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Experts estimate around 75 percent of vulva owners find sex painful at some point in their life.
Known by medical personnel as “dyspareunia,” there are basically a bajillion different reasons this could happen.
One of them is vaginal or vulvar scarring.
“Scar tissue is the body’s way of healing what’s been damaged or injured — it’s the body’s healing mechanism,” says Heather Jeffcoat, a doctor of physical therapy who specializes in sexual dysfunction, pain, and incontinence, and author of “Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve.”
Vaginal scarring occurs when scar tissue has developed inside the vagina as a result of injury, damage, or tearing — like during vaginal childbirth.
Scarring on the outside of the vagina (the vulva) is also possible.
If you ever fell riding your bike or sliced a finger cutting an avocado, you know this to be true: The tissue the body lays down to heal a wound isn’t the exact same type of tissue that was there previously.
It’s stiffer, thicker, and usually either numb or much more sensitive than the surrounding tissue (or skin).
Well, surprise, surprise: This is also true for scar tissue inside the vaginal canal or on the vulva.
So, while there are different types of scars, you’ll likely be able to see the scars on your clitoris, labia, or perineum and around the vaginal opening, either by looking down or holding a mirror between your legs.
“You may also be able to feel it,” says Kiana Reeves, somatic sex expert and sex and community educator at Foria Awaken, a company that creates products intended to reduce pain and increase pleasure during sex.
“If while touching yourself you feel the smooth, pliable tissue give way to rougher, tighter, less pliable tissue, that is likely scarring,” she says.
If you can’t see or feel the scars, how will you know they’re there?
Vaginal and vulvar scarring usually causes pain and tenderness:
- with tampon use
- during penetration with a finger, penis, or dildo
- while sitting
- while using the bathroom
- during intense exercise
Anything that causes trauma — that’s tearing, microtearing, puncturing, or splitting — to the area can lead to vaginal scarring.
Here are some of the most common causes.
The vaginal canal is designed to stretch during childbirth so a baby can pop through. It’s pretty nifty.
But sometimes the vaginal canal doesn’t stretch enough to accommodate delivery.
In these instances, two things can happen:
- The area between the vagina and the anus (the perineum) splits to allow the baby to come out.
- A doctor will perform an episiotomy cut.
According to Jeffcoat, doctors usually opt for the second option to reduce the risk of the vagina tearing straight down to the anus, aka obstetrical anal sphincter injury (OASIS).
“OASIS injuries can lead to issues such as anal incontinence, pain, and loss of bowel control,” Jeffcoat says.
Episiotomies can help reduce this risk. “If the anus is at 6 o’clock, the doctor is able to make the cut at 7 or 8 o’clock to reduce the risk of an OASIS injury from taking place.”
But here’s the thing: In both instances, scarring is possible. And in the case of OASIS injuries, it’s inevitable.
Vaginal and vulvar surgery
There are many different types of surgical procedures a vulva owner might get that require incisions and stitches, which could result in scarring.
- cyst, tumor, or fibroid removal
- vaginal reconstruction for pelvic floor prolapse
Jeffcoat adds: “Some transgender women who have had bottom surgery have a ton of scarring because the process of creating a new anatomical structure requires a lot of incisions.”
Endometriosis (and endometriosis surgery)
Endometriosis itself is scar tissue.
“Endometriosis is when [you] have cells that are like uterus cells, outside of the uterus,” Jeffcoat explains. “These uterus-like cells, however, still go through changes with your menstrual cycle and shed once a month.”
When the uterine lining sheds, it comes out through the vagina in the form of menstruation.
But when these uterus-like cells shed, there’s nowhere for them to go.
“Instead, the shedding creates scar tissue,” Jeffcoat says.
Sometimes vulva owners will have surgery to have these endometrial scars and lesions removed. However, Jeffcoat says the surgery itself is a trauma to the body that can cause even more scarring.
“And if you’re getting radiation for the cancer, that too can lead to scarring,” Jeffcoat says.
Lichen dermatoses is a class of skin conditions that can cause severe itching and sometimes scarring along the genital skin.
“Penetrative rape often causes perennial tearing or tearing in the vaginal canal,” Jeffcoat says.
If you’ve experienced sexual assault or were forced into any sexual activity, consider seeking care from a trained healthcare provider.
Organizations like the Rape, Abuse & Incest National Network (RAINN) offer support for survivors of rape or sexual assault.
You can call RAINN’s 24/7 national sexual assault hotline at 800-656-4673 for anonymous, confidential help.
More options for support and advice on next steps can be found here.
According to Jeffcoat, it’s way more common than you might think.
Think about it this way:
11 percentof all vulva owners have endometriosis
- 86 percent of all vulva owners give birth at least once in their lifetime
- 90 percent of all vulva owners are survivors of rape
Do they all have vaginal or vulvar scars? No.
But these numbers suggest it’s a more common reason for dyspareunia than most people — including practitioners! — realize.
Here’s what to do next:
Step 1: See a gynecologist
If you’re experiencing any of the symptoms associated with vaginal scarring, speak to a vulva healthcare expert, like a gynecologist, first — even if a peek between your legs shows you that you deffff have vaginal scarring.
“A medical doctor will also make sure the pain isn’t due to something like a Bartholin’s cyst, which are thick, white, and raised, and can look like scars,” Jeffcoat says.
Step 2: Find a pelvic floor therapist
“If you have vaginal scarring, you need, need, need to be working with someone trained in nuances of the pelvic floor musculature and who also understands scar tissue,” Reeves says.
Why? Because vaginal scarring may cause secondary conditions like pelvic floor dysfunction.
Pelvic floor dysfunction and vaginal scarring 101
Your pelvic floor is a muscular sling that holds all your pelvic organs — bladder, uterus, and bowels — in place.
Like other muscles in the body, your pelvic floor can contract and release. Or, at least, an optimally operating pelvic floor.
“When someone has vaginal scarring — especially if that scarring is causing them pain — their pelvic floor muscles remain in a state of contraction as a protective mechanism,” Jeffcoat says.
Think about the way your whole body clenches when you think you’re about to get hit by a ball. Well, your pelvic floor does the same.
But because the “impending ball” (aka pain) never stops, neither does the pubococcygeus muscle clenching.
This is known as hypertonic pelvic floor. It can cause tertiary symptoms like:
- painful urination
- back, hamstring, and pelvic floor pain
- pinched nerves
- sudden urges to go
Step 3: Seek out a sex therapist
In many cases, vaginal scarring makes sexual activity painful or uncomfortable. This can be tough terrain to navigate individually or with a partner.
A sex therapist can help teach you, personally, how to connect with your sexy, sensual self when genital touch may be painful.
They can also work with you and your partner to help you find new routes of intimacy and pleasure.
Unfortunately, there’s not a lot of research on vaginal scarring, so there’s no conclusive evidence that you can — or that you can’t.
“You’re never going to get rid of the scar tissue completely, but you can flatten it and make it more mobile so that it doesn’t cause any pain or restriction,” Jeffcoat says.
The first step is to reduce the pain. The second step is to return the person to a place of pleasure.
Get used to very, very light touch
Some vulva owners have scars that are so sensitive that even underwear brushing up against or a finger touching the scar hurts.
“If the scar is external or at the entrance of the vaginal canal, I have people get used to brushing a lubricated Q-tip over the scar,” Jeffcoat says.
If they can handle that, she has them graduate and get used to a non-lubricated Q-tip (which means more friction between the tip and the scar).
“From there, we can begin applying more pressure to the scar with the non-lubricated Q-tip to start to desensitize the tissue,” she says.
If the scar is external, use a finger massage
Once the scar can handle touch, the goal is to make it more pliable and mobile.
“If you can reach the tissue, you want to pinch or grab the tissue between your fingers and massage into it from both sides,” Jeffcoat says.
While you can and should be able to do this yourself, she says it’s imperative that folks are taught how to do it (from their pelvic floor physical therapist or somatic sex expert!) before giving it a whirl themselves.
Reeves recommends people use castor oil for this. “Castor oil is thought to activate the lymphocytes, which is the process that helps digest the scar tissue and make it less thick.” (Research is still needed to confirm whether castor oil helps with vaginal scarring, though).
If the scar is internal, use a vaginal dilator for massage
If you saw a vaginal dilator, you might think it’s a really skinny dildo.
But vaginal dilators aren’t sex toys. They’re medical tools that were originally designed to help vulva owners with vaginal issues, such as vaginismus and hypertonic pelvic floors.
They can also be used to massage scar tissue inside the vagina. “[Dilators] can be used to work the scar tissue back and forth and side to side, in a cross-motion,” Jeffcoat says.
Can you use your fingers? Sure. “But it’s tricky and awkward, so it’s better if you have a tool,” she says. Fair.
Again, you can do this on your own but should learn how first.
Implementing anti-inflammatory practices
“Scar tissue is basically inflammation in the body,” Reeves says. “So while anything that causes inflammation can make it worse, anything that is anti-inflammatory can support vaginal scar tissue healing.”
What anti-inflammatory practices your expert recommends will depend on your body, but they may include:
- reducing stress through meditation and mindfulness
- improving sleep quality and quantity through good sleep hygiene
- eliminating inflammatory foods and drinks, like dairy and alcohol
- increasing intake of anti-inflammatory, antioxidant-rich foods
- taking supplements like curcumin and fish oil
Or more accurately: warmth.
“Bringing heat and promoting circulation to the scar tissue can help make it more pliable when you massage it,” Reeves says.
- applying a heating pad to your lower abdomen
- soaking in a warm bath
- taking a sitz bath
Just be careful: “You don’t want to overheat the area and then be dealing with burns on top of vaginal scars,” Jeffcoat says.
Make sure you test the heat with your hand first.
“Once we’ve addressed the pain, we can start to work towards pleasure,” Jeffcoat says.
Here’s what that might look like.
Try sex positions that put you in charge
Penetration may not be on the sex menu for you.
But if it’s something you want to try, Jeffcoat recommends positions that either limit the depth of penetration or put the vulva owner in charge of the action.
- riding on top
Check out the Ohnut
“If the scarring is deep inside the vaginal canal, you might also try using the Ohnut,” Jeffcoat says.
“[This] is a device the penis owner or dildo wearer can slide down their shaft to reduce how deep they’re able to enter,” she explains.
And in case you’re wondering: It doesn’t feel like a cock ring. Rather, it doesn’t feel like much of anything.
Redefine what sex means
“There are so many ways to achieve pleasure outside of penis-in-vagina or dildo-in-vagina sex,” Reeves says.
Meaning, even if penetration is painful, that doesn’t mean your sex life is over!
She recommends reframing “sex” to include other types of pleasurable touch, like:
“If we start thinking of sex as an interaction that brings both parties pleasure, and not ‘one thing going into another,’ we open up new kinds of sexual intimacy for vulva owners who find penetration painful and their partners,” Reeves says.
Give the clit some love
Who needs penetration to experience pleasure when the clit alone has 8,000 nerve endings??
“Use your fingers, your partner’s mouth, or an external vibrator to explore just how sensitive your clit can be,” Reeves suggests.
If you’re using your fingers, experiment with different types of strokes:
- Stroke from the top down and then from the bottom up.
- Tap on the clitoral hood.
- Swipe diagonally left to right and then right to left.
- Use clockwise and counterclockwise circles.
And if you’re in the market for a clitoral vibrator, check out the following, which are available to buy online:
- We Vibe Moxie panty vibrator, which allows your partner to control the vibration from an app
- Dame Pom palm-shaped vibrator for rumbly but lower-intensity vibration
- Le Wand Petite wand vibrator for high-intensity vibration
The reason you used a Q-tip with lube is to reduce irritating friction. And that’s the benefit of using lube during sex.
“Lube cannot fix vaginal scarring, but it may help make those scars less sensitive to touch,” Jeffcoat.
One thing to keep in mind about lube: If your partner uses latex condoms, avoid oil lube. Oil-based lubes can destroy latex condoms.
Explore CBD products
Specifically: CBD lube or CBD suppositories.
“CBD is known to help with inflammation,” Jeffcoat says. “And while there’s no research to show it helps with vaginal scarring, some folks say it helps make penetration more pleasurable.”
She recommends GoLove CBD, which is a water-based lubricant that’s latex-compatible and available online.
If you and your partner aren’t using latex barriers, you might also try Foria Awaken arousal oil, which is also available online.
Reeves also recommends looking into Foria Intimacy suppositories, which you can buy here. They’re designed to go inside the vaginal canal to ease tension and promote enjoyment.
If you have an OASIS injury or secondary pelvic floor tension, anal penetration may be just as painful as vaginal penetration.
But otherwise, Reeves recommends exploring anal play.
Vaginal scarring can be incredibly uncomfortable and painful.
But take comfort in this: It’s common, there are ways to make it less painful, and pleasure with vaginal scarring is possible.
Gabrielle Kassel is a New York–based sex and wellness writer and CrossFit Level 1 Trainer. She’s become a morning person, tested over 200 vibrators, and eaten, drunk, and brushed with charcoal — all in the name of journalism. In her free time, she can be found reading self-help books and romance novels, bench-pressing, or pole dancing. Follow her on Instagram.