Pain During Intercourse or Penetration

By OBOS Sexuality & Relationships Contributors | October 15, 2011
Last Revised on Feb 12, 2015

Vaginal penetration that you desire typically doesn’t hurt, especially if you and your partner ensure that you are stimulated enough to be fully aroused.

Yet sometimes discomfort or pain during sexual intercourse or penetration may occur, even when it seems like your body is ready. If penetration is at all painful during sex, find out what the cause is and what can be done about it. A gynecologist can help to determine if there’s an underlying physical cause and advise on treatment.

The following situations and conditions can contribute to or cause pain during intercourse or other forms of penetration.

Sexual Intercourse or Penetration for the First Time

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The first few times you have intercourse or experience vaginal penetration, you may feel a small to moderate amount of pain at the entrance to the vagina. There can be some bleeding or no bleeding at all—both are normal.The reasons for the pain are not always clear, but it is typically temporary.

An unstretched hymen (vaginal corona) has typically been blamed for this pain at first penetration, but new understandings of the hymen suggest otherwise.

As Hanne Blank, author of “Virgin: The Untouched History,” comments: “If the hymen is substantial, relatively inflexible, and attached around much of the circumference of the vaginal opening, then yes, it’s fair to say that the hymen is at issue. But not all hymens meet these criteria, and women without substantial hymens can also experience painful penetration. The truth is that research has not told us with any particular specificity why it is that this discomfort happens, or why it happens for some women (regardless of hymen type) and not others.”

Insufficient lubrication

In most women, the wall of the vagina responds to arousal by producing a liquid that moistens the vagina and its entrance, making penetration easier. Sometimes there isn’t enough lubrication — you may need more time for stimulation, or you may be nervous or tense.

Insufficient lubrication can also be caused by lowered levels of estrogen, which can make vaginal tissue more fragile and affect the vaginal walls in such a way that less liquid is produced. This may occur after childbirth (particularly if you’re breastfeeding), or if you’re taking hormone therapy after breast cancer.

Some women experience insufficient lubrication during perimenopause and postmenopause and may need to look for signs other than vaginal wetness to signal arousal. Others, regardless of their age, simply produce less lubricant.

Even if you are not experiencing painful penetration, using a lubricant can dramatically increase sexual comfort, pleasure, and stamina—especially if you use condoms.

Local infection

Some vaginal infections—like monilia (yeast) or trichomoniasis—can be present even when you can’t see any signs. The friction of a penis, dildo, or finger moving on the vulva or in the vagina might cause the infection to flare up, resulting in stinging and itchiness. A herpes sore on the external genitals can make friction painful.

Local irritation

Birth control foam, cream or jelly can cause irritation in the vagina. If you think this is the case, try a different brand. If the irritation persists, it may be in reaction to the spermicide Nonoxynol-9. Alternative spermicides are extremely hard to find, so you may want to consider another birth control method.

Though latex allergy is uncommon, some people are sensitive to latex condoms, diaphragms and gloves. Alternatives include polyurethane condoms, including female condoms.

Vaginal deodorant sprays, douches, scented tampons, and all so-called feminine hygiene products can irritate the vagina or vulva, as can body wash, soaps, bubble bath, and laundry detergents and dryer sheets. Try to avoid applying or using products that contain fragrances.

Tightness in the vaginal entrance

In some situations, size matters—if, for example, a male partner has a large penis and your vagina is small. Keep in mind, though, that a woman’s body size is not related to size of her vagina.

Women’s difficulty with penetration is sometimes attributed to vaginismus, believed to be a strong, involuntary tightening of the vaginal muscles, a spasm of the outer third of the vagina.

Researchers have not always been able to identify these muscle spasms, writes Debby Herbenick, author of “Because It Feels Good: A Woman’s Guide to Sexual Pleasure and Satisfaction” and founder of mysexprofessor.com:

More recently, vaginismus has been described as “persistent or recurrent difficulties of the woman to allow vaginal entry of a penis, a finger, or any object, despite the woman’s expressed wish to do so” (see Graziottin, 2008). This is an important distinction because it reinforces the point that penetration should be consensual and wanted.

Pain deep in the pelvis

Sometimes the thrust of penetration hurts way inside. This pain can be caused by tears and scarring (known as adhesions) in the ligaments that support the uterus (caused by obstetrical mismanagement during childbirth, an improperly performed abortion, pelvic surgery, rape, or excessively rough penetration during sex); infections of the cervix, uterus, and tubes (such as pelvic inflammatory disease—the result of untreated sexually transmitted infection in many women); endometriosis; cysts or tumors on the ovaries; a vagina that has shortened with age; or a tilted pelvis.

Penetration in these cases is sometimes less painful if you’re on top or lying beside a partner.

Vulvodynia

Vulvodynia is a catchall term describing chronic vulvar pain that has no identifiable cause.

When the pain occurs around the vaginal opening (the vestibule) upon being touched or pressed, it’s referred to as localized vulvodynia. (Older terms for this condition include vestibulodynia, vulvar vestibulitis, or localized vulvar dysesthesia).

If the symptoms occur in different areas of the vulva, at various times and sometimes even when the vulva is not being touched, it’s referred to as generalized vulvodynia.

Pelvic floor physical therapy, hormonal creams and low-dose tricyclic antidepressants can sometimes help. Some women have reported finding relief with the same treatments prescribed for fibromyalgia, which causes an amplified reaction to pain.