When Sex is Painful: 5 Underlining Causes Responsible for Pain during Sex

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Sex is an important part of the human experience. For most of us, when we think about sex, we almost instinctually associate it with pleasure. Sex feels good, right? Exciting, spine-tingling, satisfying and empowering -these are a just a few adjectives that are commonly used to describe it. 

But what if your experience is quite the opposite? 

Now to be clear, we’re not talking about disappointing, boring or anticlimactic sex. Oh no, it’s far more problematic and worrisome than a less-than-satisfactory romp between the sheets. 

What if you experience pain during sex? When sex doesn’t feel good at all and you experience pain just before, during or after intercourse, it may be an indicator of a bigger issue. The pain that you experience during sex is your body’s intelligent response telling you, “Hey girl, something’s up!” In fact, you could be suffering from an underlying condition that can pose significant challenges to your health, general well-being and potentially your relationship.

Every Woman Experiences Pain Differently

The pain experienced during sex can range in intensity. It may present itself as a burning, uncomfortable sensation. For some women it can feel like a dull, persistent ache. While others describe their experience of painful sex as a sharp, stabbing jolt that can leave them temporarily debilitated. While the reason behind the slight pain and discomfort experienced during sex could simply come down to a particularly tricky sexual position, more severe and persistent pain may indicate serious health issue.

So what are the underlining causes for pain during sex? And more importantly, how do you treat pain during sex? There are a number of factors that can be responsible for the pain experienced during sex. Dealing with pain during sex, regardless of how it is experienced can be incredibly frustrating. In this article, we’ll guide you through the five most common causes, as well as providing you with available treatment options including natural remedies for pain during sex.

Pain During Sex is More Common than You Might Think

You may not be aware that the majority of sexually active women will at some point during their lives experience pain just before, during or after sexual intercourse. In fact, pain experienced during sex is actually more common than you might think. What’s even more concerning is that most women just deal with it rather than seeking help. 

This is largely due to the fact that this issue hasn’t been openly discussed in the past. Fortunately, discussing sexual issues such as pain experienced during sex has become less taboo and more women are talking openly about their experiences.

There have been a number of recent studies that reveal just how common this issue is. A study carried out by the American College of Obstetricians and Gynaecologists found that nearly three out of four women experience painful sex at some point during their life. In 2017, the largest research study conducted on the subject was published in the UK. The study comprised of 7000 participants who were evaluated to determine the prevalence of painful sex in sexually active women. The resulting data revealed that 7.5% of women reported that they experienced some form of pain during sex. 

Should you experience long-term pain and discomfort just before, during or after sex, consult your doctor or gynaecologist to find out what the underlying cause is and explore various treatment options available to you.  

Thankfully help is at hand and with more and more women openly discussing their personal journey with painful sex including the various causes, diagnosis and available treatment options, the out-dated stigma associated with women talking about pain during sex is starting to fade. 

The important thing to note is that pain experienced during sex CAN be treated and there are a number of treatment options including natural remedies for pain during sex that are available. The first step is to properly identify the underlying cause and with the help of a healthcare professional choose a treatment plan that is best suited to you.

The five most common causes for pain during sex are:

  1. Dyspareunia
  2. Vaginismus
  3. Endometriosis
  4. Diabetes-related Complications
  5. General Lubrication Problems

Compiled below, you will find detailed information on each of the five most common causes of painful sex so that you can empower yourself and feel more confident about taking the first step in seeking treatment.

1. Dyspareunia

Dyspareunia is the medical term used to describe painful intercourse. It is defined as a persistent or recurrent pain in the vagina that can occur just before, during or after intercourse. In addition to the physical pain, this condition can have negative emotional effects on a couple’s relationship.

Who can get dyspareunia?

We now know that most women will experience pain during sex (medically referred to as dyspareunia) at one point or another during their lives. It is a fairly common condition that can be caused by a number of underlying conditions. Depending on the cause of the pain, there are many effective treatments available that will alleviate or lessen the frequency of dyspareunia occurring.

What are the causes?

Many women experience pain or discomfort during sex when there isn’t enough lubrication present in the vagina. This can typically be remedied by using a personal lubricant before or during sex. However, for some women the pain they experience during sex is an indicator of a more serious health problem. Some of the most common causes for dyspareunia include:

  • Vaginismus- spasm of the vaginal muscles (see point 2).
  • Yeast or urinal infections.
  • Endometriosis (see point 3).
  • Problems with the cervix.
  • Problems with the uterus such as fibroids that can cause pain and discomfort during deep penetration.
  • Ovarian cysts.
  • Pelvic inflammatory disease (PID)- when the tissues deep inside the pelvic cavity become inflamed and the pressure of intercourse causes pain.
  • Sexually transmitted infections (STI’s) such as herpes, genital warts, etc.
  • Dryness and decreased natural lubrication of the vagina as a result of menopause. With age the vaginal lining can lose its normal moisture and thickness and become dry and inflamed during sex.
  • Ectopic pregnancy- characterised as a pregnancy in which a fertilized egg develops outside the uterus.
  • Having sex too soon after childbirth. Although every woman heals differently, it is typically advised that women should wait six weeks after childbirth before having sex as this gives their body time to heal.
  • Injury or trauma to the vulva or vagina- injuries may include an episiotomy (a surgical cut between the vagina and anus that is made during labour) or a tear from childbirth.
  • Skin disorders such as eczema. 

How is it diagnosed?

Dyspareunia is diagnosed by conducting a thorough medical evaluation that typically consists of your doctor going through your medical history, as well as asking you to describe how the pain feels, where it hurts and when it happens. Next, the doctor will do a pelvic examination on you to check for signs of infection, skin irritation or anatomical problems. In certain instances where the doctor suspects a specific cause of painful sex, they might recommend a pelvic ultrasound (as with most cases of endometriosis).

Management and treatment of dyspareunia There are various avenues for treatment and they differ according to the root cause of the pain. Your doctor will consult with you and put together a treatment plan that is best suited for your specific circumstances. Women who suffer from dyspareunia who have ruled out physical and medical causes for their condition are advised to explore the emotional triggers that cause their anxiety with regards to sex. Some women have found talk therapy and counseling beneficial in unpacking their emotional baggage associated with sex or past sexual trauma. Others have found that behavioral cognitive therapy to be extremely helpful in reconstructing a healthy relationship with sex. More recently, a growing number of women have found that using CBD products such as Enigma Serenity (cannabis supplement) and Enigma Zen (CBD vape) to be extremely helpful in managing their anxiety and promoting relaxation.

2. Vaginismus

Vaginismus is the involuntary contraction or spasm of the muscles around the vagina. These muscles are responsible for urination, bowel movements, intercourse, orgasm and childbirth. This can occur during sexual intercourse, when inserting a tampon or when undergoing a gynaecological exam. 

Who can get vaginismus?

The precise number of women who suffer from vaginismus is not known. However, treatment is available and it is important for women to discuss any concerns they have with their health care professional.

Vaginismus can occur when women are in their teens or early twenties. The condition can arise when females first attempt to use tampons or have penetrative sex for the first time. However, some women develop vaginismus later in life. It may be the case that it occurs every time penetration or intercourse is tried, or only in certain situations. The condition can present itself differently in each woman.

What are the causes?

Although certain physical conditions can contribute to vaginismus, it is considered to be a psychological condition. The following situations can contribute to vaginismus:

  • Anxiety.
  • Fear of sex.
  • Negative emotions associated with sex.
  • Past sexual abuse or trauma.

Contributing physical conditions related to vaginismus include:

  • Urinary tract and yeast infections.
  • Lack of estrogen in post-menopausal women (atrophic vaginitis).

How is it diagnosed?

Your doctor will ask you to describe your symptoms as well as the circumstances when you experience pain. A pelvic exam will be conducted to rule out any other possible causes. If there is no physical condition found and the pain only occurs during penetration, the diagnosis is most likely vaginismus.

Management and treatment of vaginismus

Vaginismus is a treatable condition. It is usually treated with a combination of Kegel exercises which help to relax the pelvic floor and some form of counselling to help the patient deal with the underlying psychological stressors. Some women have found using cannabis-infused lubricant during intercourse to be a soothing natural remedy for pain during sex. CBD rich personal lubricants such as Enigma Sensation and cannabis infused suppositories such as Enigma Comfort are known for their therapeutic and pain-relieving benefits and are a great natural alternative to anesthetic creams. A growing trend has seen more women seek out and use CBD wellness products such as Enigma Serenity (cannabis supplement) and Enigma Zen (cannabis vape) to manage their vaginsmus-related triggers such as anxiety and stress. These CBD-rich products boast a number of therapeutic benefits which many women swear by and are increasingly being incorporated as part of a holistic wellness regimen. 

How to use Enigma Sensation to alleviate the symptoms associated with vaginismus

As vaginismus is a condition that affects the muscles surrounding the vagina, resulting in the muscles to spasm or tense up, using a CBD- rich personal lubricant can help alleviate the pain. The active cannabinoids contained within Enigma Sensation cannabis-infused lube work wonders on relaxing the muscles, limiting inflammation (the main contributor of pain) and desensitizing pain-perceiving nerves. Cannabis-infused lube also increases the natural production of lubrication in the vagina which allows for more comfortable and pleasurable sex. Application is easy. Simply apply a pea-sized amount of cannabis-infused lube onto the vagina and vulva during foreplay or before penetrative sex and wait a few minutes for it to be absorbed into the desired area. A cannabis-infused lubricant such as Enigma Sensation has helped many women who have vaginismus experience an improved and more pleasurable sex life, free from pain and discomfort.

3. Endometriosis

Endometriosis is a complicated and often painful condition in which the tissue that normally lines the inside of the uterus (the endometrium), grows outside the uterus. In women who suffer from endometriosis, the endometrial tissue develops on the ovaries, fallopian tubes and the greater pelvic region. 

With each menstrual cycle, the endometrial tissue grows, thickens and sheds. However for women with endometriosis, this tissue has no way of leaving the body and as a result, the trapped blood and tissue can cause nodules, adhesions and lesions which trigger an inflammatory response as the body struggles to reabsorb the dead material.

Endometriosis can result in chronic pelvic pain, painful periods (dysmenorrhea), painful sex (dyspareunia), painful bowel movements (dyschezia) and painful urination (dysuria), as well as back, neck and shoulder pain. This cyclical pattern can become unbearably painful and may lead to other long term complications such as infertility. 

Who can get endometriosis?

Although estimates on women who suffer from endometriosis vary greatly throughout the world, it is believed that roughly 1 out of every 10 women of reproductive age suffer from the condition. In fact, it is one of the most common gynaecological conditions with one study revealing that approximately 176 million women suffer from endometriosis globally. 

Endometriosis is often referred to as the “hidden epidemic” as it is often difficult to diagnose despite it being a relatively common gynaecological condition. Some women don’t present symptoms, while others may battle with chronic symptoms for years but incorrectly assume that they simply experience a particularly heavy and painful menstrual cycle. Unfortunately for many women, getting a correct diagnosis can be a long and frustrating procedure that involves visiting several doctors before a diagnosis is confirmed. 

What causes endometriosis?

The exact causes of endometriosis are still unknown. One theory suggests that endometriosis could develop from endometrial cell travelling through blood vessels and the lymphatic system. There is evidence that the condition can be passed down through families which means that a woman is more likely to have it if someone in her family does. Research has also shown that elevated levels of estrogen, certain genes and the immune system may all play a role in the development of endometriosis. 

Other factors that may influence whether a woman is more likely to develop the condition include:

  • Giving birth later in life or not at all.
  • Starting your period at a young age.
  • Late menopause.
  • Women who tend to have short menstrual cycles (less than 28 days).

How is it diagnosed?

Endometriosis is often a difficult order to diagnose correctly. Many women with endometriosis are treated based on their symptoms alone, without a formal diagnosis. However, in order for the condition to be accurately diagnosed a surgical procedure called a laparoscopy is required. A laparoscopy is a simple procedure whereby the doctor makes a small incision in the abdomen and inserts a camera to look inside the pelvic cavity for endometrial tissue. A small tissue sample may be collected for further testing.

If the healthcare professional suspects you may suffer from endometriosis, they may also perform a pelvic exam or pelvic ultrasound. During your consultation be sure to provide your doctor with your complete medical and menstrual history, as well as any issues you may have experienced with infertility and miscarriages. When describing your symptoms try and be as descriptive as possible. 

Management and treatment of endometriosis

Endometriosis is a condition that can last for many years and if left untreated can get progressively worse. There is treatment available which largely focuses on the management of symptoms, as the underlying cause of endometriosis is still unknown. 

The approach to treatment will largely depend on what and how severe your symptoms are, as well as your personal goals. For some women with endometriosis the goal may be to become pregnant, for others it might be to decrease pain levels. Doctors will typically recommend trying a conservative treatment approach first before opting for surgery.

Treatment options include:

  • Over-the counter pain medication.
  • Hormone therapies.
  • Surgery to remove problematic tissue.
  • In severe cases, a hysterectomy will be suggested as a “last resort” treatment option.
  • Lifestyle changes such as diet changes, physical exercise and acupuncture.

THC and CBD-infused female wellness products such as Enigma Sensation (cannabis-infused lube) and Enigma Comfort (cannabis suppositories) have been shown to be remarkably effective therapies in reducing the symptoms of endometriosis. Products such as these are excellent natural remedies for pain during sex. 

4. Diabetes-related Complications

Diabetes can lead to complications in the normal sexual function of both men and women. Diabetes is a condition where a person has high blood sugar levels as a result of their body being unable to produce enough insulin. Over time, elevated blood sugar levels can lead to various complications including cardiovascular problems and nerve damage, both of which have negative implications for sexual health.

Problems that women with diabetes may encounter:

  • Reduced vaginal lubrication which leads to dryness, discomfort or pain during sex.
  • Less or no sexual desire.
  • Inability to become or stay aroused.
  • Decreased or no feeling in the genitals.
  • Difficulty achieving orgasm.

What causes sexual dysfunction in women with diabetes?

  • Cardiovascular problems leading decreased blood flow to the vagina.
  • Hormonal changes.
  • Nerve damage.
  • Side effects as a result of medication.
  • Smoking and alcohol abuse.
  • Stress, depression and anxiety.
  • Conditions relating to pregnancy or menopause.
  • Infections such as thrush, UTI or cystitis.

How is it diagnosed?

If you have diabetes and suffer from any of the above symptoms, it is recommended that you consult with your doctor and discuss various treatment options available. 

Management and treatment options:

When it comes to complications related to diabetes, vaginal dryness and pain during sex are the issues that concern women the most. Healthcare professionals commonly advise women to use personal lubricants before they engage in sexual activity as a practical solution to their problem. While most commercially available lubricants will get the job done, more women are turning to cannabis-infused lubes as an infinitely better and more natural alternative to conventional lube. Cannabis-infused lubes such as Enigma Sensation addresses many of the sexual complications encountered by women with diabetes. One of the most practical benefits of using cannabis-infused lube for female diabetes sufferers is that the endocannabinoids found in cannabis-infused lube acts as a powerful vasodilator. There is a growing body of research that supports the vasoldilatory impact of cannabis and how it may alleviate the symptomatic effects of cardiovascular dysfunction, like those experienced by people who suffer from diabetes.

Therapeutic benefits of cannabis-infused lube include:

  • Promotes increased sexual arousal and heightens sexual pleasure.
  • Stimulates and increases the vagina’s natural lubrication.
  • Alleviates pain and inflammation.
  • Increases tactile sensations.
  • Intensifies and prolongs orgasms.
  • Anti-fungal and antibacterial properties.

5. General Lubrication Problems

At some point in their lives, most women encounter bouts of vaginal dryness. We know that there are various underlying medical conditions that can lead to vaginal dryness and painful sex. However there are many general factors such as diet, stress, age and even some medications that can also have an impact of the vagina’s natural lubrication too. 

While commercially available personal lubricants may be most women’s first point of call, they often contain a number of synthetic (and sometimes harmful) ingredients that can cause health issues of their own. 

For women who are searching for natural lube alternatives, cannabis-infused lubricants such as Enigma Sensation offers them a wonderfully safe and therapeutically beneficial option (not forgetting the enhanced sexual pleasure). It is the perfect all-natural solution to combating dryness and discomfort, as well as promoting pain relief and reducing inflammation. Other natural lube alternatives are available, however they each have their own pro’s and con’s (more info on this here). 

How to choose the best natural lube for sex

When using any personal lubricant, the health and wellness of the most intimate part of your body should be the most important factor to consider. You should feel confident in your decision when choosing a lubricant and trust that it is safe to use. Peace of mind is priceless, especially in matters concerning your sexual health. 

It’s for this very reason that a growing number of South African women are choosing to include Enigma Sensation as part of their sexual health care regime. Developed by women, for women Enigma Sensation cannabis-infused lube is hypoallergenic and independently lab tested to ensure absolute purity from harmful chemicals, toxins, microbes and dangerous synthetic additives. This flagship product from Enigma Women boasts a signature blend of premium-grade, hypoallergenic Grape Seed Oil that has been infused with CBD and THC extract sourced from the highest quality, organically grown cannabis in South Africa.

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Team Enigma

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