unhappy couple in bed, husband looking at porn

Many women suffer pain that ruins sex. But few mention it, so few men know. Ask! Italian researchers asked 1,034 women aged 18 to 40 if they experienced pain during partner lovemaking. One-third (31 percent) said they did. The researchers asked how sexual pain affected them. Compared with women free of sex-related pain, they reported:

  • More sexual distress.
  • More anxiety.
  • Poorer sexual function. Poorer mental health.
  • Less sexual desire.
  • Greater aversion lovemaking.
  • Less sexual satisfaction.
  • More psychological negativity.
  • And poorer quality of life.

In other words, women’s sexual pain becomes its own little circle of Hell. 

What proportion of women experiences sexual pain? Estimates vary widely. An English study of 6,669 women suggests 8 percent. But the American College of Gynecology estimates that at some point as many as 75 percent of women experience sexual pain. One thing is certain—women’s sexual pain is by no means rare, especially pain during intercourse.

Most Women Stay Mum

Gentlemen, have any women ever mentioned sex-related pain? Probably not. A study by an international team of researchers shows why. Sexual martyrdom. Most women believe sex is more for men’s pleasure than theirs.

That study involved 382 adult women who’d reported sex-linked pain during the previous year. The researchers asked:

  • How painful was it?
  • Did you tell your partner?
  • If not, why not?

Only half (51 percent) ever mentioned it.

The women were most likely to speak up if their pain was severe, but 82 percent said theirs was “only” mild-to-moderate. However, even mild pain significantly interfered with the women’s erotic pleasure. Their silence cost them, but they grew up believing that sex “should” hurt, and that erotic pleasure is for men, not them.

Many Potential Causes and Treatments

Some women believe extra-large erections cause pain. Possibly, very few men are significantly larger than average. In addition, the vagina is elastic. During delivery of babies, it expands to way larger than any erection.

Pain is a complex, individual, mind-body experience, but sexual pain is usually caused by:

Birth control pills. Andrew Goldstein, M.D., editor of Female Sexual Pain Disorders, says, “Birth control pills are a leading cause of women’s sexual pain.” The Pill increases release of compounds that may cause pain. If you experience sexual pain and take the Pill, consider switching to another contraceptive. After quitting birth control pills, it may take months for pain to subside.

Men rushing intercourse. In pornography, boy meets girl and moments later, they’re having intercourse. Porn is fantasy, and in fantasy, that’s fine. But in real life, rushed intercourse hurts many women. Rushing intercourse denies vaginas—and the women they’re attached to—the warm up time they need to relax, become aroused, and feel receptive.

In addition, in porn, many men subject women to jackhammer intercourse. Big mistake. Unless she specifically requests rough play, always treat women gently. Don’t move any faster than half-speed. 

The occasional quickie is fine, but the most comfortable sex is slow sex— leisurely, playful lovemaking that begins with at least 20 minutes of tender, mutual whole-body caressing before the focus shifts to the genitals. 

Lack of lubrication. Even with extended caressing, poorly lubricated intercourse is a major cause of women’s sexual pain. Many perfectly normal women, young and old, don’t produce much natural lubrication. Never insert anything into a vagina that feels dry. When in doubt, apply saliva by hand or cunnilingus, and/or use a commercial lube.

Men inserting too deeply. If you’re the rare guy with an unusually long erection,it may hurt women in any position. But rear-entry (doggie style) is the most problematic. Extra-long penises may bang into the cervix (the mouth of the uterus) causing pain. Gentleman: For pain-free doggie, remain still and invite your lover to back onto your erection. Ask her to tell you her comfortable insertion limit. Never push in any deeper. 

Relationship turmoil. When couples fight and resentments fester, women may experience sexual pain. Consider couple counseling or sex therapy. For the latter, visit the American Association of Sex Educators, Counselors, and Therapists.

Gynecological issues. The bad news: Several medical conditions cause sexual pain. The good: Almost all women’s sexual pain can be cured or at least minimized.

Ladies, if you suffer pain, consult your primary care physician or gynecologist. If their advice doesn’t relieve it, contact a sexual medicine specialist through the North America Society for Sexual Medicine. http://www.sexhealthmatters.org/resources/find-a-provider

Gentlemen, accompany your partner to the doctor. Your emotional support enhances your relationship, and the physician may be able to explain things better than your partner can.

Imperforate hymen. At birth, a thin membrane, the hymen, partially covers girls’ vaginas. It usually wears away during childhood, but in some women, residual hymen tissue may cause pain. 

• Vaginismus. This condition involves muscle spasms that constrict the vaginal opening or clamp it shut, making any insertions painful or impossible. Vaginismus affects around 10 percent of women.

Sexual infections. Chlamydia, genital warts, and pelvic inflammatory disease may cause pain on intercourse. 

• Other vaginal infections. Vaginal yeast infection or bacterial infection (vaginosis) may cause sexual pain. 

Menopause. After 40, vaginal dryness and tissue thinning (atrophy) become increasingly prevalent. They may make intercourse uncomfortable or painful, even with lubrication.

• Vulvar skin conditions. Women’s genitals may become irritated by douching, pubic shaving, latex allergy from barrier contraceptives, or contact dermatitis from perfumed soaps, bubble baths, feminine-hygiene products, or underwear made from synthetic fabrics. Wear cotton underwear. Don’t douche. Avoid perfumed soaps and bath items. Get evaluated for latex allergy. If you shave your pubic hair, consider regrowing some or all of it.

• Vulvar vestibulitis (VV). This condition involves inflammation of the tiny vestibular glands just inside the vagina. Q-tip pressure causes sharp pain. 

Oxalate irritation. Oxalates are compounds found in: spinach, almonds, cashews, beets, chocolate, and other foods. Women sensitive to oxalates may develop sexual pain. 

Other medical conditions. Pain might result from: uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome, gynecological cancers, and several other conditions. 

Gentlemen, Ask!

Ideally, couples should discuss all aspects of their lovemaking, including any pain. But in reality, few women mention it, so few men know. 

Gentlemen, before things heat up, say: “I want you to enjoy sex with me. If you feel any discomfort, say so immediately.” 

For more on women’s sexual pain, see the chapter on it in my book Sizzling Sex for Life.

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