Pelvic Pain During Sex: How Women Can Reduce Their Risk |
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Half of women have experienced significant pain during intercourse.
Young women are at greatest risk.
Few women mention sexual pain to their partners, so most men remain in the dark about it.
With partner support and medical evaluation, most sexual pain can be relieved.
Vaginal intercourse can be a wonderful way to experience joy, love, and mutual physical and emotional connection. But for around half of sexually active heterosexual women, intercourse includes a nasty downside, pelvic pain.
Widespread sexual mythology holds that, for women, pain during intercourse is normal and natural, something they must live with. No! Except for carefully scripted BDSM play, sex should never hurt. If it does, that’s a problem.
Sexual pain can ruin lovemaking. In one study of women’s sexual pain, more than half (54 percent) reported loss of libido, fewer rolls in the hay, and more problems working up to orgasms. Few women mention sexual pain to their partners, unless it becomes severe—see my previous post. As a result, few men are aware that their lovers might be suffering pain, and few men ask their partners if sex feels uncomfortable or agonizing.
In addition, most women who suffer from sexual pain feel reluctant to mention it to psychotherapists, couples therapists, or doctors. Medical schools largely ignore it. Consequently, few internists or gynecologists raise the issue, or are skilled at diagnosing it. One study showed that it typically takes five doctor visits for women suffering sexual pain to receive diagnoses.
Understand the Risk Factors
Few people know the risk factors for sexual pain. That’s not surprising. It hasn’t been the focus of much research. But recently, researchers at the University of California, San Francisco, Medical Center, conducted a comprehensive survey. They recruited 2,039 women over 18 through the websites of athletic organizations in the U.S., England, Canada, Australia, and New Zealand. The women were avid exercisers and considerably healthier than average. Disproportionately few smoked, were obese, or had diabetes or high blood pressure. They were healthy, robust women.
Confirming previous research, more than half of them (54 percent) reported having experienced sexual pain, usually mild to moderate. But almost one woman in five (19 percent) called her pain severe. Meanwhile, any pain, even mild aches, can interfere with erotic pleasure.
Race, ethnicity, and marital status had no significant impact on pain risk. But the study identified other clear risk factors:
Age. The youngest women, those 18 to 30, were at the greatest risk. Pain risk decreased from age 30 to 50, then rose a bit as women became menopausal. This finding probably relates to sexual experience and assertiveness. Young women often feel anxious about sex. Anxiety magnifies pain. Young women also typically make love with young men who are sexually inexperienced, and often try to imitate porn, which features pounding intercourse that can easily cause pain. Young women may not feel sufficiently assertive to coax their lovers to embrace a gentler, more sensual sexual style.
Relationship satisfaction. Among those who felt very dissatisfied with their relationships, almost three-quarters (70 percent) reported pain. Among those who felt very satisfied, fewer than half (45 percent) complained of pain.
Weight. Heavier women reported less pain. This is counterintuitive. For many pain conditions, extra pounds increase pain, especially arthritis of the hips and knees. This finding probably has to do with the fact that study participants were unusually physically active. High levels of exercise cause hormone changes that may contribute to pain. Compared with thin women, those who are heavier don’t experience these hormonal changes as much. Being heavy may offer some protection from pelvic pain, but it increases the risk of many health problems that can cause sex problems: arthritis, diabetes, high blood pressure, heart disease, and many cancers.
Exercise. Time spent exercising had no effect on pain risk, but the type of exercise did. The workout that was most pain-preventive was cycling. However, cycling can produce genital numbness and sex problems. Women who experienced numbness reported an increased risk of sexual pain. Numbness usually results from narrow seats that put pressure on the area between the legs (perineum), or low handlebars that force women to bend forward, which also compresses the perineum. Numbness can usually be eliminated by sitting on a wider seat that supports the sit bones, and by using handlebars that allow riding seated upright.
Women experiencing any level of persistent sexual pain not relieved by over-the-counter pain medicines—aspirin, ibuprofen (Motrin), acetaminophen (Tylenol), or naproxen (Aleve)—should consult their primary care physicians or gynecologists.
However, it’s possible that your doctor may not be sufficiently informed about women’s sexual pain to treat it effectively. If so, contact the Sexual Medicine Society of North America for a referral to a sexual medicine specialist near you.
The Fundamentals of Sex
Take our Sexual Satisfaction Test
Find a sex therapist near me
Men are clueless about women’s sexual pain for two reasons: Their partners don’t tell them. And no one else does either, notably the media. Ladies, tell your partners. That’s the only way they can appreciate what you’re going through. It’s also a good way to test the relationship. If he doesn’t believe you, if he dismisses your pain, he may not be the guy for you. On the other hand, your pain is probably news to him. You might start the discussion by asking him to read this post.
It’s fine to be a horny guy. But men with strong sex drives often have difficulty hearing that the women they’re involved with suffer sexual pain. Now hear this, dude: About half of women have had this problem. If you don’t ask, if you don’t take her pain seriously, she may decide you’re a boor who deserves to get dumped. The research shows that women are very reluctant to mention sexual pain. That’s why it’s so important for men to ask about it. Ask frequently. If she reports pain, sexual adjustments often help. Work together to figure out what works for your gal. You might also offer to accompany her to doctor visits or consultations with sex therapists who deal with pain. Your support can really help—and it shows you’re a keeper.
Greenberg, DR et al. “Genital Pain and Numbness and Female Sexual Dysfunction in Adult Bicyclists,” Journal of Sexual Medicine (2019) 16:1381.
Fergus, KB et al. “Risk Factors for Sexual Pain Among Physically Active Women,” Sexual Medicine (2020) 8:501. Doi: 10.1016/j.esxm.2020.03.007.
Nguyen, RH et al. “Co-Morbid Pain Conditions and Feelings of Invalidation and Isolation Among Women with Vulvodynia,” Psychology, Health and Medicine (2012) 17:589.
Simons, JS and MP Carey. “Prevalence of Sexual Dysfunctions: Results from a Decade of Research,” Archives of Sexual Behavior (2001) 30:177.