Painful Sex? This Is Why You Are Feeling The Ouch

Have you – or are you – experiencing painful sex?

When we think of being intimate with our partner, we rarely think about potential pain or discomfort and yet so many women – especially during menstrual changes or perimenopause – start to feel uncomfortable during sex due to hormonal changes. You might start to feel a bit sore, or a bit dry, and suddenly there’s a voice in your head thinking ‘what’s going on?’ and you can’t get back into the moment. Familiar?

If this is relatable, there are a few reasons why you might be experience discomfort or pain during sex – and no, it’s not in your head. Or actually, it might be, but not in the way you think. Your body hasn’t suddenly  ‘gone off’ sex, but you likely need to adapt and change things up to accommodate the hormonal changes you are experiencing.

“It started as a sting, and then a burning sensation” – Eve

Eve*, 39, started to experience a sensitivity in her vagina during sex. Thinking it was a one-off, she joked with her partner that they needed to try a different lube. “I didn’t think too much about it, although at the time it went from a little twinge to a rough, sandpaper feeling.” Eve and her partner, Steve, introduced a different lube into their foreplay – but increasingly, Eve felt the familiar ‘sandpaper’ feeling again, and again.

After worrying something was really wrong, Eve saw her doctor and was diagnosed with vaginal atrophy. “I had no idea what it was at first. I thought dryness was something older women experienced, not someone before their 40s”. This is a common misconception – but vaginal atrophy can affect women at any age. At 39, it hadn’t occurred to Eve that her hormones could be declining, but was relieved to know that the pain was treatable with a hormone treatment. She’s also monitoring any other symptoms that could indicate early menopause or perimenopause to report back to her doctor in due course.

So what is vaginal atrophy? This term refers to the thinning, drying, and inflammation of the vaginal walls due to the body’s reduced estrogen levels. While it is more commonly associated with menopause, it can occur at any time when estrogen levels decline or fluctuate severely. Symptoms can include vaginal dryness, burning, and itching… and pain during sex as these tissues cause painful friction during sex. “It felt like a sting that progressed into a burning sensation,” explains Eve – and these are typical for the condition.

It’s important to manage the symptoms of vaginal atrophy as it rarely gets better on its own. “I’ve been prescribed estrogen gel that I insert into my vagina and that’s helped soothe the burning and sting of the dryness”, shares Eve. There are other treatments you can consider too; HRT, vaginal pessaries and moisturizers for the vulva like Glow by Hormone University’s Intimate Hydrator will soothe the discomfort and pain, while protecting the delicate tissues in your vulva and vagina and rejuvenating natural lubrication.

“I realised it was just before my period by using a tracking app” – Stacey

It’s not necessarily just a side-effect of menopause either. During our menstrual cycle, hormones fluctuate and this can lead to changes in your libido, natural lubrication (and consistency of your discharge) – and the elasticity of your vaginal walls. During ovulation, for example, you will experience a peak in estrogen, which for many women increases their libido and helps sex feel much more pleasurable. However, just before menstruation, estrogen levels drop and you will likely feel a change in the amount of natural lubrication you have and perhaps feel drier. During this time, it’s a good idea to use lubricant or intimate hydrator to protect the delicate skin in your vagina and vulva if you do experience this temporary mild dryness.

Stacey* 23, finds that sex is more painful just before her period. “It wasn’t until I used a tracking app that I realised that it was connected to my cycle,” she shares. “I find that in the week or few days before I bleed, sex is really sensitive and it takes longer for me to be ‘ready’ for penetrative sex. To be honest, it puts me off sex because it’s been uncomfortable and even actually painful at times, despite us going slow and gently.”

“Endo means I find sex painful a lot of the time” – Denver

For those who have PCOS, or Endometriosis, pain during sex can be common and not just attributed to vaginal dryness. In Endometriosis, the pain can be caused by pressure on endo lesions, or stretching of endometrial growths in the cervix and pelvic area. For those with PCOS, pressure on cysts can be very sore, and women routinely report vaginal dryness as a symptom of the disease, which is thought to be related to the way sex hormone production is affected by PCOS. “Oh wow, the pain during a flare up can be something else – it stops all play, that’s for sure”, cries Denver, 29. “Endometriosis has meant that I find sex painful a lot of the time – whether it’s because the position feels like it’s hitting a patch, or I’m tense from the pelvic pain I get.” Denver feels that her libido is much lower than when she was younger and the endometriosis hadn’t progressed as much. “No one tells you about this side effect and when it happens in your twenties, it’s far from ideal”.

If you have PCOS or Endometriosis and the pain is affecting your libido, it’s important to discuss this with your physician for further investigation.

“I was worried Lichen Sclerosus was a horrible infection” – Ashley

While vaginal pain is a common cause of pain during sex, we need to also consider the vulva. The vulva can be more sensitive than we might think – especially when our hormones are out of balance. When Ashley was in her early thirties, she started to see spotting in her pants and a stinging sensation when she went to the toilet. After an examination by her doctor, Ashley found that the spotting was due to small tears in the delicate vulval skin. “I felt so embarrassed, like I’d done something silly to cause the tears. I was really worried I had picked up some kind of infection.” The doctor explained that this was a condition called Lichen Sclerosus, a relatively uncommon condition that causes white, itchy and painful skin in the vulva. “It explained why sex had felt painful and it stung as my husband entered me.” Ashley uses topical steroids to manage the pain and inflammation and a vulval hydrator suitable for LS. “It’s much better than it was, but the doctor explained it doesn’t just disappear overnight. Managing the symptoms is key for me,”

Another condition, vulvodynia, can cause painful intercourse for women. Vulvodynia is chronic vulvar pain, that doesn’t present any clear cause but is persistent. It makes touch and pressure, including during sex, painful. The exact cause of vulvodynia is still under research, but gynecological experts believe that hormonal changes are an important factor in the presentation of the condition.

“I get so tense that penetration is difficult and painful” – Jessel

Lastly, our mental well-being plays a pivotal role in our sexual health. Conditions like anxiety and depression can significantly impact libido and how our body responds to sexual stimulation. It can also be intrinsically linked to how we feel about our bodies or feeling self conscious. This can lead to “spectatoring”, where you feel more focused on how you appear, or a sensation of observing yourself, rather than enjoying the moment and feeling ‘in’ the sexual activity. This can lead to decreased arousal and, in turn, less natural lubrication and a feeling of ‘being dry’.

“I’ve put on weight since I entered perimenopause, and I am so self conscious when we make love that I can’t separate my fears and worries about what my body looks like and just enjoy the moment,” Jessel bravely shares. “I can’t get ‘wet’, I get so tense that penetration is really difficult and often painful. My partner is understanding but frustrated. I know I need to relax, but I can’t work out how anymore.”

Body image and feeling connected to yourself during sex is important for intimacy. If you are feeling this disconnect is affecting your libido, speaking with a therapist can help unlock some of the barriers that you are experiencing and help you process negative thoughts.

4 Quick Steps To Take To Alleviate Painful Sex

Here’s four quick tips that will help relieve painful sex today… and actually work:

1. Hydration is key! Using a vulval moisturizer or hydrator, like Glow by Hormone University’s Intimate Hydrator, can help to soothe irritation and burning, protect delicate tissues, and improve the ability of cells for lubrication.
2. Hormone Replacement Therapy (HRT): For those suffering from severe vaginal atrophy or other hormone-related issues, HRT can be an option. However, it’s vital to discuss the risks and benefits with your physician to ascertain the best treatment pathway for your symptoms.
3. Pelvic Floor Therapy: Women’s health physiotherapists specializing in the pelvic floor can offer exercises and treatments to improve muscle tone and reduce pain.
4. Counseling and Therapy: For those who believe that their pain is linked to a psychological cause, therapy can be beneficial. It can also be a safe space to discuss fears or traumas related to intimacy. A sex therapist may also be able to help you with feelings that are a barrier to intimacy.