What’s more painful, gritting our teeth during an intimate moment or opening up emotionally?
For women, discussions about painful sex start early. The fear of our first time hurting can be enough to put us off. The promise of it getting better, however, spurs us on. But what if, for some people, it never gets better?
I remember feeling intense shame when this happened to me. At first I wondered if sex was painful for everyone, and we were all just acting to keep our partners happy. But then I came to the conclusion that I was in fact the odd one out, and there was something wrong with me.
The idea of telling anyone that sex hurt (let alone a partner) felt incomprehensible. It wasn’t until I finally bit the bullet and told a long-term boyfriend that I decided to go to the doctor. Our relationship was quickly deteriorating, and I hoped that sorting out our sex life would keep us together.
After various tests, scans and hospital appointments, I was diagnosed with vestibulodynia, a condition that causes pain when the inner vulva/vagina is touched. While the relationship wasn’t salvageable in the end, I was relieved to have a diagnosis. It gave me something to work with.
My story doesn’t stand alone. In a 2017 study published in the International Journal of Obstetrics and Gynaecology, it was revealed that nearly one in 10 British women find sex painful.
Zoe Hinchcliffe was 17 when she started getting unusual symptoms, including itching and burning.
“Thinking sex was the pinnacle of a relationship (it’s not), I opted for painful and excruciating sex over none at all,” Zoe explains. “This wasn’t wise and caused me more harm than good, but it’s hard to think clearly when a chronic illness jumps into your life.”
After being misdiagnosed with thrush, eventually Zoe was referred to the gynaecology department at the hospital where she was diagnosed with vulvodynia, which is pain of the vulva (even without touch).
“Interestingly, many GPs still aren’t familiar with this term when I visit the doctors,” Zoe adds. “This is why it’s so important to get increased publicity and funding on these issues, so misdiagnosis doesn’t happen and better solutions can be found for women.”
"I opted for painful and excruciating sex over none at all"
Raising awareness of the various pain issues both women and men can experience is key. As well as vestibulodynia and vulvodynia, women can experience pain through lack of arousal/lubrication, after childbirth, and due to vaginismus – a condition that causes the vagina muscles to involuntarily clench.
For men, psychosexual therapist Charlotte Simpson explains that conditions such as Peyronie’s disease can cause erections to be painful, as well as phimosis, where the foreskin is too tight.
“Chronic prostatitis can cause pain on ejaculation, and men with post-orgasmic illness syndrome often report feeling unwell after ejaculation,” Charlotte says. “Coital headache is also a problem for some individuals, where headaches occur due to sexual arousal.”
So it’s safe to say, there are a lot of reasons sex may not feel as good as advertised for all of us.
What can we do about it?
This is the million-dollar question, isn’t it? To start with, Charlotte highlights the importance of visiting your GP if you have been experiencing pain during sex.
“It’s important to consult a GP as it could be due to a number of infections or conditions, such as thrush, trichomoniasis, genital herpes or conditions such as endometriosis, IBS, fibroids, and pelvic inflammatory disease.”
Your doctor will also be able to refer you to hospital for further testing and diagnosis if required. Being persistent here is key. As uncomfortable as it may feel talking about your sex life to a stranger, if you’re continuing to feel pain during sex it’s important to keep telling your doctor until you get an accurate diagnosis, and can start treatment.
The treatment you’re offered will depend on your diagnosis, and will often use a multi-pronged approach.
“If the issue has psychological causes, it may be treated with help from a qualified psychosexual therapist,” Charlotte explains. “If the causes are physical, your GP may be able to help or refer you to a specialist. A combination of psychological therapy and medical treatment can also be very effective.”
Elaborating on how psychosexual therapy can help, Charlotte says it gives us the opportunity to understand how our bodies respond, identify what turns us on and off, and work out what makes it feel better including various sexual positions/activities since “penetrative intercourse is not the gold standard of sex”!
The treatment itself, just like sex, isn’t always straightforward. After being put on nerve suppressants, using anaesthetic gels and dilators, which didn’t help, Zoe said she was finally offered a women’s counsellor.
“However, at that time I wasn’t really open to talking about it, as I just couldn’t comprehend the chronicity of the diagnosis, and how I would ever cope with it. I stopped all treatment that wasn’t working for me, and just had to accept my condition and hope that things would change in the future.”
When asked what did help, Zoe explains it was as simple, and difficult, as talking about it with her respective partner.
“Unlike before where during sex I would just grit my teeth, bear it and then suffer afterwards, now I own my emotions and I am more honest with the other person as to how it feels. If it doesn’t feel good, I stop.”
Zoe says this was somewhat of a revelation for her, noting that as hetrosexual women, sexual enjoyment isn’t always painted equally. Realising that by not expressing her needs, she was harming herself, changed everything.
"This new-found ability to curate a pain-free sex life gave me a huge sense of empowerment"
“For my own benefit, I’m now willing to, and capable of, navigate around the pain so I can still have fun,” Zoe says. “It gave me an insight into how sex doesn’t always have to be penetrative to be exciting. This new-found ability to curate a pain-free sex life gave me a huge sense of empowerment.”
Hearing that communication was key for Zoe resonates with me. After the relationship I was in ended, I buried my issues until I met my current partner. I knew that being honest with him was the only way we would navigate it, and that’s exactly what’s happened. I would be lying if I said things were perfect, but we’re working on it, and while we haven’t yet explored psychosexual therapy, we know it’s an option.
As Charlotte notes, when someone experiences painful sex it can cause them to avoid it and lose their sexual desire, but “talking about it, understanding it, making changes and compromises can lead to a happy, fulfilling sex life”.
It’s time to shrug off the shame, speak up, and improve our sex lives. We deserve it.
Charlotte Simpson is an accredited couples counsellor and psychosexual therapist. You can learn more about her work and find a psychosexual therapist at counselling-directory.org.uk
Learning more about your condition and talking to others who are experiencing similar problems can be helpful:
Visit the vulvalpainsociety.org for information and support groups for those experiencing vulval pain.
If you have Peyronie’s disease, visit peyroniesforum.net for online support.