by Katy Thorn, originally published by Lelo.com

While not something that many women feel comfortable discussing, according to Psychology Today,  some 20%of American women—15 percent before menopausal, 33 percent after—will experience painful penetrative sex at some point during their lives. Unfortunately, the silence surrounding this, and indeed female sexual pleasure, can cause many to believe this is normal, or that they’re ‘broken.’

The best way to diagnose the cause of painful sex,of course, a visit to a gynecologist. As much as we may be tempted to self-diagnose with a visit from WebMD, it’s always best to get a professional opinion – trust us when we say your sexual well being is worth it! Often the solution is simple and effective, but involves a round of medication or a change in diet or lifestyle that are better left to the discretion of a medical doctor.

But if you’re freaking out  and assuming the worst, check out our list of some of the most common causes of painful intercourse – then go see your doc!

Sexual Positioning & Lubrication

Sometimes uncomfortable sex is simply an issue of positioning. It can be that mobility issues make some positions painful without adjustments like pillows, or you may find that some simply don’t suit your anatomy.  Some people are born with a tilted cervix, which make deep thrusting uncomfortable. This can be helped by making sure you get in an adequate amount of foreplay – we’re talking 20 minutes plus – which helps the entire uterus lift. This is actually a helpful tip for everyone with a vagina, as right after your period and immediately following ovulation, the sensitive cervix will harden and hang lower inside the vagina, making it more susceptible to being bumped during penetration.

However, if something feels not-quite-right even after you’re warmed up and well-lubricated, try a sex position that allows for more control over penetrative depth, such as receiver-on-top.

Speaking of lubrication, inadequate lubrication is definitely a common cause of sexual discomfort. Your vagina, when aroused, is built to make sure penises can enter it comfortably. This includes all the fun feelings we associate genital contact with, as well as physiological prep such as the expanding of the vagina (up to 200%!) and its lubrication.

If you’re not getting ‘wet’ enough during sex, there are a few possible causes, some which aren’t very serious at all. At the end of the day, if you’re otherwise healthy, there is no reason why not to incorporate a good body-safe lube into both your partnered and solo play.

STIs

STIs, or sexually transmitted infections, are generally spread through contact with another person’s genitals or sexual bodily fluids, but this doesn’t mean you’re in the clear if you avoid a partner’s penis or vagina or by strictly using condoms.

Some STIs, like herpes or gonorrhea, can be spread from mouth-to-genital contact, or from your partner touching their genitals with their hands and then touching you. STIs contribute to painful sex by irritating the tissue inside the vagina and around the vulva.

A prescription of pills coupled with a topical cream are usually enough to clear up infections, but it’s important to use barrier protection like condoms, dental dams and gloves with new partners AND get yourself tested regularly.

Even with perfect use (that includes during oral sex) it is recommended that you get checked for STIs every 6 months.

Vaginal Infections

If you’ve dealt with excess yeast or unwanted bacteria before, you know the painful affect it can have on  your sex life, and the same goes for urinary tract infections.  Bacterial Vaginosis, yeast infections, and UTIs will all disrupt the sensitive balance of good bacteria and pH levels within your body, leading to uncomfortable itching and burning sensations.

The achy or itchy tissue are telling your brain that something isn’t right, and you shouldn’t ignore even if you think it’s ‘just’ a UTI. Similar to STIs, a visit to a health professional and a prescription are usually enough to kick the itching and pain within a couple weeks – during which you should avoid sex.

Vaginismus

Sometimes sexual pain isn’t as easy to diagnose, and if you have otherwise gotten a clean bill of sexual health from your doctor, it’s possible that you suffer from vaginismus. Vaginismus means that during any type of penetration, ranging from tampon insertion to sexual intercourse, your vaginal muscles tightly contract, causing intense pain and a tearing sensation.

The potential causes are broad, and can be the result of sexual trauma, life changes such as childbirth or menopause, or even intense fear or anxiety about sex. It’s usually a combination of both mental and physical factors together that cause vaginismus to occur, which is why it is so little understood and often hard to diagnose. However, if you do suffer from vaginismus, a combination of counseling or sex therapy in conjunction with kegel exercises and vaginal dilators can help you reclaim your sex life.

Let’s be specific here. What exactly are vaginismus and anorgasmia? You may have not heard these terms, or at least, may not have the whole truth about them, but they may affect more people than you think. We are pleased to have renowned Spanish sexologist, Valérie Tasso offer both her simple and non-judgmental definitions and advice for dealing with these misunderstood sexual dysfunctions.

What is Vaginismus?

A relatively rare sexual disorder, vaginismus involves involuntary spasm of vaginal muscles that make penetration painful and/or impossible. (It is worth noting that someone suffering from vaginismus  may not have issue reading orgasm, and can enjoy other sexual touch such as oral sex.)

Primary vaginismus is when one has never been able to be penetrated (not exclusively by penises, either) and secondary vaginismus is when this discomfort develops later – from infection, surgery, childbirth, or psychological causes. While these psychological causes can vary, they often stem from fears or anxieties caused by cultural taboos and/or poor sexual education.

What is Anorgasmia?

Anorgasmia is simply the inability to reach the climax. It does not reflect inability to have sexual arousal or enjoyment, and is actually fairly common.

There are technically 5 types of anorgasmia:

• Primary Anorgasmia – When you have never had an orgasm (think, the movie Shortbus)
• Secondary Anorgasmia  – You have stopped being able to have orgasms.
• Situational Anorgasmia – If you can only reach orgasm under certain conditions (for example, only in your own bed, in a  particular position, only with complete silence, only with your favorite song playing, etc
• Relative Anorgasmia -When orgasm is only is reached from a particular stype of stimulation (for example, manual stimulation)
• Absolute Anorgasmia –  When there is no apparent method or circumstance in which orgasm can be achieved.

What to do if You Suffer

Vaginismus

Vaginismus, contrary to what many women may believe, is one of the sexual difficulties that best responds to sex therapy. Basically, this consists of the progressive adaptation of the muscles of the vagina, under the supervision of the therapist, and through dildosof different thicknesses.

It’s important to re-emphasize, that while the term ‘penetration’ is used, this therapy isn’t exclusively for those want to be able to have penetrative, penis in vagina sex. This involuntary impulse is exerted by the vaginal muscles, which, by the way, are very powerful and can prevent, for example, a routine gynecological inspection or the use of tampons and menstrual cups.

Discovering the causes for vaginismus to manifest is not, for us sexologists, a motive of the highest priority – though traditional therapy may also be useful –  because clinical experience shows us that body is very capable of “learning” that the introduction of something in the vagina is not unequivocally synonymous with aggression. That is why  progressive and slow adaptation, without major demands to that circumstance that in principle rejects, usually gives optimal and rapid results in the treatment of this sexual difficulty.

Anorgasmia

In relation to anorgasmia, one thing is quite clear: the difficulty that a sexually mature woman may have in reaching orgasm almost never derives from a physiological cause – though  some medication may make arousal and orgasm difficult – rather, it usually occurs from not having managed to allow your body to react naturally to the arrival of orgasm.

This is something that many people – especially male partners, may have a hard time understanding –  that women must learn to allow herself an orgasm. For many women, and unlike most men, orgasm is not something that is “given” when they reach a relative or total sexual maturity. It is not something that happens spontaneously but is something that, in the process of shaping your sexuality, learns (or does not) to allow it to happen. This is due, no doubt, to cultural factors, but also physiological, because the machinery of female enjoyment is extraordinarily more complex.

Knowing this, when we are in consultation with patients experiencing problems of anorgasmia, the first thing that we must evaluate is the type of anorgasmia that our patient presents and to evaluate its profile briefly. Those with a great need for control (do not forget that the orgasm is a brief but great “uncontrol” of existential order) or women with very anxious temperaments (the first orgasm always requires an infinite patience and tranquility) or are often behind this sexual difficulty.

Once we have framed what produces the blockage and the frequency with which it occurs, it is only “accompanying” the patient in the process of opening, of permissibility, to the experience of orgasm.

Sex toys , especially those intended for the progressive stimulation of the clitoris, are our best external allies in the treatment of these difficulties. But, the best way to get an orgasm is to not worry about having it, and to stop self-observing with negative thoughts around one’s own sexuality and one’s own body (what Masters and Johnson called “spectatoring” – watching oneself “from a third person perspective during sexual activity, rather than focusing on one’s sensations and/or sexual partner, can increase performance fears and cause deleterious effects on sexual performance.”

In both cases, and we know it’s easier said than done, you have to de- dramatize these sexual difficulties, and don’t discount the value of visiting a sexologist or sexual therapist. The vast majority of people who suffer from vaginismus and/or anorgasmia tend to think that they can never have a “normal” sex life (what is normality in matters of sexuality? Perhaps, that thought is also part of ” self-sabotage “of the patient, unconsciously).

We tend to give too much solemnity to sexual problems. Removing the idea that either of these conditions are the end of the world from your mind is  already a first great step  that makes you more receptive to therapy, and closer to a solution.

Final Thoughts

Sex, with the exception of certain (and always consensual) BDSM practices, should never be painful, and if your partner is experiencing discomfort, it’s important to stop and get to the root of the cause, adjusting your sexual practices as necessary.