Navigating Painful Sex: A Guide for Vulva Owners

Written by Sexual Wellness Institute Therapist, Josalin Brausen, Masters Intern Therapist

Have you been led to believe that pain with sex is normal, or that sex is supposed to hurt? If so, you’re definitely not alone, but I am here to tell you that painful sex is NOT normal and should NOT be tolerated. Yet, pain with sex is incredibly common, and up to 40% of those who experience this do not seek out medical care. In this blog, I am going to break down what exactly painful sex is for vulva owners, what can cause it, and what can be done about it. Just a brief clarification before we get started - pain with sex is very broad and complicated in nature and can present differently from person to person. If you are experiencing any kind of pain with sex, I hope this blog post gives you some confidence to do something about it and take back your sex life, because you deserve a satisfying and pleasurable sex life if you want one. 

Terminology Breakdown Regarding Painful Sex

First, I want to describe exactly what I mean when I say “pain with sex.” I am referring to genitopelvic pain, or pain originating anywhere in the external genitals (including the vulva, external clitoris, perineum, labia majora, and labia minora) or in the internal genitals (including the vagina, cervix, ovaries, and uterus) during sexual activity. Dyspareunia is the medical term for pain with penetrative sex and can occur before, during, or after sexual intercourse. Vulvodynia is the medical term for pain in the vulvar region that greatly varies from person to person and depending on the cause. Your pain may come and go, remain relatively constant, or only flare when the area is touched or provoked. It can also occur outside of sexual activity/the area being touched. You may experience burning, soreness, stinging, rawness, or a sharp/knife-like pain. If you are experiencing any sort of sexual pain, it will be important to get specific with your doctor. 
One of the biggest details to consider is where exactly does it hurt? If you are unsure how to describe this, it can be helpful to become acquainted with your genitals. Though it may be uncomfortable at first, grab a handheld mirror and take a look down there. You can also print out an anatomy sheet and try to identify your own parts. This can help you be clearer with your doctor and other professionals when trying to describe where exactly it hurts. *If you become self-conscious or experience shame when looking at your genitals, challenge this! Genitals come in so many different shapes and sizes and are all beautiful. You could journal about where this shame may originate from, where you learned it, and how it impacts you. A sex therapist can also help you work through this. 

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Some other things to consider before visiting your doctor about painful sex:

• Is the pain constant or does it come and go? 
  
• When does the pain start? If it does stop, when does it usually stop? 
  
• When did you first notice the pain? 
  
• Do you experience pain with the insertion of a finger or tampon? 
  
• Does the pain occur every time you have sex or only in certain situations?
  

The Vast Array of Potential Causes of Pelvic Pain for Vulva Owners

As I mentioned earlier, sexual pain is complicated and there are many things that can contribute to it. It’s also important to note that there likely isn’t one single cause, but several, all contributing to the pain. It may feel overwhelming, but fear not! It is treatable. Knowing the potential cause(s) of your pain is a big step towards being able to treat it. Here are a few of the many potential causes: 

• Lack of adequate lubrication - foreplay is important! Make sure your body is prepared for penetration and sufficiently lubricated. If your body does not produce enough lubrication on its own, use lube! For more on which type of lube would work best for you, read our blog 
• Tight pelvic floor muscles
• Inflammation, infection, and skin disorders
• Hormonal changes - including from hormonal contraceptives, endometriosis treatments, removal of ovaries, medications for breast cancer, medications for acne, and menopause
• Endometriosis
• Injury or trauma to the affected area 
• History of sexual trauma
• Anxiety
• Negative ideas about sex or one’s sexuality
• Negative body image

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The Silver Lining: Treatment Options for Painful Sex

Since many things can contribute to genito-pelvic pain, you may have to take a holistic approach and involve several professionals. This can include a primary care doctor/gynecologist who can do an external/internal examination and run appropriate tests/lab work. Pelvic Floor Physical Therapists can help the muscles of the pelvic floor work properly including teaching you how to contract and relax your pelvic floor muscles. A sex therapist/mental health professional trained in sexual concerns can help with the emotional and relational effects that the pain has caused, address sexual anxiety/trauma/anything else that may be psychologically contributing to your pain. 
If you are partnered, the pain may also be causing relationship distress. It can be helpful to open up a conversation with your partner(s) about the pain you are experiencing, what you would like to do about it, and how it’s impacting your relationship emotionally and physically in a non-sexual context. Also know that sex and intimacy does not only have to be penetration or the certain activities you find painful. Try broadening your definition of sex and intimacy and engage in other activities that do not cause you pain such as kissing, massages, oral sex, using a sex toy, listening to erotica together, shower together, mutual masturbation, or anything else you find enjoyable! The options are endless.

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Want to Talk With an Expert? Begin Online Sex Therapy in Minnesota.

You are not alone in your pain, it is not normal, it can be improved, and you deserve a pleasurable and satisfying sex life! I hope this blog provided you with some hope and knowledge about the many different treatment options available.  Sex therapy is becoming more popular and normalized, too! If you've been wondering about topics of a more intimate nature and want support, an expert sex and relationship therapist in our Plymouth, MN therapy practice can help. Let us help you take those first steps to embracing your sex life more fully. In fact, we can help you wherever you are in the state via online sex and relationship therapy in Minnesota! 

1. Contact the Sexual Wellness Institute to set up your first appointment.
2. Meet with one of our skilled online sex therapists for an intake appointment.
3. Finally feel more comfortable and confident about your sexual health, relationships, and pleasure.

Other Sexual Wellness and Couples Therapy Services in Minnesota

Our therapists want to support people from all walks of life and all stages of relationships. In addition to couple therapy, our LGBT & polyamory friendly sex therapists provide a wide range of mental health services at our Plymouth, MN counseling office. Other services include sex therapy, couples therapy & marriage counseling, EFT, evidence-based couples therapy, EMDR & sexual trauma therapy, as well as, teen therapy. In order to help serve the mental health needs of all those living in Minnesota, we also offer online counseling & sex therapy. We also provide a variety of helpful tips on our mental health blog. Happy reading!

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SOURCES:

• https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423#:~:text=Overview,and%20has%20no%20clear%20cause.
• https://www.mayoclinic.org/diseases-conditions/painful-intercourse/diagnosis-treatment/drc-20375973
• Goldstein, A., Pukall, C. F., Krapf, J., & Goldstein, I. (2023). When sex hurts: Understanding and healing pelvic pain. Hachette Go.