For many people with vulvas and vaginas, the experience of pain before or during penetrative sex can be hugely distressing. Vulval pain is something that many people experience and can happen at any stage of our sexual lives. It can lead to reduced enjoyment of sex or avoidance of sex altogether. Even just worrying that pain might return can have a serious impact on your ability to experience sexual pleasure, or to have to the kind of sex that you might want.
Some Definitions
There are different terms used by medical professionals when talking about female genital pain in relation to sex. Here are some of the most common ones.
Vaginismus
Vaginismus is an involuntary reflex spasm of the vaginal muscles. These muscle spasms may make penetration painful, and can be strong enough to prevent any penetration from occurring. People living with vaginismus can commonly experience pain in anticipation of penetrative sex also. This usually occurs in the build-up to vaginal intercourse but may also occur in anticipation of any object, such as a speculum or tampon, being placed in or even near the vagina.
Vulvodynia
The vulva is the skin surrounding the entrance to the vagina. Vulvodynia is persistent, unexplained pain in the vulva. The pain can be described as “provoked vulvodynia” which means that the pain happens when the vulva is touched. This includes pain on touching the vulva with clothing, fingers, tampons, or a penis or sex toy. Some people experience “unprovoked vulvodynia” which means vulval pain even at times when the vulva is not being touched.
The pain of vulvodynia is often described as a burning or soreness. The intensity may vary from mild discomfort to severe pain, and can interfere with a whole range of activities, including sex. The burning sensation may be felt over the entire vulva, or localised to just one part of the vulva or the clitoris. Some women also experience pain around the inside of the thighs, the upper legs and the anus.
The cause of vulvodynia is unknown, but it may be a result of irritation or hypersensitivity of the nerve fibres in the vulval skin. Possible triggers include a thrush (candida infection) or giving birth. It is not an infection and it is not related to cancer. In women with vulvodynia the vulva usually looks normal. Sometimes the vulva looks more red than usual, and it is commonly mistaken for thrush. In fact, repeated use of anti-thrush creams can make soreness worse.
Skin Conditions
The vulva can become dry and sore from using soaps, shower gels, bubble baths, vaginal creams and deodorants, which can cause irritation and in some cases lead to pain. Some women are allergic to latex in condoms, which can directly contribute to (and exacerbate) discomfort associated with penetration.
Other skin conditions can affect the vulva too; these include thrush, psoriasis, eczema and lichen sclerosis. These are usually itchy, but sometimes women just feel sore. The skin may be red and inflamed, or white patches may be visible. It is important to be examined by a doctor to see whether you have a skin condition, and to seek appropriate treatment (usually with a topical cream).
The experience of female genital pain
For different people, the experience of pain and discomfort can vary widely. For some, pain can include a burning sensation or stinging, whilst for others it might be itching or a dull, intense pain during and after intercourse. The experience of pain can be constant, or it can become worse at particular times. Pain may be worse when the vulva is touched or in anticipation of penetrative sex. It can range from mild discomfort to severe and long-lasting pain.
For some, pain does not just occur in relation to sex, but with anything that might involve touching their genitals. This might include using tampons and gynaecological examinations (or even the thought of these things).
Experiencing recurrent pain in relation to sex can be frustrating, disheartening and anxiety provoking. It is not surprising that many women end up avoiding sex or feel like they are unable to enjoy or endure penetration. Pain can leave many in a cycle of avoiding sex, not enjoying sex or not having an orgasm when they do have sex, and ultimately feeling less sexual desire.
This is incredibly common and is lots that can be done to support you to reduce pain experiences around sex.
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