Dyspareunia = catchall medical term for “painful intercourse”.
For some of the below conditions, I mean non-penetrative sex in addition to intercourse, and some involve vulva pain in additional to vagina pain.
PS: This list is not exhaustive and is provided for informational and educational purposes only. It’s not intended as medical advice and should not be a substitute for a visit or a consultation with a healthcare provider.
1. Less than ideal arousal
During sexual arousal, the vagina expands in length and width, while the cervix retracts. Increased blood flow to the genitals (vagina, labia, clitoris) increases sensitivity.
If this physiological process of arousal hasn’t fully transpired before the stimulation and friction of sex begin, ouch feelings can occur. Ouch being the technical term, of course.
2. Less than ideal lubrication
The blood flooding the labia/clit/vagina during arousal phenomenon (vasocongestion) is also responsible for vaginal lubrication. Plasma from the increased blood seeps through the vaginal walls, and this is the primary source of vagina lube.
Whether because arousal/vasocongestion was not enough, or if it’s due to other reasons, not having enough lube to reduce friction in the vagina or around the vulva is painful.
Remember going down a plastic water slide as a kid but there wasn’t enough water and your ass cheeks squealed on the way down, leaving your skin behind? Yeah, it’s like that.
Decreasing estrogen due to menopause make the tissues in your vagina thinner, and the friction on the fine skin can cause pain. Reduced lubrication production can also be a factor during menopause- see above.
From STIs like Chlamydia and Trichomoniasis to UTIs and your garden variety yeast infections, many different infections can cause vaginal and/or vulvar itching, burning, or stabbing pains. Yay!
Vaginas can get angry at certain condoms, lubes, and tampons, and vulvas can get wrathful at some soaps and body washes.
2/3 of folks with endometriosis have some sort of sexual function dissatisfaction, including dyspareunia. It is especially wide spread in those who have endometrial tissue that has replanted itself around the vaginal canal and the pain is often described as sharp and severe.
The intersection of gynecological and gastroenterological pain sensitivity is a thing. I don’t fully understand it, nor does it seem the medical research community, but the correlation is there.
Cysts on the ovaries can crowd the pelvic area and cause pain in the vagina during the rigors of sex, not to mention the hormonal impacts- see above.
I put my hand up to your face, your eyes blink in a protective reflex.
Vaginismus is I put my hand up to your vaginal opening, and it blinks in a protective reflex.
An involuntary muscle spasm, vaginismus makes insertion of a penis, finger, toy, tampon, or gynecological tool damn near impossible, and extremely painful if attempted anyway. It can be caused from trauma, past painful vaginal experiences (so pain begets pain), or nothing at all.
A chronic pain of the vulva around the opening of the vagina with no identifiable cause, in my experience it feels like a knife blade in your vag and it’s horrible.
It’s something I struggled with several years ago, and it was awful. Tampons were impossible. I needed a pediatric speculum for gynecological exams and I still winced. Penetrative sex was bloody and tear-filled.
This was around 2009 or so, and thankfully I had a sex-positive Ob/Gyn who took my complaints seriously and treated me successfully. No more vulvodynia.
And I never heard anyone else talk about it until the past year, and suddenly I’ve met DOZENS of folks who are experiencing chronic vulva pain that has either been diagnosed as vulvodynia, or hasn’t been examined yet but sounds a whole lot like vulvodynia to me.
My guess about the uptick is there's more comfort with talking about vaginas these days and less shame about it.
But talking about it is just the first hurdle. The medical community has been slow to show priority about understanding this condition- where it comes from, why, and how to treat it more effectively.
A rudimentary Google Scholar search yields just 9,000 returns for “vulvodynia”. Comparatively, “erectile dysfunction” yields 208,000, and ED doesn’t feel like one’s penis is being stabbed, so that seems fair, but I digress.
SO WHAT TO DO ABOUT THE VAGINA OUCH?
Make an appointment with your gynecologist. Advocate for yourself. Don’t accept a half-assed answer from the MD or any minimizing of what you are experiencing.
Get tested or ask your doc about pain treatment during an STI outbreak.
Try different positions.
Try different condoms and vulva-friendly body wash.
I’m going to say it again because it bears repeating: USE LUBE!
Talk to your partner. Again, advocate for yourself and what you need (more kissing, sex acts other than penetration, more gentle touches, whatever it may be).
Make an appointment with your favorite sexologist and sexual wellness coach to strategize sexual technique, communication with partner(s) and/or doctors, and emotional management approaches to work through the process.
HERE’S WHAT NOT TO DO:
Yes, these may be explanations, but ultimately sexual activity should NOT hurt, and it doesn’t have to.