Experiencing sexual health issues can be especially distressing due to our culture of shame and silence around sex. Many people who feel pain during sex are isolated in their experience, and have little support or resources. Some common causes of vaginal pain during sex are vaginismus, endometriosis, pelvic inflammatory disease, dyspareunia, vulvodynia, a UTI, or STIs. It’s important that you discuss your symptoms with your doctor to figure out if you need medication or other medical guidance.
While an OBGYN can absolutely help you figure out your diagnosis, many medical professionals are ill-equipped to help people heal from vaginal pain during sex because it is still widely misunderstood. Historically, people with vulvas who experience pain are not believed, often dismissed, or told their pain is “all in their head”. Vaginal pain during sex is common and there are a few ways to manage and heal from this.
Mental health has a huge impact on sexual function. When someone is feeling off balance in their mental space -- whether because they’re burnt out or depressed or anxious or experiencing PTSD -- the body holds that energy as well. Many sexual dysfunctions like vaginismus are directly related to how someone is feeling in their relationship(s) or in their body. Trans and GNC folx may be prone to vaginal pain during sex because of body dysmorphia, depending on their relationship with their body. A therapist can help unpack the root causes of sexual pain. These sexual dysfunctions are also cyclical in nature. Depression could be the cause of vaginal pain, but experiencing chronic pain also amplifies mental health issues such as anxiety or depression. Having a support system to heal in this process is vital — a therapist can be one component of that. And having a support system to figure out what healing means to you is also vital.
Physical vaginal pain during sex is typically caused by muscle spasms in the pelvic floor. The vagina is “tightening” itself in order to self-protect (whether for emotional or physical reasons). Pelvic floor specialists can help guide you through a process of abdominal massages. Your partner(s) may be able to assist with gentle vaginal massages (non-sexual), or you can try vaginal dilating. All of these practices aid the vagina in learning to relax the muscles so they don’t involuntarily spasm when touched.
People experiencing vaginal pain may still want to have penetrative sex. However, it can feel overwhelming when your body is not matching your conscious desires and not meeting your expectations. There are now sex toys that help people experiencing vaginal pain ease into penetration. Ohnut is a wearable toy (for the person penetrating) that serves as a buffer of sorts to ensure the penetration doesn’t go in too deep. The toy comes with four linkable rings to adjust the depth desired for each partner. Adding lube into sex is also incredibly helpful for easing into penetrative sex.
Remember, you never have to engage in a certain kind of sex just because your partner wants to. If you’re experiencing pain during sex, it’s likely your body is communicating something to you. Don’t push yourself too far out of your comfort zone for someone else’s pleasure. Sex is about pleasure for everyone involved, so be sure to prioritize yours as well!
Get to know your Vulva
Bodily shame can play a role in painful sex and is an indicator that it’s time to get comfortable with your vulva. You are the author of your own sexual narrative — and you get to decide what words are used for your genitalia. It doesn’t have to be ‘vagina’ or ‘vulva’ if that word doesn’t fit your experience. Get creative and make up your own language if that feels exciting, sexy or comfortable. You can also begin to explore what your vulva looks like at different times by using a mirror. Look at them after you take a shower, before you go to bed, after you masturbate, or while you’re menstruating. Vulvas tend to change in shape or color depending on where someone is at in their cycle and how aroused they are. Building a positive relationship with your body — on your terms — is healing in and of itself.
Context is everything
While mainstream representations of sex often depict spontaneous desire, onset by a glance, kiss or touch, many people actually experience responsive or context-driven desire. This means that people get turned on by a build-up of events, or within a certain context or setting. You might be incredibly turned on by your partner touching you on the couch, but you’re simultaneously stressed about an exam you have tomorrow. That stress acts as a break on your sexual desire. Understanding the context in which you feel the safest and most comfortable to have sex is incredibly healing when working through sexual functioning issues or chronic pain. This is a personal process, and it may take some trial and error to figure out what works best for you. When you know this, try to communicate that with your partner(s) so you can work together to ensure positive sexual experiences where you feel relaxed and safe to explore with them.