“Everyone is doing it” – right? But is everyone enjoying it? Discussions around sex and sexual pleasure have never been so open, but for many people sex can be a painful experience, and we need to talk about it.
Some of us, especially folks with vulvas, experience pain during sex, leading to cycles of fear and avoidance. But painful sex is nothing to be ashamed of – in fact, it is suggested that up to 75% of people with vulvas experience pain during sex at some point in their lives .
So what are some common causes? For many vulva owners, the answer might be vaginismus.
Vaginismus is the involuntary tightening of the vaginal muscles, leading to feelings ranging from mild discomfort to severe pain during penetrative sexual acts. For some vulva owners the condition can prevent penetration entirely, stopping anything from entering the vagina; penis, sex toy, finger or even a tampon.
There are two variations of the condition. Primary vaginismus develops around initial experiences of penetration, such as your first sexual experience or attempt at using a tampon. This can keep teens and young adults using pads over tampons or menstrual cups, and can inhibit sexual experiences and development of self-esteem.
Secondary vaginismus describes a development of these painful vaginal muscle contractions later in life. Vulva owners may have experienced pain-free sex for years before developing secondary vaginismus.
In either case, common causes and treatments are similar, but vary from person to person. Vaginismus can develop as a response to anxiety, a history of trauma, sexual taboos or expectations around sexual experiences. The misconception that pain during sex (especially for your first time) is normal for vulva owners can heighten anxiety and expectation. This leads to a cycle of anxiety and painful penetration that continues to reinforce itself over time. Something to understand is that the body and mind are interconnected, meaning causes and treatments may be too.
Experiencing pain is nothing to be embarrassed about, but vaginismus can influence self-esteem, sexual experiences and relationships. As the condition is closely related to one’s perceptions around sex, vaginismus can worsen over time as experiencing pain can lead to further tightening of the vaginal muscles.
The good news is there are a vast range of treatment options. Support and treatment can include CBT (cognitive behavioral therapy), seeing a sex therapist, pelvic floor physiotherapy, Kegel exercises and the use of vaginal dilators. This work can be done solo or with a sexual partner and can alleviate pain over time. Many people with vulvas recover entirely. Exploring non-penetrative sexual acts in both solo or partnered sex can also greatly alleviate the pressure of penetration, placing focus on sensation and exploration rather than traditional, heteronormative perceptions of sex.
Unfortunately, research fields and the medical industry have a deeply rooted patriarchal and sexist history. This has led both sexual pleasure and dysfunction among vulva owners to be chronically under-researched, misunderstood and culturally taboo. But research is catching up! We know more about vaginismus and other such conditions now than we ever have before.
So, if you experience pain during penetrative sex, reach out to a GP as your first point of call. Remember that there is no shame in experiencing pain during sex, you’re far from alone in it, and discussing it is the first step towards working through it.
Awareness of sexual ‘dysfunction’ needs to occur individually, socially and societally. Every one of us deserves a broader understanding of sexual pleasure and pain, as it benefits us, our friends and our partners. Don’t be afraid to broach the subject of vaginismus or painful sex with others – collectively, we can work to increase awareness and shift sexual stigma.
 ACOG. (2018) When Sex is Painful, American College of Obstetricians and Gynecologists, <https://www.acog.org/womens-health/faqs/when-sex-is-painful (“When Sex is Painful”)>.