Firstly, let's separate sex pain that occurs 'situationally', and sex pain that is a problem. Let's face it, we've all found a bad angle, or had an overenthusiastic (or oversized!) partner, and found ourselves hurting. This pain is typically a 'trauma' in the sense that a large, hard object hits against the vaginal walls (less painful) or the cervix (more painful). The other pain that can occur in this situation is pain during entrance, which is typically around the perineum as the skin might struggle to stretch and accommodate or be yanked (*shudder*) at a bad angle. These types of pain are typically not happening consistently - perhaps with the exception of cases where a partner is very well endowed. In these cases, we would consider adjusting position, taking time with foreplay, and being careful, rather than assuming there is an underlying issue with the vagina or vulva that needs resolved.

But, what about all those other types of pain...?

Pressure

When it comes to pain, one of the most overlooked types of pain is actually more aptly called discomfort rather that outright screaming pain. This discomfort can usually be described as a feeling of pressure, and, as many women point out, the feeling can be that you are about to have a bowel movement (aka. poop) when a penis or other object enters you - which, let's face it, is not how we want to be feeling at that moment in time!

For women who feel this sensation, there is usually no issue with external foreplay, such as oral sex, and no discomfort in the vulva, but when something enters the vaginal canal, there can be an unpleasant feeling of pressure on the back wall of the vagina (towards the anus) and for some women, during sex, it can feel as if they might have a bowel movement.

This is typical of anal prolapse, a rectocele, or uterine prolapse. For cases of vaginal or urethral prolapse, the pressure can be more 'frontwards', or there can be irritation in or around the clitoris or urethral opening.

We have gone into more depth on prolapse in this blog. As for a rectocele, this is a condition where the rectum, the last part of the large intestine, bulges forward and pushes against the back wall of the vagina. This bulge can cause symptoms like a feeling of fullness or pressure in the pelvis, difficulty emptying the bowels, and sometimes, pain during sex. It often occurs due to weakened pelvic floor muscles, which can be caused by factors like childbirth, aging, or chronic constipation.

Tightness

Tightness is another common issue that is distinct from pressure or other types of pain. This tightness can cause two issues; the first issue is that entering the vagina can be painful both in and around the vulva and vaginal opening/perineum, and the second can be when something is actually inserted, there can be a clamping or complete lack of elasticity.

Tightness like this can occur for different reasons, such as vaginismus or vaginal atrophy. It is important to note that, with atrophy, there will likely be other symptoms, but not always, whereas with vaginismus, tightness is usually the only symptom. Vaginismus is the body's automatic reaction to the fear of some or all types of vaginal penetration. Whenever penetration is attempted, your vaginal muscles tighten up on their own. Ouch.

For vaginal atrophy, many women find that they feel tightness (though it is different for everyone). This tightness occurs as the tissues have become thinner and dehydrated, and there is less blood flow, and the muscles of the vaginal canal have become tighter and less elastic, leading to the sensation of being overly tight.

Irritation or Burning

There are a lot of different things that can cause irritation or burning symptoms:

• Urethral prolapse can cause feelings of irritation at the urethral opening.
• UTI's can cause feelings of irritation or burning (before any other symptoms have started) around the urethral opening.
• Vaginitis, BV, yeast infections and other STD's or pH imbalances can all cause burning sensations in and around the vulva, vaginal opening, or clitoris.
• Vaginal Atrophy can cause burning, typically in the vulva or vagina, this is due to micro tearing as the skin has lost elasticity, and typically is felt in the vaginal opening, canal, or inner labia.

Sandpaper or 'Friction'

The most common cause of a sandpaper or cheese-grater like pain is vaginal atrophy. A combination of tightness and irritation, that sandpaper sensation is due to the lack of elasticity, micro tearing, and subsequent irritation, leading to the entire area feeling inflamed, angry, and very, very painful. This sensation can be all around the vulva, clitoris, and internally, and some women do experience bleeding if the tissues are really dried out.

Stabbing

Stabbing pain is surprisingly common, and unfortunately, the help online is infuriatingly vague - "it could be dyspareunia, the medical term for pain during or around sex." Um, ok? But, what is causing it?!

Well, a few things could be to blame: bladder inflammation (i.e., interstitial cystitis), ovarian cysts, endometriosis, uterine fibroids, or bowel problems, as well as more severe prolapse, can all lead to sharp, stabbing pains. Another cause could be pudendal neuralgia. So, let's take a look at those...

Interstitial cystitis is a chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. You can learn more about it here.

Ovarian cysts are fluid-filled sacs that form on or inside the ovary. Most ovarian cysts are harmless and disappear on their own. When ovarian cysts grow large, they can put pressure on nearby structures, causing pelvic pain. If a cyst ruptures, it can also lead to sudden, severe pain. Uterine fibroids are non-cancerous growths that develop in the uterus. They can vary in size and number, and some may cause symptoms. Uterine fibroids can cause pelvic pain, especially during menstruation or sexual activity. Large fibroids can also put pressure on the bladder or rectum, leading to discomfort.

Pudendal neuralgia is a chronic pelvic and perineal pain syndrome originating from damage, injury, inflammation, or irritation of the pudendal nerve.

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus. This extra tissue can attach to other organs, such as the ovaries, fallopian tubes, and intestines. The combination of tissue growth, adhesions, and inflammation can cause significant pain.

OUCH!

All in all, there are a lot of different ways we can OUCH during sex - and it is worth remembering that, for many women, they can experience this type of pain regardless of whether or not they are having sex due to sport, activity, clothing friction, and so on.

For many women, estriol - like in Silky Peach - can significantly help reduce many of the issues that cause pain during sex, such as dryness, atrophy, and pH issues that can lead to bacterial changes.

Try it today, and see if it can help you!