Painful penetration, a topic often shrouded in silence and discomfort, is a reality experienced by many individuals. Beyond the physical discomfort, it can cast shadows on emotional well-being and intimate relationships. In this blog, we embark on a journey to unravel the intricate layers of painful intercourse, delving into the underlying reasons that contribute to this often overlooked but significant aspect of sexual health. By shedding light on the root causes, we aim to provide insights, understanding, and guidance for those navigating the complexities of painful penetration. Join us as we navigate this sensitive terrain, offering a compassionate exploration of the factors that can impact intimate moments and ways to foster a more fulfilling and pain-free experience.

What is Dyspareunia?

 

According to the National Library of Medicine, dyspareunia is defined as “genital pain that can be experienced before, during, or after intercourse.” There are two primary forms of dyspareunia: superficial and deep. Superficial dyspareunia is when pain and discomfort are restricted at the vaginal opening. This can look like pain when inserting a tampon, pain when placing pressure on the opening, and during insertion. Deep dyspareunia can be recognized as pain and discomfort deeper in the vaginal canal. This can look like experiencing pain-free oral sex or digital stimulation but experiencing pain when being penetrated by a dildo or penis as it feels closer to the cervix.

 

Affecting up to 45% of people with vulvas, in the absence of treatment, whether it be therapy or medical intervention, can result in low self-esteem, sexual aversions, fear of sex, anxiety, and depression. Now, this makes sense when you think about how connected our lives are to sex and the performance of sex.

Sources of Painful Penetration

 

Not every case of painful penetration is due to dyspareunia as there are multiple other sources; inadequate arousal, insufficient lubrication, trauma, vaginismus, and pelvic inflammatory disease are what we will cover. 

 

Insufficient arousal can result in painful penetration because, in the absence of adequate arousal to the vulva and vaginal canal, the muscles are more tense, there is less lubrication which means friction is more likely to occur. The walls of the vaginal canal aren’t as relaxed and prepared to be penetrated. As just touched on, insufficient lubrication can be another source of painful penetration as the friction at the vaginal opening and within the canal can be uncomfortable and painful. For both these experiences, it would be encouraged to explore the potential causes with a sex therapist and explore possible solutions that align with your sexual needs. 

 

Is it not uncommon for survivors of sexual trauma to experience painful penetration? This can be for a multitude of reasons, like the body being physically harmed from the trauma, sexual aversions, and the long-term impact of unresolved trauma on the autonomic nervous system. The latter can look like the vaginal canal tensing in anticipation of penetration or sexual intimacy, even if consciously the individual wants to participate. However, even if someone wants to participate in sex, the mind and body may still have symptoms and things that may need unpacking. Further, suppose there is a trigger or re-traumatization, whether it be a boundary violation, a specific sexual act, sex in its entirety, an emotion, etc.. In that case, it can call the body to shut down in anticipation. 

 

Overlapped with sexual trauma, vaginismus is an automatic reaction to fear of some or all types of vaginal penetration. This can look like tensing up when inserting a tampon, digital penetration, and penetration with a dildo or penis or various sizes. Trauma survivors or people who have had harmful or negatively impactful experiences with sex or penetration, when presented with a situation to experience penetration can experience a tensing of their body and then painful penetration. 

 

Lastly, pelvic inflammatory disease is an infection of the female reproductive organs that is usually sexually transmitted. Some common symptoms are pain in the lower abdomen and pelvis, heavy discharge, unusual bleeding, and pain during penetration. PID can put people at an increased risk of ectopic pregnancy, infertility, chronic pain and more. Ongoing inflammation of the pelvis and possible scarring of the sex organs are reasons for experiencing pain. If you or your partner has PID, consulting with both a medical professional and a sex therapist can aid in navigating treatment.

How can a sex therapist help?

 

Working with a certified sex therapist can help you explore the potential sources of your painful penetration and help search for solutions. Do you need to keep a bottle of lubricant by the bed? Maybe it’s time to create and hold space for your pleasure and what that looks like to you. What if societal impacts are showing up in your sex life? What if there are religious messages? The list of what can be explored, unpacked, and potentially resolved when exploring painful penetration is endless. It might be valuable to consider if couples therapy is the right fit versus individual therapy. In couples therapy, you and your partner can explore the pain and discomfort together and collaborate in search of solutions.

 

Meet the Author

Hi! My name is Hunter, I am an LMFT-C and Certified Sex Therapist with an emphasis on sexual education, kink/BDSM, trauma, ethical nonmonogamy, and more! As a therapist at Respark, we work very hard to bring sex-positive care both in and out of session. Happy reading!

 

References:

Dyspareunia – StatPearls – NCBI Bookshelf, www.ncbi.nlm.nih.gov/books/NBK562159/. Accessed 14 Dec. 2023. 

NHS Choices, NHS, www.nhs.uk/conditions/vaginismus/. Accessed 14 Dec. 2023. 

“Pelvic Inflammatory Disease (PID).” Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594#. Accessed 14 Dec. 2023. 

Reed, Susan D. “Dyspareunia-Where and Why the Pain?” Menopause (New York, N.Y.), U.S. National Library of Medicine, 1 June 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC9191839/#:~:text=Dyspareunia%20is%20specifically%20defined%20as,from%208%25–45%25.