Couple happy together

Is sex without pain possible? Sex shouldn’t hurt!

But too often it does.

As a gynecologist I have talked with many women about the most intimate details of their bodies and lives, including difficulties with sexual intimacy. Sometimes it’s a lack of interest; don’t want to. Sometimes it’s an inability to respond; want to, but don’t/can’t. And sometimes it’s a matter of significant physical pain.

God designed sex to be a ravishingly beautiful bonding experience between husband and wife, a way to express and grow emotional, physical, and spiritual intimacy. And it’s not a surprise that pain is a serious mood-killer for a woman!

Putting up with physical pain during sex because you’re “supposed to” does not lead to intimacy. You need to find a way to experience sex without pain.

Body, Mind, and Soul

Sex is not only a matter of the body; it deeply involves the mind and the soul also. The initial trigger for physical pain with sex may or may not be an issue in your body. But regardless of the initial trigger, all aspects of you become involved when sex comes to equal pain.

A woman’s sexual response is a very integrated thing, perhaps in some ways more complicated than a man’s. Sex begins in the mind. Everything else affects a woman’s sexual arousal; her general physical health, past experiences, what’s going on in the marriage, and even religious messages she’s come to believe. It’s not just that these things affect how a woman feels about sex; they also have a definite biological impact on her body.

So the first thing to know about painful sex is that it’s “all of the above.” Addressing this challenge in your marriage will require addressing body, mind, and soul.

Physical Causes of Painful Sex

As a physician I’ve seen many physical causes of painful intercourse. Most of them fall into one of these categories:

  • Endometriosis. The same type of tissue that lines the uterus (and bleeds with monthly periods) can develop in other areas of the pelvis and cause scarring and pain, especially with deep penetration at intercourse. Many women with this condition suffer for years before getting an accurate diagnosis. Medical treatment can help significantly.
  • Vaginal/cervical infections. Sometimes though not always related to a sexually transmitted infection, inflammation of the genital tissues and vagina make vaginal intercourse painful. Appropriate medication usually helps significantly.
  • Lack of estrogen. The decrease in natural estrogen at menopause, or briefly after the birth of a child, causes the vaginal/genital tissue to loose elasticity and lubrication, sometimes making intercourse feel like rubbing sandpaper over your most tender parts. Local estrogen treatment and/or extra lubricants may make a huge difference.
  • Allergies. An allergy to seminal fluid is uncommon but possible, and leads to swelling and pain that begins with intercourse but lasts for hours to days. Some women show an excessive response to artificial chemicals such as parabens in personal care products. In such cases, using condoms or using all-natural body care products may resolve the issue.
  • Vaginismus. This is an involuntary spasm of the vaginal muscles making intercourse painful or difficult. Sometimes though not always this is a response to past abuse, trauma, or even moral/religious feelings about sex. A wise and gentle pelvic physical therapist and/or specific self-care exercises at home often helps a lot.
  • Vulvodynia. An abnormal sensitivity of nerves in the genital area to even gentle touch. Various medical treatments have had different levels of success.
  • Other Medical Illnesses/Medications. Many other factors can impact a woman’s sexual arousal. And if a woman is not adequately aroused, sex is often painful.

This brief summary is not a substitute for a thorough medical evaluation. Some gynecologists have more training, experience, and interest in this area than others. You need someone who will listen, who will ask about the details of your pain, and who will make you feel like a partner in finding solutions. For example, local pain at initial vaginal entry is very different from deep pelvic pain with thrusting during intercourse.

Mental/Emotional Component of Painful Sex

If sex has caused pain in the past, or if a woman is afraid that it will cause pain, her brain will naturally attempt to prevent that pain by shutting down her ability to respond sexually. Other mental/emotional challenges can do the same. It’s an involuntary response, and it can become a vicious cycle.

Some of the mental/emotional factors that may play into painful sex include:

  • Previous sexual or physical abuse
  • Domestic violence
  • Guilt or shame about previous sexual experiences
  • Broken aspects of the relationship with your spouse
  • Fear of sexually transmitted infection or pregnancy
  • Negative messages about sex from parents, church, culture, etc.

This does not mean painful sex is “all in your head!” It’s not; it’s in your body! But the mind aspects are just as important, and they may be the key to resolving your pain.

If a woman’s brain associates sex with pain or trauma or being “dirty, she may deeply struggle to be aroused sexually even if her marriage is healthy now. If her brain shuts down, her body will usually shut down too. Being fully sexually aroused is often necessary for a woman to experience sex with pleasure instead of pain, and that takes her brain being in a good place.

Spiritual Component of Painful Sex

We’ve alluded to this already. If you believe sex is primarily a “duty” to your husband, or you’re carrying shame and guilt from your past sexual experiences, or you emotionally “sense” sex as dirty and sinful, your body will struggle to be aroused and painful sex may result.

God designed sex to be good for you too! Read the Song of Solomon; the book opens with the woman’s strong desire and arousal. The picture of sex as for the husband’s benefit alone is one of evil’s distortions of what God designed sex to be.

So if you don’t feel about sex with your husband as the Shulamite woman did in Song of Solomon, it’s time to do some work.

Some First Steps

There’s good news. It’s possible to retrain your brain pathways so that sex does not equal pain in your mind. It may take time, but it is possible.

If you’re struggling with “sex equals pain,” here are a few initial steps.

  1. Get a medical evaluation. There may be some physical factors involved that medical treatment will significantly help.
  2. Consider your past. If abuse, violence, guilt, or shame are connected to sex for you, consider getting help. Our Sexpectations course is one place to address that.
  3. Take it slow. You may need to back off from intercourse for a time while you retrain your brain. When you are ready to begin again, go slow. And there are many ways to enjoy sexual intimacy with your husband short of full vaginal intercourse.
  4. Address body, mind, and soul. It’s not either/or; it’s “all of the above.” Healthy sex between husband and wife is a whole-person experience, and dealing with all parts of you will be important in making life-giving intimacy possible.

Intimacy with your husband – physically, emotionally, and spiritually – is worth investing in.

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