Women and Painful Penetrative Sex

"I thought sex was 'supposed to hurt!"

Imagine the myth that vaginal penetration is meant to be painful--that this is a woman's burden--being handed down from one generation to the next, from mother to daughter or peer to peer.   The sad truth is that many women tolerate painful penetration (whether with a penis, fingers, or a toy) rather than letting their partner know. 

I was recently quoted in a well-written article in HealthCentral.com, "9 Reasons Sex Hurts and What to Do about It."  What I would add to the article is more about the role of pelvic pain, which is one of my areas of specialization.  Pelvic pain is associated with tight or hypertonic muscle tone of the pelvic floor muscles. 

This tightness can occur for a variety of reasons, from endometriosis to trauma carried in the body.  Some women have such tight pelvic floor muscles that penetration is impossible, resulting in a condition known as vaginismus.  But other women are able to have penetrative vaginal activity, and they will do so repeatedly because--unfortunately--that is what they are socialized to believe they are "supposed to" provide to their partner. 

And it isn't just heterosexual couples who have penis-vagina intercourse (PVI) who resonate with this thinking.  Women who are in partnership with sex / gender minority people may also continue tolerating painful vaginal activity operating under a similar belief.

Sometimes this goes on for months, but sometimes for years.  I have one woman tell me that she got so distressed at the idea of having painful PVI with her husband of several years that one night, when he initiated sex, she shrieked and ran from their bedroom and down a flight of stairs!  Once he understood what was happening he was completely sympathetic and accompanied her to the doctor's office. 

While she had some hormonal involvement due to being in perimenopause (low estrogen can make PVI uncomfortable), the physician suggested that because of her fearful response that she seek out help from a sex therapist.

We worked together for a few months, exploring why she continued to have PVI if sex hurt.  Aside from believing that "it's supposed to hurt," she also did not want to insult her husband and make him think that he was somehow to blame because of lack of skill as a lover.  Understanding that she owed it to herself to communicate what she was experiencing was empowering for her, and it helped the couple grow closer. 

Combined with the hormonal therapy and some relaxation techniques, she and her partner were ready to restart their sex life anew, both confident that PVI would be comfortable and the intimate experience they both wanted. 

While the idea that "sex is 'supposed to' hurt" may seem like one from days gone by, it is still present.  Women need to know that nobody needs to participate in any sexual activity that is painful or uncomfortable, but also that if it is, there is help for painful sex.