Painful Sex
There are lots of reasons why sex can hurt. There are lots of different times in your life that sex can hurt.
Sex can hurt because:
1. You don’t actually want to have sex
2. You are stressed
3. Your pelvic floor is too tight
4. You are constipated
5. You are going through hormonal changes
6. You have allergic reactions to products
7. You need to use lubrication
8. You have an infection
9. You are too clean
10. You are getting on your own nerves
1. You don’t actually want to have sex: There are natural steps that take place for someone who wants to have penetrative sex. The steps I will be outlining pertain to vaginal penetration. Very simply, the steps are desire, then physical arousal, then production of natural lubrication and lengthening of the vaginal canal. Without all of these steps, it is likely that penetrative sex will be a little or a lot uncomfortable.
2. You are stressed: Your brain is so intimately involved with the functions of your body and sex is no exception. When you are stressed out, so many things happen. Your stress hormone levels change. Your blood pressure changes. Your muscles tense. Many people are familiar with how stress creates tension in the neck and can contribute to headaches. Well, the same thing goes for the vagina and the rectum. It’s true.
When you experience a heightened state of stress, fear, anxiety, anticipation of something unlike (like pain), your pelvic floor muscles in the vagina and rectal area will become tense. This means they become a little tighter. They become a little shorter. When they should be relaxed and at a normal length, they are not. They stay a little contracted. So when something penetrates the vaginal canal, it is not very comfortable. The shortened length of the vaginal canal makes insertion a little less comfortable (or altogether uncomfortable) and the movement of thrusting in the vaginal canal can feel more like friction than pleasure.
3. Your pelvic floor is too tight: If you’ve been stressed for a long time, you’ve had a rough month, semester, year or if you’ve had a rough marriage or childhood, your pelvic floor muscles will stay in a chronic state of tension. Without getting treatment of some sort for this, the muscles will likely stay this way. Having sex with a pelvic floor that is always tight can make sex uncomfortable. When sex is consistently uncomfortable, then the anticipation that sex will be uncomfortable will feed into this mental loop. Then you are stuck in a pattern of A) I’m not really enjoying sex B) I should probably have sex to maintain this relationship/please my partner/out of obligation/etc. C) Penetration is about to happen and I know this is going to hurt E) The anticipation of the pain causes an additional reflexive tightening of the pelvic floor muscles F) Sex hurts again. This cycle can be broken. But, your brain has to be part of the process of unwinding the pelvic floor muscles.
4. Constipation: There is only so much space in your pelvic cavity. If you are constipated, then you probably have some stool in the rectum. The rectum sits just behind the vaginal canal. If you place a finger in the vagina and push that finger towards the direction of the buttocks, then you are pressing on the rectum. Now imagine the rectum isn’t quite collapsed, but instead has stool in it. Then that stool is kind of collapsing the vagina a little. There is limited space here so if something is going to penetrate the vaginal canal, it’s a whole lot more comfortable if there isn’t something already in the rectum.
5. Hormonal Changes: Sex hormones play a huge role in the sexual experience. Estrogen and testosterone are the primary sex hormones. These levels change in the body during different parts of the reproductive cycle each month and throughout the life span. They also change during pregnancy and with lactation. This means that the sexual experience will change too. Some people experience more pleasurable sex during certain stages of pregnancy. Some people experience more discomfort with during and just after lactation. Some people experience discomfort with sex because of medications that have affected sex hormones. Some people experience more discomfort just before, during and after menopause. Not only can these hormonal changes affect the sexual experience, but they can cause a lot of seemingly unrelated issues like urinary leakage, symptoms of urinary tract infections and the need to urinate intensely or really often.
6. Allergies: If your body is allergic to certain products you use, materials in your clothes or foods that you eat, you will release mast cells and histamine. These create inflammation in your body. You may notice a rash or bumps on your skin or watery eyes or swelling. What you typically do not notice, however, is what happens to your genitals. There is a part of the vulva that is very sensitive to inflammation. This is called your vestibule. Inflammation at this tissue can look like redness, but sometimes it looks like nothing at all. Instead, you feel symptoms. One of these symptoms can be discomfort with sex.
7. Lubrication: Lubrication is just going to make the sexual experience more comfortable and for some, more satisfying. The use of lubrication has nothing to do with your interest in your partner or your partner’s ability to perform sexually. It has nothing to do with pride or shame. It has everything to do with common sense. Using the right lubrication will always enhance the vaginal penetration experience. Period. But, you read that right. The right lubrication is key.
8. Infections: Most of the time a urinary infection or a vaginal infection is pretty symptomatic. You know you have an infection or you are at least suspicious that you have one. But, sometimes it’s not so obvious. Some people don’t know they have an infection until they start to really aggravate the urinary or vaginal tissues with pressure and friction, ie. penetration. Inflamed tissue does not like this pressure and friction and at this point it is reasonable to be suspicious of a possible infection. However, self-diagnosing and self-treating an infection isn’t a good idea. You can actually make your symptoms feel worse or you can make them last longer if you try to medicate yourself without knowing exactly what is going on. The same thing goes for seeing a doctor. If they are treating you based on what you tell them, it would be wise to ask for actual testing to make sure that you are being treated for an infection that you actually have.
9. You are too clean: A lot of people use soap to clean their genitals. In general, we think of the vulva as a potentially smelly place. We think that smelly places like the armpit and the foot need to be washed so they smell less, right? So, why wouldn’t the same apply to the vulva? Or…to the vagina? It’s because your vulvovaginal area was made pretty efficiently. For many, issues actually start because you are using soap. Soap – even the kind marketed to women – actually gets rid of everything. There is good bacteria in the vulva and inside the vagina that needs to stay around. Soap gets rid of this. Without the good bacteria, you cannot actually fight off infection well. Additionally, you get rid of food for some of the sex hormones that you need in this tissue. So, you are actually far more likely to develop genital order when you use soap! Odor could be the least of your worries because using soap makes you much more vulnerable to infections, tissue damage and pain with sex.
10. You are getting on your own nerves: One of the coolest nerves in the body is located really close to the vagina. This nerve has three jobs. This is the only nerve in the body with three jobs. This nerve is the pudendal nerve and it is responsible for what your genitals feel, what your genitals do and your ability to control the muscles at the genitals. When this muscle gets injured, it gets angry. When it gets angry, it starts to talk. The “talk” can feel like so many things because this nerve is responsible for so many things. The pudendal nerve can get irritated from a trauma like an accident or surgery. It can also get irritated from the muscles surrounding it being too tight for too long. It’s like if I’m the owner of a cat shop and I decide what music is played in the shop, what the cats get fed and whether or not they get their claws filed. If I’m super irritated because the building owner wants to raise the rent, I’m really going to be feeling the pressure and make some odd choices under the stress. In this state, I’m going to not operate normally. I’m going to probably play really loud ‘80’s hair rock, I’ll feed the cats only brussels sprouts and everyone that picks up a cat will get scratched. When you walk into my cat shop, if the music doesn’t kill you, the noxious brussels sprout cat farts and the shredding of your arms will. My once successful cat shop will no longer be the pride and joy of Main street. This is what happens with the pudendal nerve and your genitals. Crazy stuff can happen and none of it has to make sense. So, when you go to the doctor reporting that your genitals have gone awry, your doctor typically doesn’t know what to make of it. They look at you as if you really did let loose a brussels sprout fart…in their exam room.