Pain during sex: Endometriosis, Vulvodynia, or Vaginismus

pain during sex

Ever experience pain while inserting a tampon or trying to have penetrative sex? If you have, you’re definitely not alone and it could be a medical condition. Intense pain, burning, or throbbing when trying to have penetrative sex (medically referred to as dyspareunia), inserting a tampon, and/or sporadically without an obvious cause may be a condition that requires further medical support. Navigating the information regarding the possible causes for this pain can be overwhelming (we’ve been there!), so we’ve compiled an outline of a few possible reasons behind the pain you’re experiencing.


What is endometriosis?

People with vaginas have a tissue that lines the uterus called the endometrium. Endometriosis occurs when endometrial tissue is found in places it should not be, such as the pelvic cavity and other reproductive organs like the fallopian tubes and ovaries. In some rare cases of the disease, endometriosis can spread to other, non-reproductive organs.

When would I feel pain?

If you have endometriosis, you would most likely feel pain during and after penetrative sex, before and during periods, or during bowel movements.

What does endometriosis pain feel like?

If you have endometriosis, you would feel deep internal discomfort and pain in your abdomen. Additional symptoms are abnormally heavy periods, infertility, diarrhea, constipation, fatigue, and nausea during periods.

How common is endometriosis? What causes endometriosis?

It is estimated that 1 out of 10 people between the ages of 12 and 52 have endometriosis (approximately 200 million people worldwide). Even though endometriosis affects so many, the disease is largely under-researched. Because of this, the causes of endometriosis are not scientifically confirmed but are theorized to be:

  • Metaplasia — when your body produces tissue cells in an area where that particular cell type is not typically found
  • Genetic disposition — if someone in your immediate family has endometriosis, you are more likely to develop it
  • Lymphatic/vascular distribution — when tissue cells from the lining of your uterus travel through the lymphatic system or blood vessels to other areas of the body
  • Immune system dysfunction — some people who have endometriosis also exhibit certain immune system defects
  • Environmental factors — a few studies have suggested that toxins in the environment may affect the immune system and reproductive hormones


What is vulvodynia?

Vulvodynia is a condition that causes chronic vulvar pain. The vulva is the external part of your genitalia, which includes the clitoris, labia majora, labia minora, vestibule, and urethral meatus. Those are a lot of anatomical terms! See a straightforward diagram here.

Vulvodynia can either cause pain in one specific spot on the vulva (referred to as localized vulvodynia) or cause pain consistently in various areas of the vulva (referred to as generalized vulvodynia). In both cases, the pain occurs regularly for more than 3 months. Most people with localized vulvodynia also have provoked vestibulodynia (PVD), meaning that when pressure is applied to a specific spot on the vulva, intense pain is felt.

When would I feel pain?

If you have vulvodynia, you may feel pain spontaneously or when pressure is applied to your vulva like when attempting to insert something in the vagina. Other instances in which you may experience pain are during gynecology exams, times of prolonged sitting, or when wearing tight pants.

What does vulvodynia pain feel like?

Those who have vulvodynia say that it feels like an intense burning sensation (in some cases, in a specific spot on the vulva), stabbing pain, rawness, and soreness.

How common is vulvodynia? What causes vulvodynia?

Approximately, up to 16% of people with vaginas experience vulvodynia at some point in their lives (another study estimates vulvodynia affects 25% of people with vaginas). Even though vulvodynia is quite prevalent, the condition often goes misdiagnosed or undiagnosed altogether.

Due to a lack of intensive and ample research, the causes of vulvodynia are currently unknown. However, with a recent increase in studies, researchers hypothesize vulvodynia may be caused by:

  • Injury or irritation to the nerves that transmit pain from the vulva to the spinal cord
  • A high number of pain-sensing nerve fibers in the vulva
  • Past vaginal infections
  • Weak pelvic floor
  • Changes in hormones


What is vaginismus?

Vaginismus is a condition that causes your pelvic floor muscles to spasm or involuntarily tighten, making it difficult to insert anything into the vagina (tampon, vibrator, penis, and even, at times, a small cotton swab).

There are two types of vaginismus: primary and secondary. Primary vaginismus is when you’ve never been able to insert anything into your vagina. Secondary vaginismus is when vaginal penetration has been possible before but is no longer possible due to pain.

When would I feel pain?

If you have vaginismus, you would most likely feel pain when attempting to insert anything (a penis, vibrator, a finger, cotton swab, etc.) into your vagina. This pain would make penetration difficult, or even impossible.

What does vaginismus pain feel like?

With vaginismus, many have described what feels like a wall blocking entry and intense stinging or throbbing.

How common is vaginismus? What causes vaginismus?

It is estimated that 0.5% - 1% of people with vaginas experience vaginismus. Vaginismus does not always have a known cause, but medical professionals list potential causes as previous sexual trauma, heightened stress levels, previous physiological trauma, or other instances of painful intercourse.

What if I don’t experience intense pain but some discomfort? Is that normal?

Overarchingly, painful sex (and pain in general) should not be written off as a “to be expected” or normal occurrence — sex should be consensual, enjoyable, and pain-free. Oftentimes, if you’re experiencing mild discomfort while having sex, lube can be a game-changer.

Additionally, we encourage you to check out our blog posts on yeast infections vs. UTIs and sexually transmitted diseases (STDs). Yeast infections, UTIs, and some common STDs can cause pain during sex if not treated, so be sure to give them a read as well! With all of this in mind, if you’re experiencing any pain, please contact your primary care provider for assessment.

What to do if you think you have one of these conditions

If you think you may have one of these conditions, know that you are not in this alone and should not feel any shame. You are also not fated to live with this pain. Thankfully, because so many have come forward to showcase the prevalence of these conditions, research and treatments are improving. As a few next steps, we encourage you to do further research and see your primary care provider as soon as possible to discuss the next steps and treatment options.

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