This article was scientifically reviewed by Human Sexuality expert Dr. Laurie Mintz in June 2023.
Surrendering to the call of our innermost desires is the collective pulse of our humanity. Those moments when we lose ourselves in time with our partner’s tempo transports us beyond ourselves.
But when penetration hurts, the transcendent potential of a sexual encounter with your partner can elude you. When attempting penetration, one may feel that their body is betraying them. You may be thinking that everyone else seems to lap it up and relish the moment. For your friends, sex comes easy. They dish about new sex toys or their partner’s strap-on, while you sit on the sidelines, unsure of how to join in on the sex talk without being a killjoy. When penetration hurts, even hearing about acts that didn’t interest you before (like fisting) might lead to FOMO.
Painful penetration, formally known as dyspareunia, can put your sex life in the garrote. When everyone else is sailing on the bliss of getting railed, it’s easy to feel like you’re alone. Very few women feel comfortable talking about their painful sex life over cocktails with friends. But the truth is, more people understand your pain than you think. It’s tough to wrangle down the exact number, but as anywhere from 3 – 18% of women worldwide suffer from this, and studies in the U.S. find anywhere from 7 – 46% suffering from painful penetration.
It may feel like a death knell to intimacy, but you have options. Through both expanding your relationship to sexuality and seeking professional help, there is much you can do to reclaim your sex life.
What Does Painful Penetration Feel Like?
Although dyspareunia goes by one name, the pain itself takes on many different shades. Every single body is unique, and one person’s experience will look nothing like another’s. Some folks with dyspareunia may even experience this pain in new ways throughout their life.
That being said, there are a few common breeds of pain people report feeling, including:
Pain at the opening, caused only at entry or at certain angles
Intense pain during penetration of all kinds, including a finger or tampon
Sharp, stabbing pains during thrusting
Burning or aching, either during thrusting or when a particular spot inside is hit
A throbbing ache, often dragging on for hours after penetration
Within these different iterations of discomfort, there are also individual quirks that vary from body to body: some folks may hurt only during positions like doggy style that press on the front of the vagina. Others may have pain during thrusting only part of the time, trapping them in limbo, wondering when sex will be painful, and when it’ll come easy. Still others may feel pain only during certain times of the month.
The combination of shame and an unpredictable relationship to pain makes many folks hesitate far too long before seeking help – starting with identifying the root of their discomfort.
What Causes It?
While it would be easier if we could point to one cause, the truth is that painful intercourse can be caused by a variety of diseases and issues including but not limited to:
Pelvic inflammatory disease
Skin disorders in the genitals
Fibroids or other growths
Scarring from hysterectomies or other pelvic surgeries
Accidents and other traumatic injuries
With all these different potential diagnoses, identifying the root of your pain can be a lengthy, exasperating process. But there is hope for change – and it starts by taking action.
What Can I Do About It?
It would be an understatement of the decade to say that painful penetration is frustrating. What is supposed to lead you to the land of milk and honey is instead a battlefield. Nervous before penetration even begins, your tense muscles might also exacerbate the problem at hand.
Thankfully, those of us who struggle with dyspareunia aren’t without options. We have the agency of the modern era on our side. And this quest for pleasure begins with finding a doctor who takes you seriously. Many healthcare professionals are unaware of the diverse causes of dyspareunia, and thus it is essential to seek a physician well versed with sexual pain and especially one who won’t tell you to just relax, have a glass of wine, or that it is all in your head.
Don’t settle for a life without answers. To find a qualified sexual medicine physician, go to the website of the International Society for the Study of Women’s Sexual Health (https://www.isswsh.org/). A knowledgeable MD can help find the underlying cause of your pain and suggest treatment, which will depend on the cause of the pain.
Medical treatment options can include oral tricyclic antidepressants, oral or topical hormonal replacement, oral NSAIDs, botox injections, and treatments of any underlying infections. Pelvic floor physical therapy is highly recommended along with the medical treatment, as it relaxes the pelvic floor muscles and re-educates the pain receptors. Cognitive-behavioral therapy is also often recommended to assist with reducing anxiety and fear related to painful penetration. Surgical treatment is often used as a last resort when all other medical and behavioral treatment options have failed.
Indeed, a team approach–working with a physician, a psychologist and pelvic floor physical therapists is often the treatment of choice.
Take Matters into Your Own Hands
Needing professional help doesn’t mean that there is nothing you can do to help yourself, and specialists are often scheduled out for months in advance. You don’t have to wait. Start by investigating your own pleasure, focusing on your external body. While penetration may be off-limits, satisfying sex does exist that is penetration-free.
As you rediscover your body, turn the evening into a sensual event by taking a bath, lighting some candles, and then gently probing your body. Find whatever feels good, and lean into it. By exploring your nipples, clitoris, and other external erogenous zones, you can learn about your pleasure and reclaim agency over orgasms. And if you do find yourself ready to take steps towards penetration, don’t forget to have plenty of lube on hand.
Use Penetrative Aids
For better or worse, everyone’s experience with painful penetration is unique. As you rediscover your own sexuality, you may be curious about controlled penetration. Solo play is an excellent, safe way to see what feels comfortable for you. Opting for a vibrator (like the LIV 2) may be a crucial piece of the puzzle, putting you in control of the depth and intensity of your experience. You may discover that certain angles or shallower depths feel wonderful. That knowledge will be a wellspring of relief.
Sometimes though, penetrative acts need a helping hand. If you’re struggling with penetration, but want to explore making it work for you again, a sexual aid like wearable rings are a must. These stackable rings fit perfectly around the base of any shaft (from your vibrator to your beau’s own member) and act as a buffer that keeps them from going too deep. Perfect for partnered play and solo play alike, these rings are a great way to rediscover pleasure.
When inserting a single finger or tampon hurts, your pelvic floor specialist may recommend investing in a dilator set. Used for reintroducing penetration for those of us with pelvic pain as well as those of us who have had vaginoplasty, a dilator set has insertables with increasing thickness. The main purpose? Getting folks accustomed to penetrative experiences. But go slower than you think in introducing the next size up; talk to your pelvic therapist about using dilators, or join a subreddit to engage in a virtual community of folks who share your experience.
Experiment with Different Positions
Partnered play doesn’t have to be over when penetration hurts. Any lover worth having will be down to experiment to find what works best for you. Although some penetrative acts may be uncomfortable for you, there’s a possibility that others feel good. The only way to find out is through careful trial and error.
For some people, certain angles hurt less (or don’t hurt at all). To see which ones feel best for you, start out in a position that you can control, like being on top. That way, you’re in charge of how deep their dildo or penis goes, and you can lean forward or back to find the right angle for your deepest pleasure. If and when being on top tires you out, explore missionary poses and sideways poses, both facing your partner and with your back to them. These positions don’t invite as much depth and are usually slower-paced – great for tentative exploration.
Talk to Your Partners
Contrary to what outsiders may think, painful penetration doesn’t have to mean your sex drive disappears. The existence of pain doesn’t have to negate a libido. A fulfilling sex life and painful penetration can go hand in hand. It starts with a conversation.
With a new partner, cushion this chat somewhere between the STD talk (when your clothes are still on), and the part where you’re both panting and naked. As you make out or head to the bedroom, bring up this reality of yours. Your best bet is to share with confidence. Instead of worrying about it being unsexy, be frank, and say it in a way that makes it clear you’re not looking for a pity party. Tell your partner about your pain, and what you need for a pain-free but satisfying encounter for both of you.
This conversation is also the right time to bring up anything that will help your satisfaction, including rings, lubrication, or vibrators. Don’t hesitate to share exactly what it is that drives you wild in the sack. Clitoral stimulation, anal, breath play, some lengthy sixty-nine, shallow penetration, impact play… the list of pleasure available without any penetration or without deep penetration go on and on. Through this litany of things that work well for you, the folks you’re getting down with will start salivating at the endless opportunities for pleasure that the night has in store.
Painful Penetration Doesn’t Have To Be the End
It may feel like a death knell to your sexuality, but think of painful penetration as just a hurdle – not an unscalable wall. Through slow practice, conscious discussions, and the gumption to find healthcare that actually serves you, the road to a vibrant sex life is waiting for you.
Have you experienced dyspareunia? I’d love to hear what has helped you reclaim your pleasure in the comments below!