Advice for dealing with painful sex (penetration)

April 18, 2016 2:52 PM

I'm in my mid-late thirties, a woman dating men, and penetrative sex has always been painful or uncomfortable to varying degrees. What are some ways I can deal with this?

It's not an issue of lubrication. I don't have any medical issues according to my gyn check-up. Certain positions, like doggie-style, are more painful, while missionary seems less-so or not painful at all, sometimes. Once the penis is inside, there can be less pain (some pain on entering). Although, with doggie-style the pain in there when the penis is inside- feels like it is hitting/rubbing against something?

I am not sure if this is psychological or physiological. I don't have any medical issues that I know of, but maybe there is something about my physiology causing this? Maybe I have psychological barriers up? I have done some reading on vaginismus. I am in therapy, and plan to bring this up.

I'm dating casually now, and would like to have sex without worry. I know this is something I need to talk to partners about, and have us go slow. For my age, I don't have a ton of dating experience (esp. long-term relationships), but I have dated a fair number of men generally.

Any advice/experience on what the issue might be, how I find out, and how I deal with it would be helpful! I have done, and plan to do research, but it is always helpful to read direct experiences on AskMe. And links or articles etc. that would be helpful are definitely welcome as well.

posted by anonymous to Health & Fitness (17 answers total)

Did your gynecologist check for uterine fibroids? I didn't know I had them until they started causing me to bleed heavily in my 30s, but intercourse was always somewhat painful.
posted by Young Kullervo at 2:59 PM on April 18, 2016

What about vulvodynia? My friend has had it for years and it comes and goes with no explanation. Might be worth asking your gynecologist about if they haven't brought it up.

feels like it is hitting/rubbing against something?

Have you found any correlation between the pain and how turned on/comfortable you are? I sometimes get this kind of pain when I'm not fully turned on so my cervix isn't extended fully to make room for the penis.
posted by monologish at 3:05 PM on April 18, 2016

I am not sure what your specific issue could be, but any time I've had this problem it was one of two things:
Realizing I'm not actually attracted to my partner, not necessarily physically, but that I just wasn't "into" them as I thought. I am able to have casual sex but need at least a degree of rapport or connection of some kind, not necessarily emotional but knowing that we have a good energy exchange. The second was lack of good lubrication due to stress, fatigue or just no reason at all. How is your general health? Do you suffer from any depression/anxiety, even if mild?
posted by a knot unknown at 3:08 PM on April 18, 2016

Did you specifically mention this problem to your GYN? You should, if not.

Also, do you experience any pain during pelvic exams?

Bottom line, there are things that could cause you to feel pain that wouldn't otherwise come up in a standard well-woman exam. If this is a serious problem that has an impact on your sex life, you should talk to your doctor about it even if nothing specifically presents at your appointment.

I agree that this sounds a little like vulvodynia, but I'm not a medical professional at all.

I'd also add, as a non-medical bit of advice, that some positions just aren't comfortable for me, or can't be achieved comfortably with my partner, and that's OK. Maybe you just don't like doggy-style? Perfectly OK to tell partners that.
posted by Sara C. at 3:10 PM on April 18, 2016 [1 favorite]

A really great book on women's sex and sexuality is Come As You Are. If you think that there might be a psychological component then this book has some really good insight into the mind-body connection of women's sexuality in a way that is informative and accepting of the wide variation in what we bring to the bedroom -both physically and emotionally.
posted by metahawk at 3:46 PM on April 18, 2016 [3 favorites]

In addition to reading about vagimisnus, I would also start reading about vulvodynia (sometimes more precisely called provoked vestibulodynia or PVD). Actually at some point I found a list of all whole bunch of types of dyspareunia that I read all of until I found one that sounded like my experience. The diagnosis method for vulvodynia is basically the doctor touches your vulva with a q-tip, you scream, and they conclude you have pain there.

You can find therapists who specialize in sex issues which may be helpful. One of the best things I've done is see a pelvic floor physical therapist; it may be worth getting a referral to see someone like that to see if they can find any muscle issues they could help with. Mindfulness meditation is another thing I have sometimes found helpful.

Further questions you may want to think about and discuss with your doctor: Do you have pain with bike or horse riding? Tight pants? Tampons or pads? Oral sex? Urination or bowel movements? Any problems with frequent yeast infections?

There are more comments about vulvodynia in my history plus feel free to memail me if you'd like talk more.
posted by carolr at 3:48 PM on April 18, 2016 [1 favorite]

Nthing all the comments re: getting checked out for a pelvic pain condition like vulvodynia and vaginismus.

Has your health care provider ever mentioned that you have a retroverted, or tipped uterus? It's pretty common, and something that can make most positions where you're facing away from your partner somewhat uncomfortable.
posted by blerghamot at 3:54 PM on April 18, 2016 [6 favorites]

I highly recommend you look into pelvic floor pain... There are physical therapists for women who specialize in pain during intercourse that is not "medical". They do stretching and can do biofeedback to track the tension of your pelvic floor muscles. And dilator work. I thought mine was purely my cervix or uterus or something because it felt like that hitting against something you describe, but that sensation can be caused by pelvic floor issues. And I recommend you look into it now before it becomes a psychological "intercourse=pain" thing. Wish I had sooner. Good luck!!
posted by chela at 5:07 PM on April 18, 2016 [2 favorites]

Speaking from personal experience: pelvic floor physical therapy! Find a new gynecologist if yours has never heard of it, or thinks it's only for women with incontinence.
posted by stowaway at 5:10 PM on April 18, 2016

Do you tear in the perineal area?
posted by Knowyournuts at 5:18 PM on April 18, 2016

One thing to try in addition to the great recs above: various sizes of insertables when you are solo, turned on, totally relaxed, and taking your time. This will at least give you more info as to when/in which positions this occurs, and could give you more info on what, if any, mental state reduces pain.

Good luck to you; you are not alone, and you deserve the sex life you want.
posted by kapers at 5:53 PM on April 18, 2016

From an anonymous Mefite:

Once the penis is inside, there can be less pain (some pain on entering). Although, with doggie-style the pain in there when the penis is inside- feels like it is hitting/rubbing against something?

Could that something be your pelvic floor muscles, tensing/seizing up? That might be vaginismus. It's not always obvious when your pelvic floor muscles are tense. Have you tried exploring that area with your fingers?

I am in treatment for vaginismus, and these are a few things that have helped:

· The vaginismus.com dilator kit.
· Heal Pelvic Pain (most useful parts: using dilators or a dildo to massage and stretch pelvic floor muscles, and squats to stretch the pelvic floor).
· Seconding Come As You are, it's a great book, even if it's not directly related to vaginismus.
· A sex therapist and an ob-gyn with experience in vaginismus (referred by my therapist).

As chela mentions, it's better to have control over this problem before your mind starts connecting penetration with pain. Vaginismus —if that indeed is the problem— is highly curable, it just needs a bit of work. You can have penetrative sex, so you're miles ahead of most people!

posted by LobsterMitten at 5:56 PM on April 18, 2016 [2 favorites]

Seconding kapers: have you tried using a small insertable toy (with plenty of lube) when on your own? Something like the small size of the Silk (link not wild, but not really safe for work). It's not quite as thick as a thumb, so not intimidating-looking. If you're lucky, in addition to helping you better understand what's causing you pain, if you're lucky, it might also help you separate penetration from pain in your mind, which can only help.
posted by praemunire at 6:54 PM on April 18, 2016

I sympathise. I'm pretty sure mine's related to chronic yeast infections, and both are linked to hormone levels. I'm on my...third? Round of month-long low-dose diflucan with a mild hydrocortisone cream (not antifungal cream). I'm getting there. Long term, am also pondering HBC to regulate things as the yeast infections and whatnot are the tip of my iceberg of annoyances. I have atypical PCOS and likely endometriosis.

I will nth that psychologically associating pain with sex has messed with my libido.

One book I've found helpful is Ending Female Pain by Isa Herrera. I saw a pelvic floor PT for awhile after the birth of my child which didn't hurt.
posted by jrobin276 at 7:30 PM on April 18, 2016

I found A Woman's Guide to Overcoming Sexual Fear and Pain really helpful for my situation, becuase everything I read online seemed vague enough that I might have had all of the possible conditions, not just the 2 I actually had! It gives you things to try at home to help you narrow down the source of the problem, by teaching you how to rule out some and performing basic checks for others. Then it tells you which sort of professional advice you need, if any (GP, reproductive health specialist, physiologist, psychiatrist, etc), and strategies to fix things. I've linked the 1997 version that I used successfully a few years ago, but apparently there is an updated 2015 version out there somewhere. Even if you can only find the original I still think it will help you (or anyone else with a similar problem).
posted by harriet vane at 1:53 AM on April 19, 2016 [1 favorite]

It does sound a little bit like you are going for penetration before you are actually properly aroused, particularly if things improve after a few minutes when you have warmed up a bit. Your partner could help by extending foreplay a bit longer, and if he is trying to jump straight into PIV without any foreplay (as many guys do) then that is your problem right there.

The "hitting something" sensation sounds like he's hitting your cervix. You may have a retroverted uterus, or just a combination of short vaginal vault and/or large partner. Ways of avoiding the pain, aside from "being more aroused first", include dropping one or both shoulders so you are in more of an extended puppy yoga pose, as opposed to table top pose (using yoga descriptions to remain safe for work). You can also try rotating your upper body a bit (obviously without the arms in the air). Twist your cervix out of the way, basically.
posted by tinkletown at 3:43 AM on April 19, 2016

Ooh, I'm so sorry. I know how frustrating this can be. If it's not due to lack of arousal, you might have a tipped uterus. Try using a curved toy the *opposite* way you normally would (ie tipped down towards your spine instead of curving up towards your g-spot). If that feels better, your uterus is almost certainly tipped.

Also, if there is a lot of pain on entering, your hymen may not be fully gone. If it was thick to start with, or your first few partners were not that big, there might be bits still attached which are tearing a during penetration and healing after. It's not super common but it does happen. There are, um, ways to address this on your own, if you take my meaning.

Focus on the positions most comfortable for you, there is nothing wrong with that! And be patient with yourself -- healing the psychological trauma of painful sex takes a while. You may find yourself unconsciously tensing (which will make it hurt! gah!) even after you have figured out what's going on and addressed it.
posted by ananci at 2:44 PM on April 19, 2016