Not getting enough time or sexual stimulation to become aroused before starting intercourse
Sex is supposed to feel good, so if you feel any pain or discomfort, it’s a sign that something might be wrong (either physically, emotionally or psychologically). People of all sexes can experience pain or discomfort during any type of sexual activity and particularly during intercourse. It can range from feeling mildly uncomfortable to feeling intense pain and may or may not happen with visible symptoms (e.g. redness, bumps, rash, sores, swelling).
People can feel pain in the penis, testicles, anywhere in the vulva area, at the vaginal opening, inside the vagina, the anus or deeper inside the body.
What could be causing my sexual pain or discomfort?
Physical conditions, diseases, certain medications, infections, pelvic surgeries and STIs are often the cause of pain in the pelvic and genital areas during sex.
If you have a penis sex can become painful or uncomfortable if you have a tight foreskin that doesn’t pull back easily or when the penis is stimulated without enough lubrication.
If you have a vagina one of the most common causes is vaginal dryness. Using a water-based lubricant can help. Some common causes of vaginal dryness include:
Hormonal changes such as menopause
Antihistamines or other medications
Feelings that can get in the way of your ability to relax and become aroused (e.g. fear, stress, anxiety, etc.)
Hormone replacement therapy for people who are transitioning from female to male (FTM). Androgen therapy (and suppression of estrogen production) can cause vaginal atrophy and dryness, which can result in dyspareunia (painful vaginal intercourse). This can be alleviated with topical estrogen cream. It might seem strange to take testosterone and also use estrogen cream, but it can help significantly for people who experience a lot of dryness and atrophy.
Some people have a condition called vaginismus. It makes the muscles at the entrance of the vagina contract involuntarily and can make penetration painful or even impossible. This is usually caused by a psychological reaction that the person doesn’t know they’re having.
Psychological, Emotional, or Relationship Factors
Psychological, emotional or relationship factors have been known to cause or contribute to sexual discomfort or pain. This may be the case if you have:
anxiety or depression
negative feelings or attitudes toward sex
past experiences of sexual abuse or trauma involving your genitals
problems communicating with your partner(s)
Feelings of gender dysphoria, widely described and experienced as distress due to discomfort with one’s assigned sex, and the desire to live as another sex.
After giving birth
If you have given birth, either vaginally or via C-section, it’s important to know that most health care practitioners advise you wait 6 weeks postpartum (after delivery) to have vaginal sex. The 6 week delay gives you some time to heal. Especially if you experienced a tear on the perineum (the skin in between the vaginal opening and the anus), an episiotomy (a cut made on the perineum) or the use of surgical instruments like forceps. For some, it may take longer than six weeks before they feel ready to have penetrative sex again (and may focus on other sexual activities for a while).
What if it’s been months since you gave birth and you’re still experiencing pain?
Common causes for pain after childbirth
Low estrogen levels in the vagina: estrogen keeps the vaginal tissues healthy, supple and well-lubricated. Breastfeeding can lower estrogen levels enough to cause dryness and pain. Using a lot of lube is a solution. If it still isn’t enough, you can ask your health care provider for a cream with a small amount of estrogen (which is also OK to use if you’re breastfeeding). Once you get your period again, the estrogen levels will be high enough and you can stop using vaginal estrogen cream.
Scar tissue: People who’ve required medical interventions during their delivery are less likely to have sex again at 6 weeks. The use of forceps or a vacuum increases the risk of a tear or an episiotomy. And a tear or repair needs to heal. It’s normal to take more time before having vaginal sex if you feel the need to. Most people will have started having vaginal sex again by 6 months postpartum. That said, if you are concerned, you can get evaluated to make sure your body is healing appropriately.
Muscle spasm: The muscles of the pelvic floor can become inappropriately tight after delivery (both in the case of vaginal births and C-sections). Sometimes a muscle spasm can develop in response to repeated attempts at painful sex (getting anxious about the pain). But sometimes it just happens. Specialized pelvic flood physical therapy is the treatment and is highly effective.
Irritation: An infection can cause an itchy, burning or sandpapery feeling during urination or sex, vaginal redness or a cottage cheese-like discharge. Vaginal examination by nurses, doctors or midwives during your delivery and/or rapid hormone changes can lead to a yeast infection or bacterial vaginosis, which is usually treated with antibiotics. See your health care provider to get a proper diagnosis and treatment.
The bottom line is that sex shouldn’t be painful. If months have gone by since your delivery and sex is still painful and you are concerned, consulting a health care provider is recommended.
What can I do to reduce the pain?
People with vaginismus can try pelvic muscle training, relaxation techniques, counselling.
If you continue to feel pain during sex, you can stop what you’re doing and explore other activities that feel good. Or you can choose to stop sexual activity altogether until the pain and discomfort goes away.
You should never feel guilty, ashamed or embarrassed to stop whatever you’re doing and to tell your partner(s) that you’re uncomfortable or feeling pain. Pretending that everything is fine can actually make things physically and emotionally worse or make you more anxious about sex.
If you’re concerned that emotional or relationship factors could be affecting you, you can ask yourself if there’s anything about sex, your relationship, or your partner(s) that’s making you uncomfortable. If you’d like to explore this more, see our page on improving your sex life.
If you are being abused or forced to have sex, it’s important for you to tell someone and to get help. You can read more in our page on sexual violence.
When should I talk to my doctor?
If you know or think you have a medical condition that could cause pain, or if you also feel pain during non-sexual activities (e.g. urinating, exercising, biking, sitting) you should talk to your health care provider as soon as possible. If your pain or discomfort continues to interfere with your enjoyment of sex, you should talk with your health care provider.
There are several possible causes for erectile difficulties. These can include both physical and psychological factors.
Some factors that can contribute to erectile difficulties
problems with blood circulation to the penis
high blood pressure
heart conditions (heart disease)
nerve damage (i.e. from prostate surgery)
being nervous about having sex (especially with a new partner) or having performance anxiety
feeling uncomfortable talking about sex with your partner(s)
having relationship problems (not as easy to get aroused)
not getting enough sleep
drinking too much alcohol
Medicines that may interfere with an erection include some:
blood pressure medications (e.g. beta-blockers)
heart medications (e.g. digoxin)
peptic ulcer medications
If you think that a medicine you are taking may have something to do with your erection difficulties, DO NOT stop taking your medicine and DO NOT take less of it without talking to your doctor first. In many cases, your doctor can change the medicine you’re taking or adjust the dose so that your erections are not affected.
Things you can do to deal with, and avoid, erectile problems:
eat a healthy diet
stop smoking or cut down
avoid using drugs
get enough sleep
avoid too much stress
limit the amount of alcohol you drink, especially before having sex
during sex, take your mind off your penis and pay attention instead to kissing and touching your partner(s). The less you worry about having an erection, the more likely you are to get one.
try talking openly and honestly with your partner about your sex life together (including the pressure you may be feeling about having erections).
Getting Help for Erectile Difficulties
See your doctor if you find it lasts longer than two months, or keeps coming back. Or, ask for a referral to a doctor who specializes in this area. There are many options for treatment and care. You can undergo medical tests to find out if there’s a physical cause for your erectile difficulties.
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