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.
As a sexologist I am often asked if I know of any resources for a variety of sexual health services and information, so I decided to create this handy list of my most commonly shared referrals. Be sure to bookmark this for future reference to help yourself or a friend in need!
Note: Nearly all of these resources are non-profits and rely on donations to continue providing these incredibly valuable services. If you’re able, consider paying it forward and sending them a few bucks!
National Abortion Federation
Professional association of abortion providers with information, resources, and a directory of abortion providers by state.
Information about abortion, live chat feature to ask questions, and a directory of abortion clinics by zip code.
Directory of funds available to help pay for your abortion by state.
Image via Scarleteen
Inclusive, comprehensive, supportive sexuality and relationship info for teens and emerging adults
Sex education for teens, by teens, published by Answer, a national organization that provides and promotes unfettered access to comprehensive sexuality education for young people and the adults who teach them.
I Wanna Know
A site from the American Sexual Health Association, it offers information on sexual health for teens and young adults.
San Francisco Sex Information
Free, confidential, accurate, non-judgmental information about sex by phone or email answered by volunteer sex educators.
Image via Bedsider
Comprehensive information on birth control methods, a directory of where to get them by zip code, and a reminder app.
Comprehensive information on birth control methods, a quiz on which method is best for you, a directory of Planned Parenthood locations by zip code, and a reminder app.
Clinical Sex Therapists/Psychotherapists
Directory of clinicians, mental health practitioners, and psychologists with training in sexuality and certification by state.
Domestic Violence Survivor Support
Directory of emergency shelters by zip code, 24/7 hotline, and information on how to get an Order of Protection.
Advocates for Youth
Printable lesson plans and materials for elementary to high school aged students on dozens of sexual health topics including decision making, relationships, sexual orientation and gender identity, stereotypes and discrimination, and reproduction.
The Center for Sex Education
Curricula, manuals, and sex educator resources.
Our Whole Lives
Honest, accurate, lifespan sexuality education curricula with step-by-step instruction for program planners and facilitators, with 7 programs speaking to participants’ needs by age (grades K-1, 4-6, 7-9, 10-12, young adult, adult, and older adult.)
Image via UCSD LGBT Resource Center
Directory of LGBT Community Centers by zip code (LGBT Community Centers offer services that often include community space, youth drop-in centers, books and resources, counseling, healthcare services, leadership opportunities, and social events).
The Trevor Project
Crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender and questioning (LGBTQ) young people ages 13-24 via phone, chat, or text.
Legal help desk provides information and resources regarding discrimination related to sexual orientation, gender identity and expression, and HIV status.
A free, 3 full day conference with 250 workshops of all types for anyone who feels like they belong there, anyone who identifies as an ally to the trans community, and anyone looking to respectfully learn more about themselves and others.
Sunshine Behavioral Health - Transgender Addiction Resources
Resources for Transgender individuals seeking substance use treatment.
Research and Data
Research reports, fact sheets, and infographics on sexual and reproductive health.
The Journal of Sex Research
Scholarly peer-reviewed journal devoted to the publication of research articles on diverse topics in contemporary sexual science.
Sex and Disability
Sex and Disability
Information and blogs about sexuality and disability.
Sex Positive Doctors
National Coalitions for Sexual Freedom
Directory of psychotherapeutic, medical, legal and other professionals who have stated that they are “kink aware” and knowledgeable about and sensitive to diverse expressions of sexuality.
I am often asked by folks if I can know of a sex-positive, non-judgey, feminist gynecologist and/or obstetrician in their area. Sadly, such a database does not exist to my knowledge, but someone really should create one! Slut-shaming gynos are the worst!
Equal Employment Opportunity Commission
Information on sexual harassment and discrimination in the workplace and how to file a Charge of Discrimination.
U.S. Department of Education, Office for Civil Rights
Information on sexual harassment in school and how to file a Title IX complaint.
Sexually Transmitted Infections
Image via Center for Disease Control
Information on infections, treatments, and prevention from the CDC.
STI testing location finder by zip code from the CDC.
Resources for People Living with HIV from the CDC.
Sexual Violence Survivor Support
Directory of Rape and Sexual Assault Crisis Centers by zip code (Rape and Sexual Assault Crisis Centers offer services to survivors and their families that often include free counseling, legal assistance, advocacy and accompaniment to the hospital, police station, and/or court hearings, and 24/7 hotlines).
1 in 6
Live chat help and online support group for male survivors.
Talking to Kids About Sex
List of books to aid in parent to child sexual health conversations (Robie H. Harris’ 3 book series is especially good).
1. One-on-one sexual wellness coaching worldwide via phone.
2. Private sex education classes for adults in San Diego, CA.
3. Sexual health and pleasure products.
4. Sexuality education, information, and insight via blog posts and graphics.
**These sources are provided for informational and educational purposes only and are not intended as medical advice and should not be a substitute for a visit or a consultation with a healthcare provider or other appropriate professional.**