When Is Painful Sex Okay?

It seems like everyone is either having it or thinking about it. That's right, "it" is sex. Let's address the biggest myth out there about getting it on: painful sex. 

Sex should never be painful. Boom, I can drop the mic and walk away. Post over.

Just kidding, let's delve into this more. You are probably thinking something along the lines of... "ok but what if". Although having pain during sex may be common, it isn't normal and it should not be something you feel like you should put up with. No ifs, ands, or buts. Pain during sex is a red flag. Something isn't working the way it should.

As you become turned on, blood flow increases to the area, the labia enlarge, and your body produces the world's best source of lubrication. Foreplay is crucial, and it needs to be something you enjoy. If you aren't lubricated then sure, any type of vaginal penetration is going to hurt. This is a simple fix - speak up and let your partner know. He or she isn't psychic and can't feel what you feel. Yes, it may be 100000% terrifying to speak up like that, but pain-free sex is also 100000% worth it. If you have difficulty with lubrication, try a water based lubricant. 

Here are the two most common reasons I hear (and used to believe!): 

1. "It's all in your head." No, its not. The thoughts and attitudes you have towards sex are a reaction to an experience you had or are having. If you feel pain, it's real and you should find the reason and solution to it. 
2. "He's too big." The length of the vagina can vary from woman to woman, but the vagina's capacity to accommodate size is unbelievable. Y'know what might be too big to pass through a vagina? Babies. It's about time we lay this myth to rest. More likely it is the technique which is causing you pain, such as being too forceful or the depth of penetration (i.e. something is hitting your cervix). Techniques, positions, etc can be changed so again, speak up! 

Some things which may cause painful sex include: 

1. UTIs and yeast infections. Having sex while you have either of these may result in passing along the infection to your partner. Yes, men can get yeast infections too! 
2. Low estrogen levels. Estrogen helps with lubrication. Estrogen levels vary during the menstrual cycle and drop during/after menopause. If your healthcare provider determines this is the underlying cause, you may be able to simply use a topical estrogren (or other forms of it) to clear up the problem. Topical forms are a safe alternative because the effects of the medication are limited to the area they are applied to, and for the vagina estrogen is great! 
3. Vulvodynia or vestibulodynia. The ending "dynia" means pain, so these conditions mean pain in the vestibule or vulva. If you need a refresher on pelvic anatomy, check out this post. In these conditions, sensations which typically aren't painful such as clothes rubbing on the tissue may be excruciating. There are treatments for these conditions which may include medications and working with a pelvic floor physical therapist. 
4. Vaginismus.  This occurs when the pelvic floor muscles go into spasm and do not allow any type of penetration (in some cases even for a pelvic exam or small tampon). Again, work with a healthcare provider to accurately assess and diagnose this condition. 
5. Other causes. There are multiple other conditions or underlying contributors to  painful sex, some of which could qualify for an episode of "medical mystery." This isn't meant to scare you but rather to raise awareness so that you can seek help if you need to. And if you have pain with sex, then you should! 

Bottom line: Don't accept pain during sex as normal. Be open with your partner about what you are experiencing. Find a healthcare provider you trust to work with you towards diagnosis and treatment.