Sex Talk: Got Pain?

Sex Talk: Got Pain?

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Have you even noticed how glamorized Hollywood tends to make sex out to be? Sex is something that can be done anywhere, anytime, at the drop of a hat and the woman is ready and excited to go, right? Yet that is so far from reality. Hollywood sets women and men up for these high expectation sexual experiences, and once those expectations aren’t met, many are left feeling like failures or as if something is wrong with them. Then to make them feel like they are going even more crazy, you through on a sexual dysfunction and many times they start to feel broken. Have you seen many (if any) movies or shows depicting women having a sexual dysfunction? I haven’t. The truth is, is that in America over 20 million females will face painful sex (Goldstein, Pukall & Goldstein, 2011). Mayo Foundation for Medical Education and Research (2012) approximated that one in five women will experience sexual pain.


That’s a lot of women struggling with the same thing. I see that woman often in my office. If you are struggling with sexual pain here are some terms to help you identify what you are going through and ways to help yourself have that healthy sex life that you deserve.


The overall term for painful sex is called dyspareunia (dis-puh-ROO-ne-uh). Painful sex can appear in many different forms. Sometimes the pain presents its self in the following ways:
– pain upon penetration or while putting in a tampon
– pain with certain people or during certain times,
– new pain after not having pain during intercourse,
– deep pain during thrusting and burning or aching pain.


The most common discomfort described are categorized but not limited to Vestibulitis, Vaginismus, and Vulvundynia.


Vestibulitis affects the entryway of the vagina called the vestibular. The sensation has been described as feeling like someone is cutting the vestibular with a knife, or a sharp, intense, burning pain. Researchers are not sure why this happens. Some theories predict that it could be due to an allergic reaction, the vulva being dehydrated, not enough lubrication or a hormonal or chemical cause. Clinical observations in California have been looking at the correlation between high progesterone birth controls contributing to the thinning of the vestibule, which would make that area easier to tear or become tender. Treatments include:
– topical medications such as lidocaine, cromolyn and estrogen,
– some anti-depressant pills such as amoxopine and clomiparemine,
– cognitive therapy from a therapist.


Though these might not take care of the problem fully, they can help the pain subside some and prevent the pain from worsening.


Vaginismus could also contribute to vestibulitis. This is when the muscles in the pelvic floor and the vagina tighten up and make penetration difficult or impossible. In recent studies Vaginismus Help found that the prevalence rate for vaginsmus was as high as 47% making it a problem that affects many women in society today. The research went on to say that 50% of women who reported attending sex therapy had been dealing with vaginismus. There are many reasons vaginismus could occur, one being vestibulitis.


When there is a pain on our body, the body learns to defend that part by tensing up, which is what the vagina is doing too. One of the biggest components to vaginismus is anxiety. Anxiety could heighten around sex if there has been sexual abuse in a persons past, being told not to have sex, negative sexual experiences, low self esteem, among others. In using vaginal dilators, talking with a sex therapist about the concerns and also discussing the situation with a medical professional (i.e. gynecologist and/or pelvic floor specialist), this problem can be reduced or alleviated. One of the main interventions used in sex therapy for vaginismus is called sensate focus. This allows the client to work not only on the relaxation component of her pelvic floor, but also the psychological component that could contribute to the reflexive tightening. Pelvic Floor Specialist can provide great help in using biofeedback allowing the woman to see her muscle contractions on the computer screen. In using exercises, pelvic floor specialist can help women become more aware of muscle tightening in their vulva and vaginal area and over time allow for intercourse to become less painful and even pain free. Below is a diagram of the cycle of vaginismus provided by


Vulvodynia is pain in the vulva region while vaginismis and vestibulitis are central to the vagina. This type of pain can be due to a skin condition leaving the nerves ten times more receptive because of unexplained inflammation. The sensation can feel like burning in different parts of the vulva. Pain can occur after or during sitting too long, wearing tight clothes, pressure to the area, and sometimes just from wearing pants. The pain can stretch to the inner thighs and the perineum.


Though still being researched, speculations point towards this list (but not limited to) of what could cause vulvodynia:
– injury
– increased nerve sensitivity
– abnormal response to infection or trauma
– genetics
– hypersensitivity to yeast or a different organism located in the vuvla
– weakness or spasms in the pelvic floor


Treatment options include:
– oral medications to stop the pain
– topical medications
– pelvic floor muscle therapy
– modifying diet
– surgery
– nerve blocks


Living with painful sex can feel very lonely and embarrassing. In the midst of working through the pain remember to work on the intimacy with your partner. Go on dates, affirm one another, utilize more foreplay and don’t keep having sex if there is pain. Continuing to have sex through the pain can create more physiological difficulties along with physical damages.


Disclaimer: I am a licensed professional counselor, sex therapist. With any pain or changes, it is always good to seek medical advice such as a gynecologist, pelvic floor specialist, general practitioner, dermatologist, vulvovaginal specialist, or pain management specialist. Please feel free to email me with any questions.



  • Center for Pelvic Floor and Core Rehabilitation Center
  • National Vulvondynia Association
  • The Centers for Vulvovaginal Disorders
  • “The V Book” by Elizabeth Stewart
  • “When Sex Hurts” Goldstein, Pukall & Goldstein