Vaginismus is the main culprit when women experience painful sex. But it isn’t the ONLY reason for painful sex.

This month, for the pelvic floor series, we’ve been talking about painful sex and how to treat it, and looking at why evangelical women experience painful sex at more than twice the rate of the general population.

Usually when sex hurts, vaginismus, an involuntary condition where the muscles of the vaginal wall contract, is the culprit.

But I’ve received emails this month from women experiencing pain during sex without having vaginismus, and so I’d like to share today some of the other conditions that can make sex hurt. Please don’t read these and diagnose yourself with all of them! Several are very rare. I just want  you to be aware of what these conditions are, in case you do have something to talk to your doctor about.

UPDATE:

Before I get into the medical conditions, so many on social media have reminded me that the main reason is lack of arousal! Absolutely. I talk about this all the time that I see it in a different category and so didn’t mention it here. But chapter 4 in The Great Sex Rescue is all about the problems with lack of arousal. If you aren’t aroused, sex can hurt!

In this post, though, we’re going to look at medical issues that can cause intercourse to become painful. For most experiencing some pain and discomfort, though, the problem may simply be lack of arousal.

Problems with the Vulva Vestibule

The vulva vestibule is the area between the labia minora, including the urethral opening (where urine comes from), the vaginal opening, and the clitoris. Different conditions can affect this area, including bacterial and yeast infections; inflammation; atrophy (where tissue and muscle gets weak and thin); muscle problems (vaginismus); and nerve problems. Let’s look at these in turn.

For help with vaginismus, please see the posts on the causes of vaginismus and how to overcome and treat vaginismus. 

1. Malformations of the hymen (anatomic problems)

The hymen is a thin membrane partially covering the opening of the vagina. In the normal course of life events, the hymen opens progressively more, and intercourse usually opens it entirely (although often it’s broken from intense physical activity earlier in life).

Some women, though, have thicker hymens than usual, and intercourse doesn’t break them. Some women have only a small opening that allows for menstrual blood and other discharge to leave the vagina, and may even allow insertion of a slender tampon, but that’s it.

And some women may not realize this until after they’re married.

A normal and thorough check-up by a physician would normally catch this before you’re married so that you can have the hymen surgically removed. If it isn’t caught until afterwards, the surgery is not difficult and the recovery is quite quick.

With vaginismus, the penis would be able to come into contact with the vagina, but then would not be able to go any further, and you’d feel the pain in your muscles. With a hymen issue, the penis wouldn’t even penetrate to reach the vagina, and you’d feel more of a stinging sensation.

2. Recurrent Infections and Vaginitis (problems with an infectious root)

One of the big causes of discomfort or a stinging sensation during intercourse may be UTIs and yeast infections. And unfortunately these two often go together. You take antibiotics to get rid of the UTI, and that can cause a yeast infection!

I’ve known women who have been on this roller coaster for years, where intercourse seems to trigger the UTI, and they’re also extremely susceptible to yeast infections.

If you’re having recurrent infections, please talk to your physician about this and seek extra help. You may benefit from changing your diet; changing the detergent you use; and more to try to overcome the yeast infections. You can also support your urinary tract with diet changes.

The big thing is to give intercourse a break until the UTI is completely cleared up. What often happens is that we treat the UTI until it’s no longer affecting us, but it hasn’t completely gone away. It’s only 95% gone. And then you aggravate it again and it flares up again. Give it a chance to be 100% gone.

Other infections can also wreak havoc in that area of the body, including untreated STIs (sexually transmitted diseases), or outbreaks of chronic STIs like herpes. Again, a physician can help wtih this.

Unfortunately, when infections become common or even chronic, vaginitis is often the result. Vaginitis occurs when the inflammation stemming from infection is so severe that the body produces so many white blood cells that they spread out of the vagina to “coat” the whole vulvar vestibular area, causing a secondary infection. If you start to have recurrent infections, STOP and talk to a doctor seriously about how to stem the problem and cure it once and for all before doing a merry-go-round of treatments and potentially making things worse.

3. Lichen Sclerosus et al. (inflammatory skin conditions where everything is much more sensitive and painful)

Other than vaginismus, the condition I get the most emails about is lichen sclerosus, which affects about 1.3% of women, usually after menopause. There are other diseases of the skin (dermatoses) that can also cause pain, but lichen sclerosus is the most common.

As Healthline describes it, “Lichen sclerosus is a chronic, inflammatory skin disease. It causes thin, white, patchy areas of skin that can be painful, tear easily, and itch.” Often physicians recommend corticosteroid cream to help treat this, but there is increasing literature that changing your diet can help reduce symptoms as well (though the jury is still out on this). Check out Healthline’s article for more help.

4. Atrophic Vestibulitis (where there’s a weakening, or atrophy, of the vulva and vagina)

Okay, that’s a very scary sounding condition, but basically what it means is that you have pain and often a deep burning sensation during intercourse. In this case, the cause is hormonal imbalances, often due to menopause, chemotherapy, a surgical removal of the ovaries, or even the birth control pill. It’s estrogen and testosterone (along with other hormones) that regulate blood flow to our genitals, keep everything well hydrated, and keep everything moving nicely. When the blood flow isn’t there, the whole area can “atrophy”, which means it basically gets smaller and weaker. The vaginal wall can thin, and make it much more susceptible to trauma and tears, and much less conducive to enduring thrusting!

The clitoris can also be affected, making it less likely to move, and even painful to the touch.

If you’re experiencing this, talk to your physician. If you’re post-menopausal or have had chemotherapy, some hormonal therapies can help. If you’re on the Pill, changing birth control along with some hormonal treatments can help restore the proper balance.

5. Neuronal Proliferation (where the nerve endings are increased and extra sensitive)

This one sounds really scary, but it’s seriously not that common. It’s a condition where there are increased nerve endings and sensitivities in that part of the body, which can make any touch, let alone penetration, very painful and overwhelming.

If you’ve always had this, it’s a very difficult syndrome to treat and should be seen by a specialist (again, though, this is VERY rare). Some people develop it because of irritants, though, especially to medications for yeast infections. In that case, there are easier treatments.

6. Vestibulitis, or general sensitivities (inflammation due to allergic-type reactions)

Finally, there’s the last category which is a bit of a catch-all. Sometimes the vulvar area can come into contact with something it just doesn’t like, and erupt in a big angry swollen tantrum. And, again, this can be chronic and recurring. Maybe you’re sensitive to detergents that wash your underwear; to chemicals in pads in tampons; to your razor; to your soap; even to different fabrics.

Reducing the use of soap in the vulva area can help (you actually don’t need a lot of soap; water on a facecloth is really all you need, and if you want more, try some baby oil). Change your detergent to something scent-free. Consider trying Diva cups rather than pads or tampons, or even use cloth menstrual pads washed in scent-free detergent, and change them frequently. Whatever you do, DO NOT use any internal cleaners. You don’t need them. Make sure your underwear is cotton. And, again, talk to a physician if you’ve changed all this and you still have problems.

The big takeaway from all of these problems that can cause painful sex: Take it seriously early.

Often we hesitate to go to the doctor about problems with the pelvic area, because, quite frankly, we don’t want to get naked and up in stirrups (more on that tomorrow!). But when you don’t deal with something early, it can spiral and you can end up with several of these problems at once. Vestibulities can cause chronic UTIs and yeast infections, which can spiral into vaginitis, which can trigger vaginismus. So deal with everything when it’s only one thing you’re dealing with!

And, honestly, most of these things do have treatments that work. Again, though, the earlier you talk to your physician, the better. When things start to feel “off”, go and ask. And if you don’t get a good answer, or if your doctor just keeps writing prescriptions for more antibiotics, advocate for yourself and say that you don’t just want treatment for symptoms; you want to get to the bottom of the actual issue.

Sometimes it takes seeing different doctors. Don’t be afraid to ask for a second opinion or to go to a specialist. This is serious stuff, and this can really affect your mental state, too. Take care of your body. You deserve it!

Have you ever had one of these issues–pain without it being vaginismus? Tell us your story in the comments!