Painful Sex: STD or Something Worse?

Perhaps, pain during sex isn’t new to you. Recently a chat with one of your girlfriends made you realize, wait, sex isn’t painful for everyone always? Or like, ever? Maybe you noticed in the movies when they make it seem like this sensual, montage of glorious sensations and there’s no better way to bond with your partner than sex. Or, you’re just new to this unpleasant sensation. So, what the heck’s up with the painful sex?

Pain or discomfort in a woman’s labial, vaginal, or pelvic areas during or immediately following sexual intercourse is clinically named “dyspareunia.” Which, according to the Oxford dictionary, this is a 19th-century Greek word where dys- means “difficult,” and pareunos means “lying with.” 

Usually, this condition isn’t considered an emergency. The concern should arise if the pain increases in severity, the symptoms last longer than a few minutes, bleeding or vomiting follows the pain, or if rectal pain (even if you didn’t do anal) also follows intercourse.

It is fairly common for women to feel pain when having sex for the first time. The most common first-timer symptom is pain upon entry or intromission. However, if painful sex continues after the first couple of encounters, it could be dyspareunia. The symptoms range from deep pain, muscle spasms, pelvic cramping, or muscle tightness.

There are three general terms to describe dyspareunia: Primary, secondary, and psychological.

Primary, or complete dyspareunia, is when the pain has existed for the woman’s entire sexual lifetime. It is also when the pain lasts throughout sexual intercourse and is noticeable at the start or at a shallow level of penetration.

Secondary, or situational dyspareunia, develops seemingly out of the blue. When sex once was a pleasing, intimate activity, it is now bringing uncomfortable or even painful sensations. “Deep thrust” pain is when the pain originates in the cervix, or the lower abdominal area, and is noticeable during or after penetration. It is usually described to feel like the partner is “bumping” into something which causes pain with pelvic thrusting. This could indicate irregularities of the pelvic organs, such as endometriosis, adhesions, or uterine prolapse.

Psychological dyspareunia is when intercourse is painful without any physically identifiable cause. This can occur at any point during sex, including before.

What causes painful sex?

There are a variety of reasons why sex may be causing a woman pain or discomfort. The culprit could range from untreated sexually transmitted diseases, vaginal dryness,  effects of undiagnosed diseases, and emotional/lifestyle conflicts such as belief systems that cause emotional guilt or anxiety.

STDs that result in painful sex:

Genital warts, gonorrhea, chlamydia, herpes, trich, and syphilis are infectious diseases that can spread through not only sex but also skin-to-skin contact. At first, these STDs may have no symptoms, which often leaves them undetected and the person ignorant of the disease worsening. If left untreated for long enough, STDs may cause changes in the genitals that make sex uncomfortable or even painful.

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Genital warts are common and result from certain types of HPV. Genital warts produce skin-colored or whitish bumps that show up on a woman’s vulva, vagina, cervix, or anus. They aren’t dangerous but can be itchy. Aside from the fact that having sex could put your partner at risk of also developing an STD, sex may irritate the warts and cause you some discomfort. Apart from that, they usually aren’t painful but aren’t pretty to look at.

Gonorrhea (the clap) is a bacterial disease. Symptoms may include discomfort when peeing, painful bowel movements, yellow or bloody discharge, spotting between periods, and pain during sex. Painful intercourse can indicate that untreated gonorrhea has, unfortunately, progressed into Pelvic Inflammatory Disease (PID). With the help of antibiotics, gonorrhea can be cured. It is important to note, if left untreated for too long, gonorrhea can cause infertility and/or miscarriages.

Chlamydia is another bacterial STD like gonorrhea. If left untreated, it can seriously damage a woman’s reproductive organs. It may not only cause infertility but as well as damage to the eyes, throat, and lungs. It may spread from the cervix to the fallopian tubes. This can cause pain or bleeding during sex, spotting between periods, nausea or fever, abdominal and lower back pain, or a heavy feeling in the hips.

Herpes can develop sores on the vulva and inside the vagina that look like cold sores. They can be excruciating and sting when urinating. Since it can also affect the cervix (lower part of the womb), it can cause cervicitis if the ulcers get infected. This results in pain during sex, unusual vaginal discharge, or abnormal bleeding.

Trichomoniasis (trich) most commonly infects the lower genital tract of women (vulva, vagina, cervix, or urethra). Trich can cause itching, burning, redness, or soreness of the genitals, thus making sex pretty unpleasant.

Other biologically related causes:

• • Vaginal dryness can result from a lack of stimulation. This is the most common factor that makes sex painful for the woman involved. Vaginal dryness can also happen due to perimenopause, hormone imbalances, or medications. 

• • Lack of desire, the feeling of wanting to have sex, or lack of arousal, the physical and emotional changes that occur as a result of sexual stimulus. This is similar to vaginal dryness but it stems from an issue relating to the sex drive.

• • Obstructions or anatomical changes such as endometriosis, pelvic mass, ovarian cysts, or surgical scars.

• • Vulvodynia is the name for a vulvar chronic pain that has no identifiable cause. This pain is not exclusive to occur during sexual intercourse.

• • A vaginal infection (fungal, parasitic, or bacterial) that is located in the entire vaginal area. Vaginal infections are often caused by STIs.

• Injuries or irritations of the vagina due to any causes like infections (STDs or UTIs), vaginismus (muscle spasms of the vaginal wall muscles), or skin conditions that affect the genital areas.

Underlying psychological causes:

Although pain during sex is usually caused by tangible issues, underlying psychological issues, which are extremely valid, should be taken seriously.

Depending on your background and past experiences with sex, unpleasant emotions like anxiety, shame, fear, or embarrassment while having sex may make it hard to relax and become aroused. This is an emotional cycle that only grows worse if you aren’t able to reconcile with the reasons why you may be feeling this way about sex.

Your mind may be aware of this and there may be a dialogue that goes a little like this:

“I’m not getting aroused. I should relax. But, I can’t. I’m not ready to be doing this. But I want to. But I’m not getting aroused. This sucks. I need to relax.”

And then the thought process starts over again.

It might not be you!

Relationship problems with your partner may also interfere with your sexual response. This can be anything from doubts that you’re with the right person to mismatched sex drives.

If your partner also has a sexual problem it may cause you to overthink sex or end up hating it. For example, if your partner is dealing with inhibited ejaculation, when the male is slow to ejaculate, after a while your body may stop producing natural lubrication which could potentially lead to long, painful intercourse.

It’s also important to be okay with the idea that you just may not be ready to have sex. Everyone’s relationships and bodies are different. Listen to your body emotionally and physically, and actively communicate with your partner. Sex is not meant to be forced. Only do it if and when it feels right.

How is it diagnosed?

There has been a medical record of dyspareunia as far back as the ancient Egyptian scrolls. Luckily for us, we know much more about it than we did back then. These days, it’s not so difficult to establish the source of the pain nor to treat the issue.

You can expect a few things when being diagnosed by a medical professional. Many questions should be asked to get a thorough medical history. Getting tested for diseases, such as STDs, and an extensive physical examination will help reveal the most probable cause of this pain.

Questions likely to come up are:

• • Are you experiencing any inflammation?

• • Are you having painful spasms of the vagina that prevent intercourse?

• Where is the pain located or is it in the entire vaginal area?

Your gynecologist could require an ultrasound, CT scan, or an MRI of the pelvis. An examination of the abdomen, lower back, pelvis, rectal or rectal-vaginal will give the doctor a better understanding of both the anatomy and location of your pain.

If referred to a urologist, a cystoscopy will show the interior lining of the bladder and urethra through a lighted probe.

In the case of a psychological cause, the help of psychologist or psychiatrist could be sought to evaluate possible social or psychological contributors.

Is this normal?

The popular statistic is that 1 in 3 women undergo painful sex at some point. But because the symptoms aren’t always the same, the number varies. However, the stats are skewed because there is often a stigma that surrounds openly discussing sexual practices between not only women but also sometimes with doctors. It can also be difficult for some to admit that their sex life is less than perfect.

Those that only experience pain every once and a while typically ignore it and assume it will solve itself. It also isn’t unheard of for couples to be married for years and not seek the diagnosis for the woman’s pain.

This means the actual number of women who experience painful sex is difficult to accurately determine, yet it is definitely not an uncommon situation.

What are the treatments?

Medical treatments vary depending on the diagnosis but a few are:

• • Topical vaginal creams

• • Water-soluble lubricants

• • Vaginal relaxation exercises

• • Passive dilation and estrogen

• • Vaginal reconstructive surgery

• • Antivirals / antibiotics to cure STDs

• If tissue sticks together (pelvic adhesions), surgery will remove or cut them free.

Other than treatments done with the help of a doctor, there are a few at-home regimens available. Applying lubricating gels to the outer sexual organs, the vulva and labia, as well as using lubricating products in the vagina may be helpful to some women and ease pain. Sex toys such as vibrators or dildos may be useful to help introduce penetration or stimulate the woman in a way that isn’t painful. There are vaginal dilators, but women should discuss this with a health-care professional before attempting to use one.

How can I avoid painful intercourse?

Try performing other sexual activities that don’t hurt, or work to learn with your partner what type of stimulation works best for you. Oral sex or mutual masturbation could be helpful. If that is still too much, sensual activities done together, like a massage, could also achieve intimacy.

Getting tested for STDs can help you avoid letting one go untreated until it develops into something much more serious and painful. If you are unsure of what is causing you pain but suspect the possibility of STDs, please check out our website here.

Painful sex isn’t something you have to live with forever. Dyspareunia is readily identified, diagnosed, and treated. These uncomfortable feelings should never be the source of shame and there is no need to keep them to yourself. You’re not complaining. You’re taking control of your health.