Pain during intercourse is a troubling secret for many women.
They might have intercourse about as often as other couples do but hide the pain from their partners.
Many never speak to a doctor.
Others get brushed off when they seek help.
The doctor “might do an examination, and say, ‘There’s nothing wrong. Maybe you need more lubricant,’” clinical psychologist Natalie Rosen, an assistant professor at Dalhousie University, in Halifax, Canada, told Healthline. “But using more lubricant won’t cure the pain.”
The truth is, you can get relief from treatment and counseling, and telling a partner is also a good place to start.
Rosen and other researchers reported that communication on this issue improves sexual satisfaction for both people.
You might change your sexual repertoire and also ultimately find intercourse less painful.
Painful sex is common
Pain can occur at any age. It may also come and go.
In a study released earlier this year, 7.5 percent of nearly 7,000 sexually active women in the U.K. said they had had pain during sexual intercourse within three months prior to the study.
For about 2 percent, the pain occurred “very often” or “always” over at least six months, and was a source of distress, the study team reported this year in BJOG: An International Journal of Obstetrics & Gynaecology.
The estimates of how many women experience pain during intercourse over their lifetime range from 10 to 28 percent.
Pain after menopause
The drop in estrogen levels brings on vaginal dryness and other symptoms in about half of all postmenopausal women.
Vaginal dryness can even make riding a bike unpleasant. Yet it’s common for women to suffer without seeking help.
“Many women greet this with resignation,” said Dr. Mary Jane Minkin, an OB-GYN, and clinical professor at Yale School of Medicine in Connecticut.
Minkin told Healthline that a first move might be to try the product Replens. If that doesn’t work, she recommended speaking with a doctor about other treatment options.
Many women are afraid that taking estrogen is a cancer risk. But very little estrogen enters the bloodstream if you use a method that delivers the hormone directly to your vagina, Minkin explained.
The options include a cream, injectable tablets, and a ring that dispenses the medication slowly over three months.
If you decide to treat other menopause symptoms, you may opt for a pill or patch.
There are also two nonestrogen options for dryness: A tablet you swallow called Osphena (ospemifene), and a vaginal insert call Intrarosa (prasterone), which arrived in U.S. pharmacies nationwide last week.
Choosing among any of these is a matter of personal preference, Minkin said.
Even without dryness, a woman may have pain in their vulva — the external part of the female genitals.
When the pain has no obvious cause, it’s known as “vulvodynia.”
This condition occurs, on average, around the age of 30, in 3 to 14 percent of women.
Provoked vestibulodynia (PVD) is the most common form of the condition in premenopausal women. It causes a sharp or burning pain that occurs near the entrance to the vagina when it is pressed.
This condition may also cause some women feel pain the first time they insert a tampon.
In other women it can come from sitting a long time or wearing tight pants — or even sometimes without any pressure or touch.
According to the National Vulvodynia Association researchers have speculated about a range of causes, including weakness in the pelvic floor, hypersensitivity to the yeast common in that area (Candida), or various kinds of nerve damage.
The condition begs a serious question: Why do people experience pain so differently?
“Answering that will win you the Nobel Prize,” Minkin quipped.
Women with vulvodynia are two to three times more likely to report another pain problem like irritable bowel syndrome (IBS), or bladder infection symptoms without an infection (interstitial cystitis).
But addressing a separate pain condition isn’t likely to relieve pain during intercourse, Rosen said.
Vulvodynia and dryness related to menopause can occur together.
It’s also possible to experience vulvodynia while on hormone treatment, one study found. The same study found that the pain often lingered after sex for women of any age.
The effects on relationships
About a third of partners are unaware of the pain.
Women who experience pain during sex may become wary that any affectionate touch is an overture, and both members of the couple tend to find it harder to talk about sex.
Does this mean someone can simply be the wrong partner?
“It’s more complex than that,” Rosen said.
The findings of the study out of the United Kingdom support her conclusion. Women reporting pain were more likely to say that they didn’t share their partner’s sexual preferences or appetite, but they were no less likely to be happy with the relationship overall.
Rosen advised women to open up.
“Partners appreciate the information. They don’t want the woman to be in pain,” she said.
The goal is to experiment and “vary the script,” Rosen said.
It’s best to have sex with an upbeat goal — liking your partner’s pleasure, for example — rather than to avoid losing the relationship or another feared outcome, she said.
When you’re motivated by avoidance, both you and your partner are less likely to be happy.
This has been true for Mark and Rita (their names have been changed to protect their privacy).
The couple enjoyed frequent intercourse for a decade, and then when both had entered their 50s, their sex life stopped.
“When I questioned her, I got vague answers,” Mark told Healthline.
By his 60s, Mark was longing for sex and considered a divorce. He asked Rita to see a counselor with him.
In their sessions, Rita admitted that intercourse hurt, and they agreed to try having sex again.
“The therapist said ‘This is your homework. Come back when you’ve done it,’” Mark said.
They haven’t returned.
Mark said they’ve tried lubricants and different positions, but nothing seems to work.
“The pain is instantaneous. She flinches,” he said.
Mark senses that Rita would be fine without any sexual activity at all.
“She’d probably let me do it, but I don’t want to,” Mark said. “I don’t get the sense she wants to, except to keep me from leaving.”
What you can do
Cognitive behavioral therapy has the most scientific support, Sophie Bergeron, a professor of psychology at the University of Montreal, told Healthline.
Women learn to manage thoughts and emotions about the pain. For example, the fear that it’ll never go away, as well as shame and anger.
In studies of a small group of women with provoked vestibulodynia, Bergeron and her team found that surgery, biofeedback, and cognitive behavioral therapy all gave participants measurable improvement that lasted for two and a half years.
In a separate recent study, 10 weekly sessions with a physical therapist reduced pain during intercourse more effectively than the standard alternative of applying lidocaine, a desensitizing ointment.
Bergeron suggested looking for an expert in pelvic floor physical therapy, which includes those who treat stress urinary incontinence.
Minkin said, “Be sure you have a gynecologist or doctor you feel comfortable talking about this with, and don’t give up hope.”