerate any form of vaginal penetration. It goes without saying how this could have devastating effects on self-esteem, relationships, and sexual well-being. Without trying to downplay the horrendous experience women with vaginismus go through, the same can be said of all painful sex. It really can have huge ramifications in terms of how we view ourselves, how we behave, and ultimately how we love.
There are many factors to consider in addressing why sex is painful. These include emotional, psychological and physical reasons and are often complex. Underlying infection, undiagnosed conditions like endometriosis and hormonal imbalance need to be ruled out, which is why its important you discuss this with your doctor first, as there’s normally some tests to tick off. There are lots of reasons your vagina might be feeling a little dry or sore. Oestrogen plays a big role in lubrication and health of vaginal tissue; so some medications/birth control pills, breastfeeding, the 4th trimester, hysterectomy surgery and menopause can all play havoc with your hormonal regulation and cause vaginal dryness. But it doesn’t mean a healthy sex life is off the cards; far from it! Nerve entrapment and scar tissue can also cause issues – and can also managed with physiotherapy. But in this blog, I wanted to share some of my expertise and insights into some of the common factors that can affect sexual pleasure in the hope that it reaches someone who it finds it helpful!
1. Our biggest sexual organ is the brain
A lot of people forget that for true intimacy (and pleasurable sex), we must be relaxed, receptive and ultimately in an environment we feel safe in. This makes honest and open communication the very foundation of pleasurable sex. This is a challenge for a lot of women for sooo many reasons. Firstly, does your partner know that sex can be uncomfortable? Are they open to discussions about what strategies you could try to help? Have you tried anything already? Has it been constructive?
The sexual pleasure of women has never been front and centre in discussions around, or depictions of sex. Whether you’re into porn or not, you will be aware that the majority of content focuses on men’s sexual desires, and not so often around the female perspective. Porn is overwhelmingly produced by men, for other men to consume. A recent study researched the top 50 most viewed porn videos of all time and found, unsurprisingly, found that 78% of these videos showed men having an orgasm, compared to just 18% of women (and, let’s face it, these “orgasms” are probably just fantastic acting). So listen up lads – you have some unlearning to do too!
It’s not even just porn that’s guilty of this; up until recently (thank god for the Sex Education era) most depictions of sex have centred around the man’s pleasure. Certainly, when I was growing up, I NEVER heard a conversation about female masturbation; but I heard plenty of men discussing it. Sexual trauma is also much more common among young women. Our early sexual experiences can shape our understanding of sex and, when we examine these, can often help explain the “why’s” of painful/non-pleasurable sex. It is important to point out that these experiences do not define you – OR define your relationship with sex – but they are often important to acknowledge in order to move forward. I would strongly recommend talking to a professional, or if that is not an option, a trusted friend. Feelings of guilt, shame, and all the negative connotations that we can create around certain situations can really play out in a lack of communication in the bedroom.
Another huge issue that directly impacts far more women than men is a lack of confidence in the way they view their body. Luckily, in this social media age we are able to access so many more images of normal women; that is to say, women who are NOT supermodels but who we have been conditioned to believe are NOT sexy and do not deserve to love themselves without condition. Despite this much needed visibility, we are still bombarded with images and products promoting diet culture and these industries profit off compounding the idea that we are not worthy unless we are thin. Without trying to sound twee, learning to love yourself and give your body space to grow and change without judgement is a massive block for a lot of women. For anyone this resonates with, I would recommend unfollowing (or muting) anyone on socials that makes you feel shit about yourself; comparison is the well-known thief of joy and there is simply nothing good that can come of comparing yourself to unrealistic body ideals. There are some incredible body positivity (and body neutrality, if positivity isn’t for you) pages that you should follow instead and I promise, they can help you heal your relationship with your body!
I think it is so important to firstly address communication as the key to unlocking a more positive sexual relationship. Sex should be something that ultimately is enjoyable and anyone you are willing to be intimate with should understand that completely. You should be able to laugh when you inevitably get cramp, giggle at those awkward position changes, when one of you gets hit on the head, or there’s an unexpected fart; this sort of intimacy is not taught to us but it is what it takes to build the trust required for a healthy sexual relationship. To communicate openly is not only the basis of consent, but it sets the important precedent for a sexual relationship where you can both explore sexual pleasure WITHOUT shame or embarrassment.
Tips to improve sexual communication:
· Be honest. If something is painful; don’t endure it! Who’s benefitting from that? There are ALWAYS other options. TALK to your partner – it may take time but I’m sure they will be willing to help improve your satisfaction (and if not, do I even need to say dump their ass?)
· Reflect on why you think sex is painful. Is it the position? Is it the lack of lubrication? Are you just not ready? Is there something nagging at you that you know isn’t right? Once you have a better understanding of yourself, the answers tend to come more easily.
· If something really is making you burn with embarrassment, try writing it down first. Say it to yourself in the mirror, say it in the dark with your back to your partner; just SAY IT! More often than not it will get a better response than you expect, and if not, what’s the worst that can happen?
· See the funny side. Normalise laughing during sex! You should be having fun!
2. Use lube – lots of it!
I know for a fact that most of my friends don’t use lubrication during sex and I’m always astounded. Lubricant makes literally everything better; masturbation, intercourse, foreplay (I will accept that oral sex is probably the exception to the rule here – but there’s flavoured lube for that!). Some women obviously don’t have a problem with vaginal dryness, but that doesn’t mean lubricant doesn’t have a place- it helps reduce friction, in the same way that a decent pair of cushioned socks helps you not get blisters! It can also help explore new things more easily.
Picking the right lubricant is a big deal for sure, as the last thing you want is to be sticky. Keep it simple: pick a water-based lubricant. My favourite is the classic KY Jelly (now Kynect) as it’s water-based, paraben-free, perfume and additive free, perfect for daily use and specifically designed to compliment the natural pH of the vagina. There’s also some great sexual wellness info on their website, so I’ve linked it if that tickles your pickle.
3. Pelvic floor muscles
I had to get the other two out of the way before talking about the big one. One of the most common reasons for painful sex is your pelvic floor muscles – and indeed this is one of the main symptoms of pelvic floor dysfunction! Something I come across ALL the time is an “overactive” pelvic floor; we are taught to squeeze our lives away but how often have you focused on actually letting go of your pelvic floor? There are stories from women all to often who have raised their concerns about painful sex with their doctor and are told something like “just relax and have a glass of wine” – let’s call out this patriarchal bullshit once and for all; you are not the problem.
Pelvic floor muscles, like any other muscles, can get tense, short and tight over time and leave you feeling very sensitive and quickly fatigued. If we aren’t taught from the outset where these muscles are and how to use them, where the hell do you start fixing that problem? The good news is that muscles are innervated, soft tissue, adaptable structures and WILL respond to the right type of training. This can include stretching (your core, hip and back muscles are all densely connected to your pelvic floor and tightness here can cause issues internally), breathing exercises, specific pelvic floor training (with or without internal trainers like kegel balls), and manual therapy – but you will need individualised, professional guidance with a program like this, particularly if you have symptoms of pelvic floor dysfunction.
An insight I’d like to share is I think some of this pressure comes from needing to “feel tight” whilst having sex – if you’re constantly squeezing and not focusing on your own pleasure, it’s no surprise this can perpetuate the cycle of an overactive pelvic floor. You don’t need to be constantly squeezing for dear life. Communication is SO important here because the variables that YOU have control over – tempo, depth, intensity, position – are the things that you can play around with to see what works for you, and what doesn’t. Even if you’re just reading this because of the juicy sex content, and you’ve never had painful sex; have you ever relaxed your vagina (to the point where you’re gently bearing down) during intercourse? It’s a whole new world, trust me – you can thank me by spreading the word to your sisters far and wide!
Ultimately, there is help out there if you are currently putting up with, or even just occasionally experiencing painful sex. There is an important conversation to be had about sexual well-being as a vital part of our overall health, and I will continue to be an advocate of sex-positivity, especially concerning women, to help keep that narrative front and centre in discussions concerning pelvic health. Please reach out if you have any questions, comments or feedback, I’d love to hear from you!
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