Should Sex Hurt?

Should sex hurt?

BIG, FAT, NO.

Pain with sex is never normal, but unfortunately not all that uncommon. I’ve often heard from my patients that they just have “the normal amount” of pain when they’re with their partner. They often just “grin and bear it.” Sister, there is no normal amount of pain with sex! It’s supposed to be fuuuuun!

In the medical world, we call pain with intercourse Dyspareunia. There are all sorts of sub-categories that I’ll get to in a different post, but in general, we can lump it all under dyspareunia.

Before we continue, I want you to know that dyspareunia is VERY treatable and NOT something you just have to grin and bear. THAT’S GOOD NEWS!

Here’s a simple breakdown of what might be causing the pain:

Tissue stretch.

This will typically be pain at initial penetration that may get better as you keep going. It’s common after having a vaginal delivery, especially if there was tearing. And it’s often pretty quick and easy to treat with desensitization and stretching—good news!

Try this just before penetration: put some lube on your thumb, then place it just inside the vaginal opening. Press downward to stretch the tissue, while focus on relaxing the muscles.

Overactive pelvic floor.

Our muscles react to pain by bracing for it, right? If you’ve had pain with sex in the past, your pelvic floor is likely bracing for it, aka tightening up. Which will likely, in turn, cause pain. And make you tense up more...and on and on. The key here? Learn to release the muscles. Sometimes it’s as simple as learning to relax the muscles. Other times, especially if it’s been going on for some time, the muscles may need to be released by a professional like a PT (basically a massage, but internal.) These muscles can get knots and trigger points just like any other muscle, and can be released just like any other muscle too.

Try this: Focus on your sitbones widening as you take in a big inhale, then release the breath. Now try pushing out with a big inhale. Focus on breath and pushing out to actively release the muscles while your partner pushes in.

Tightness in the hip rotators.

I can’t tell you how many times I’ve heard someone say “it feels like he hits my cervix.” The cervix is not typically sensitive! Most often when this occurs, usually with deep penetration, it’s a deep hip rotator called the obturator internus. More good news? It’s often easy to release.

Try this: Pull your knee toward your armpit (kind of like a one-sided happy baby pose), and relax there for a couple minutes. Or try that position during sex and see if it helps.

There are more complex causes of dyspareunia that we’ll get to later, but these three are the top ones I see in the clinic. Can you relate to something in here? Take it as good news! Find a PT (make a free 15-min phone appointment with me!, or if you’re not in my area find one here) and let’s get it taken care of. Often times it can be addressed in just a couple visits.

I can imagine a world where no woman says she just has to “grin and bear it.”

YOU are worth more than that.