Uncomfortable sex can be, well – a pain. And despite being pretty common, it’s still one of the most neglected issues in women’s health. Discomfort can make it really difficult to engage in or enjoy sexual intercourse, and because of how taboo conversations around sex can still be, it can be an isolating experience if you don’t feel able to talk about it. This can have an effect on not only your mental, physical and emotional wellbeing, but also on your relationships and body confidence.
We’ve got the lowdown on common causes of sex-related discomfort down under, plus the facts to give you clarity, confidence and put you back in control.
What’s the lowdown?
- Sex should not be painful or uncomfortable but almost 1 in 10 women experiences this!
- Uncomfortable sex can be the result of physical or psychological factors, or both
- Paying attention to where you feel sore is important
- A chat with our pelvic physio or sex coach could help
- Your sexual health is worth prioritising. See your healthcare professional, so that more serious causes can be ruled out.
Why might sex be uncomfortable?
The medical term for painful sex is dyspareunia. One way of classifying it is according to when you first experienced it. Primary dyspareunia refers to pain from when you first started having sex while secondary is developed later. An awareness of which of the two fits for you is helpful for your healthcare professional to know. This, and knowing where it feels sore.
In other words: Is it the V or the P?
V is for VAGINA
Your vagina is the connecting tube between your vulva and your cervix. Think of it as the connection between the outside and your body’s inner core. If the pain you experience during sex feels pretty superficial, around the vulva or the entrance to the vagina, it could be due to any of the following:
A common culprit, vaginal dryness can create friction during intercourse and make it a rather uncomfortable experience. When aroused, fluid is released through the walls of the vagina to prepare for penetration. Sometimes, this fluid might not be enough. People who are breastfeeding, going through menopause or who are on certain medications such as antidepressants or contraceptive pills may experience this.
Vaginismus is an automatic bodily reaction to the fear of any type of penetration of the vagina. As a result, when penetration is attempted the vaginal muscles tighten up involuntarily. This spasm can make sex difficult. Most people find that they have it when they try to insert tampons or the first time they try and have sex. Treatment usually focuses on exploring your feelings towards penetrative sex and may also involve exercises to get you feeling more comfortable about it. At The Lowdown, we offer one-to-one online sessions with both a sex coach and a pelvic health physiotherapist. They can provide advice on the mental aspect of vaginismus and penetration, or physical exercises to help you strengthen and better control your vaginal muscles.
Infections, Inflammation or Irritation
Thrush, bacteria, viruses or sexually transmitted infections (STIs) may cause vaginal soreness. These infections will typically feature itching or burning and/or discharge that is different from your normal. If this is the case, treating the infection will usually fix the problem.
Your vulva or vagina may also become irritated after using body products you may be allergic or sensitive to, such as douches, perfumed soaps or lubricants. It can also occur if you have something stuck up there e.g. a tampon (yes, this happens!).
Tears to genital tissue can happen during labour and childbirth. If ignored, these may cause discomfort during sex, sometimes for extended periods of time. Splitting of the skin around the entrance to the vagina can also happen when the skin is stretched during sex and can be a cause of recurrent pain.
P is for Pelvis
If your discomfort feels deeper, the issue could be higher up.
Your pelvis is the lower part of the trunk of your body and contains a whole array of organs plus your bladder and rectum (part of your bowel). In women, these other organs will typically consist of the cervix (aka the ‘neck of the womb’), uterus (womb) which is lined with endometrium (womb lining), fallopian tubes (connecting the ovaries to the womb) and ovaries.
Problems with the cervix
During vagina-penis intercourse, the penis can meet the cervix at maximum penetration and/or in certain positions. Sometimes, this deep penetration can cause discomfort – it’s even got its own name: collisional dyspareunia.
Problems with the uterus or ovaries
Sex can be uncomfortable if you have a disorder of these areas, such as fibroids or cysts.
Fibroids are non-cancerous growths made up of muscle and tissue. They can develop in or around the womb and tend to vary in size. Around 1 in 3 women with fibroids will experience symptoms, such as heavy periods, lower back pain and – you guessed it – painful sex.
Ovarian cysts are tiny sacs of fluid that can develop on an ovary (the part of the female reproductive system that produces and stores eggs). These cysts are common and usually go away themselves, unless they grow too large or split. When this happens, possible symptoms include painful sex, pain in the pelvic area and bloating.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the female reproductive system which includes the womb, fallopian tubes and ovaries. You are at higher risk of PID if you have an STI that is left untreated.
Retroverted or ‘tilted’ uterus
Nearly 1 in 5 women will experience discomfort because they have a retroverted uterus, where the uterus tilts backwards towards the rectum instead of forwards towards the belly. This does not usually affect your fertility, but it can make certain sex positions uncomfortable.
Did you know: Smear tests are a straightforward and necessary part of screening for abnormal cells on your cervix that could develop into cervical cancer if left untreated. In the UK, if you’re a woman or assigned female at brith, you are invited for screening from age 25 and every 3 to 5 years depending on where you live.
Problems with the lining of the uterus (endometrium)
Endometriosis is a common disorder affecting as many as 1.5 million people per year in the U.K. It is a condition where the womb lining grows in other parts of the body such as on the bowels or bladder. It can be a really difficult condition to live with because it can be hard to diagnose and complex to treat. We’re really passionate about spreading endometriosis awareness here at The Lowdown, as our Founder Alice suffered with it for years. Check out our webinar on endometriosis with leading expert Professor Andrew Horne for more information on signs, symptoms and treatment, as well as our blog on the best contraception options to help manage endometriosis.
Another condition is adenomyosis, where the endometrium grows deep into the muscular wall of the womb. This can lead to thickening of the womb lining, heavy bleeding, and painful sex.
A urinary tract infection (aka UTI) can occur in any part of your urinary tract i.e. your bladder, ureters (the tubes between your bladder and kidneys) and kidney. Bladder infections, in particular, may make sex incredibly uncomfortable. Classic symptoms include pain or burning when you pee and/or peeing more often. If you experience recurring UTIs often, this can be especially difficult to deal with, but treatment options are available. Our community also recommends D-mannose to help prevent UTIs from happening in the first place!
What can I do if sex feels uncomfortable?
If you experience recurrent pain during sex, whether in your vagina or deeper in your pelvis, it is super important to see your doctor. Potential things your doctor might do after finding out more about your challenges include: examining you, looking at your cervix, swab tests, arranging scans, blood or urine tests, treating infections, reviewing any medications you are taking that might be causing your symptoms, referrals to a gynaecologist and more.
Until then, there are a variety of things you could try to make your experience of sex more pleasurable (as it should be!):
Get screened for STIs
STIs can be tricky stuff if left undiagnosed or undertreated. If you are sexually active, taking care of your sexual health is an important part of staying healthy and enjoying sex. Regular STI checks are widely available at sexual health clinics across the U.K.
Not sure where to go? We’ve got you. To find your nearest one, head to our sexual health clinic finder. Sexual health has never been easier to take care of!
If sex is painful for you and you think it might be because of vaginal dryness, incorporating lubricants into your sex life could be worth a try. In some cases such as vaginal dryness due to menopause, vaginal oestrogen can also help.
Ever heard Aaliyah’s hit song “Rock the Boat”? No? Have a listen! If you’re having trouble enjoying sex because it hurts, try changing position.
Our amazing resident pelvic physiotherapist has a wealth of knowledge on all things related to your pelvic floor and managing some causes of painful sex (including endometriosis). You can book a consultation in a few clicks, or find out more about your pelvic floor by watching our pelvic health webinar.
(And the Aaliyah reference will make sense after you hear the song, we promise).
Be kind to yourself
Beyond the physical causes listed above, anything from previous traumatic experiences or negative personal, cultural or religious beliefs about intercourse can make it an uncomfortable experience. Your emotional wellbeing matters. Be open with your partner about your discomfort and how you feel. It’s also important to look at your body and learn what feels good for you.
Speaking with a sex and intimacy coach can be a great step. Book a consultation with our resident sex coach to talk about it in a non-judgmental, safe space that puts you first.
In summary, there is no shame in acknowledging sex is uncomfortable or painful for you. If you do experience this, it’s a good idea to have a chat with a healthcare professional. Until then, give some of our tips a try!
Dr Silvia Anie-Akwetey is a writer, artist and GP-in-training with previous experience in Emergency Medicine. She also has a Masters in Science Communication from Imperial College and is passionate about global health, reproductive medicine, tech and creativity.
When she isn’t doctor-ing or writing, you might find Silvia gigging around London or dancing to Latino music.