Why You May Be Experiencing Pain During Sex (for Wives)

If you experience pain during sex, you are certainly not alone. Pain during sex is called dyspareunia, and research shows that about 7% of women experience pain it.[1] Of those 7%, about one-quarter of them reported that the pain had been occurring frequently or every time they had intercourse over at least 6 months. Today, we’d like to look at some of the most common causes so that if you’re experiencing dyspareunia you maybe have a starting point to know how to explore and hopefully resolve this challenge.  Pain during sexual intercourse is a relatively common issue. Of course, the lifetime prevalence is going to be higher, and I would expect that every person is likely to have at least some discomfort if not some pain during the course of their sexual interactions with their spouse over the lifetime of their marriage. This can be tough to talk about for some people, so we hope that today’s show serves as a bit of an icebreaker and introduction to the subject.  We’re not sexologists, sex therapists or medical professionals. I am a marriage counselor so we do address sexual issues, but just be reminded that if you are experiencing pain your wisest course of action is first of all to talk to your doctor or gynaecologist, and possibly to book an appointment with a sex therapist. There are more reasons for pain during sex than what we will cover, for example, we are not going to address urinary tract infections or sexually transmitted infections. But anxiety and menopause are two major causes so we’ll start with them. Sexual Anxiety Sexual anxiety (or sexual performance anxiety) is something that affects men and women of all ages, regardless of how much experience they have had with sexual intercourse. There are a variety of possibilities here. A newly married wife may be too self-conscious to tell her husband what she does not enjoy: this could lead to some trepidation or anxiety about having sex which could result in pain during sex.[2] In some cases, the anxiety may be short-lived and go away on its own. In other cases, it may be something that occurs on a regular basis and interferes with a healthy sex life.[3] According to sex educator Amy Jo Goddard (n.d.), two things are generally the root cause of sexual performance anxiety. She states, "this response is conditioned by the way in which we were brought up to think about certain aspects of sex and our own bodies, and by social expectations that impact our relationship with our own sexuality."[4] This means that messages from your family of origin, your church, or from locker-room discussions or friends at school — all those sources could potentially contribute to anxiety during sex. Other times it may simply be a lack of sex education: perhaps not that you don’t understand how sex works, but that you’re just not prepared for all the realities of sexual encounters with your husband. Everyone functions differently and has different needs when it comes to sex, and not being well educated can lead you to feel unsure about the techniques of giving, achieving or receiving pleasure. Additionally, you may experience fear because of myths concerning pregnancy, or myths about how your body is supposed to react during sex, and these beliefs can be very anxiety-inducing.[5] Of course, anxiety impacts arousal, which impacts your body’s ability to prepare itself for penetration and intercourse. It’s also important to note that the anxiety doesn’t have to be sexual performance anxiety. It could be anxiety about anything: how you’re going to pay the bills, your child’s health, the family get-together that’s coming up, whatever. General anxiety can also impact your sexual experience, potentially resulting in discomfort or pain. What to do About Anxiety Obviously, with such a wide variety of potential sources for anxiety it is challenging to cover all the possible solutions. If your anxiety is more generalized then taking care of that anxiety may just as easily end up taking care of the pain during sex as well.  But let’s look at sexual anxiety specifically.  There are a few things that you can do to reduce your anxiety. Check is your own expectations of yourself. Don’t expect yourself to be a perfect romantic partner right away (if you are recently married) or even all the time (if you’ve been married a while). It takes time and patience as well as a lot of trial and error to become a proficient lover. It helps if you can learn to talk openly and honestly with your husband if there are certain things you don’t like.[6] Learning to express your wants and needs is important. If you keep things bottled up, especially fears, they will likely increase your anxiety and make sex more difficult or painful. If you’re worried about taking too long to orgasm, struggling to stay aroused, or just not being aroused in the first place, those are things that you will need to find ways to talk about and work through collaboratively, preferably without either party feeling blamed or taking the problem personally. How can you look at this as a problem to solve together? How can you frame this challenge into something that gets solved between you, real-time, in the context of intimate connection and tender, loving care? It’s important to be kind to yourself as well as respectful to your spouse during this process. If you know there is a deeper psychological reason behind the pain, it’s worth facing that issue with your spouse and seeing a therapist if it persists. If you always have pain during intercourse, it can create a difficult cycle to break out of because you may involuntarily tighten your muscles in anticipation of the pain, and that tightening causes further pain.[7] One basic approach to try here is to reassure yourself that your spouse wants to be with you, that he welcomes your presence and your sexual needs, and that he wants you to be at ease and comfortable with him. What you’re doing is really trying to lower the sense of demand or pressure and move yourself to a place of openness and curiosity.  Menopause and Pain Menopause may involve falling hormone levels, which can have a variety of effects. You may be less interested in sex than your husband and that may make sexual encounters tense and stressful which could easily lead to pain. There can also be a physical shift towards vaginal dryness, which leads to pain during intercourse.[8] Dwindling estrogen due to menopause is the number one reason for pain during sex at midlife and beyond. Hormone shifts make the tissues in your vagina to become thinner and dryer. That leads to physical friction during sex; your vagina may also become less stretchy so things may feel tighter during intercourse.[9] There are a number of ways to compensate for the effects of menopause in order to reduce pain during sex. The first thing to know is that you can go to your doctor for a prescription of estrogen: this may help make intercourse less painful and comes in three forms: a cream, a tablet or a ring.[10] For some women, simply using a good water-based lubricant during sex may help with a lack of lubrication, especially if dryness is the issue more than soreness. You can also use a vaginal moisturizer which is something that you would apply regularly, not just during sex. There are both over the counter and prescription options for moisturizers. Putting more emphasis on foreplay may help: being more aroused before penetration means you will be more lubricated. Give yourself more time to enjoy caressing, perhaps oral sex, or different positions. As well, having sex more often will lead to increased blood flow to your sexual organs, which may help with lubrication, which will make intercourse less painful. Vaginismus Can Be Painful Next is a common condition called vaginismus. This involves an involuntary spasm in the vaginal muscles that comes from a tightening of the pelvic floor muscles.[11] Vaginismus sometimes is caused by anxiety about having sex or a fear of being hurt during sex. If you have this condition you may also notice pain inserting a tampon. In terms of what to do about vaginismus, doing counseling related to the source of fear or anxiety related to sex or penetration can help with this. There are also a set of exercises called Kegel exercises that can help you learn to relax the muscles surrounding your vagina. In covering anxiety and menopause and vaginismus, we’ve dealt with some of the most common sources, but let’s just run through some more potential sources of pain in case some of our listeners are experiencing these as well. Uterine Fibroids Uterine Fibroids are benign lumps that grow on the uterus. Symptoms may also include heavy periods, cramping and an urge to urinate as well as painful sex. Your best option here is to see your doctor. Treatment options may include embolization (a minimally invasive surgical technique and hormone therapy or a hysterectomy (removal of the uterus).[12] Endometriosis This is a difficult condition where the tissue that lines your uterus can grow elsewhere within or even outside of your pelvis, causing pain in your stomach, pelvis and back during sex.[13] You definitely want to see the doctor if you are experiencing deeper pain, not just pain at penetration so your doctor can diagnose this and recommend treatments.[14] Pelvic Inflammatory Disease With PID, the tissues deep inside become badly inflamed and the pressure of intercourse can cause deep pain. Again, you’ll want to see a doctor here for appropriate treatments.[15] Vaginal Infections This is possibly one of the simpler causes: you may have a yeast infection which causes pain and itching in the vaginal area. This can be treated with an over the counter product,...