Why is Sex Painful? The Female Perspective
Learn why sex is painful for women and what you can do about it.
The last thing anyone wants is pain interrupting their relationships, intimacy, and sexuality. And yet a reported 10-20% of women in the United States experience painful sex (Sorensen et al. 2018). Moreover, I have encountered countless female patients with painful sex who gained the courage to tell their healthcare provider and were told to have a glass of wine and “just relax”. I am here to tell you that most of the time this is not the answer.
The medical term for painful sex is dyspareunia. This pain can be with touch to the vulva (the external genitalia in females), pain with initial insertion, and/or pain with deep penetration. There are actual, medical and scientific causes of these symptoms. You can experience these symptoms with or without any history of sexual trauma/abuse (contrary to popular belief). You can have painful sex at your first sexual encounter or after consectutive, pain-free experiences.
Diagnoses associated with female dyspareunia include:
- Vulvodynia and vestibulodynia
- Interstitial cystitis
- Pelvic floor myalgia
- Pudendal neuralgia
- Vulvar dermatoses (i.e. lichen sclerosus)
The causes of painful sex in females can be from hormonal changes/deficiencies, muscle dysfunction, nerve dysfunction, scar tissue and adhesions, inflammation, or infection.
In a gynecological pelvic exam, the doctor’s goal is to assess the pelvic organs for signs of disease, infection, and cancer. These are routine health screenings to improve female quality of life and longevity. However, medical doctors are not trained to regularly assess the pelvic floor muscles and nerves.
This means that your medical doctor is regularly screening inflammatory and infectious causes of painful sex. A pelvic floor physical therapist is regularly screening dysfunctions in muscles, nerves, and scar tissue as causes of painful sex. PTs are also trained to evaluate signs of hormone deficiencies and know when to refer you back to your doctor or to a healthcare provider who can evaluate your hormones in greater detail. I recommend that if you have talked to your doctor and are still struggling to find answers to your pain, seek care from a pelvic floor physical therapist.
Sorensen, J. et al. (2018). Evaluation and treatment of female sexual pain: a clinical review. Cureus. 10(3): e2379.