What's REALLY Causing Painful Sex for Women?

If there is one thing I remember about sex during my marriage, it’s that it was painful. 

Painful at entry.
Painful during thrusting as he hit my cervix, no matter the position.
Painfully raw inside, just seconds after starting penetration.

And painfully alone.

He’d orgasm, blissed out, and I’d be feeling so utterly broken for not knowing what was happening to my body — or being able to change it.

I was a married woman who struggled with painful sex, inability to orgasm, and eventually, a complete and utter lack of sexual desire. 

Then, there was the sexless marriage, too.

I didn’t go down without a fight. 
I searched all over for answers. 
I sought out help from the medical field. 

At the time, I was a graduate student at Stanford University, and I found the best of the best …
A gynecologist.
A gastroenterologist.
Even a lung specialist.

Everything was ruled out.

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Pelvic inflammatory disease — negative.
Endometriosis — negative.
Ovarian cysts — negative.
Uterine fibroids — negative.
Sexually transmitted diseases — negative.
A tumor the size of a newborn baby that could be causing pelvic pain so severe — negative.

What I did have fell under the catch-all label of vaginismus — a tight and painful vagina.

A vagina that wouldn’t open up when it’s “supposed” to.
A vagina that’s misbehaving.
A vagina that’s betraying me.

I had gotten advice to learn to use vaginal dilators to stretch the muscles, but that felt like trying to force open something’s that shut.

And I was told to masturbate, as if masturbating would open things up, like a magic key to everything.

But nothing had changed in my relationship. I was scared, shut down, and disconnected from my own body — not to mention my husband. And we were doing the same thing that we were doing before, having no clue how to change things.

What I wanted the most was answers and actionable information — how to have sex again, how to feel better about myself and how to reinstate the intimacy that I’ve lost with my husband because of the sexless marriage.

Don’t get me wrong. Being diagnosed with something, anything really, gave me comfort and relief. But that was not even close to being enough.

I wanted things to change.

And while everyone looked for things that are wrong with me (was it vaginismus, vulvodinia, tumors?), no one — not a single person — ever asked the real question.

Is what you’re doing in sex enough to have you enjoy it and want to open up?

No one ever asked:

  • Do you get enough sensual touch that your body enjoys?

  • Do you have enough time for you to open up?

  • Do you feel safe with each other to share your desires?

  • Do you feel connected, understood and met by your partner?

  • Do you speak up about what you want and need?

  • And is your partner listening?

Everything I was told was about what is wrong with me.

No one dared to ask the questions about the real culprit — the conditions of the sex that I was having.

And no one provided the step-by-step guidance and a roadmap out that I was desperate for.

………..

Pain in sex is extremely common for women. This one paradigm shift will put you back in charge of your body.

Pain during sex is a very common problem for women. As many as 75% of women will experience pain during sex at some point, according to the American College of Obstetricians and Gynecologists.

For many, the pain is occasional and situational, caused by conditions such as certain medications, STI outbreaks, bacterial or yeast infections, polyps, cysts or fibroids, endometriosis or traumatic child birth. In such conditions, treating the source and healing shifts the pain during sex.

But for many millions of women, painful sex is a persistent reality — every time they have sex.

It’s called dyspareunia or genital pain associated with sexual intercourse.

It’s not explained by any medical condition or trigger. It just is. And many women experience it. Too many women.

It can look like: 

  • Tightness and pain upon entry

  • Pain against the cervix when being thrusted into

  • Tearing and bleeding

  • Painful cramps and spasms

  • Inner soreness and rawness if penetration happens for more than 1-3 minutes

When you’re in a relationship, it’s easy to make it personal.

It’s easy to draw the conclusion that it’s you, or your body, or your sexuality.

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I’m just not made for it.
What’s wrong with my body. I must be broken. 
I should be enjoying this, why am I not?

Stats like this — that a whopping 75% of women experience painful sex — are supposed to normalize our experience.

When in fact, there is nothing normal about 75% of women experiencing painful sex.

That’s a lot of “sexually broken” women.

Instead of only looking at what’s wrong with these women medically and blaming it on our presupposed sexual “dysfunction,” we should be asking a different question.

What is it about the sex that we’re having — the way it’s “done” — that’s not working for so many women?

It’s easier to see it in another setting. Take this analogy, for example.

You go to a 3-star Michelin restaurant that’s been extremely well reviewed in the media and by your friends. 

It’s a dream come true for you. You’ve been salivating over the idea of a delicious meal: something that would awaken your senses, something that would surprise and excite you, something that would leave you satisfied and wanting more. 

Others have raved about it, and you want a piece of it, too.

You put full trust into the chef, and you let them serve you the best of the best with the tasting menu. They’re amazing, after all, why not just let them decide.

Then you’re served beef. Amazing, pasture-raised, grade A beef. From the best farmer and butcher in the whole country. Freshly delivered.

And … served raw. Every single dish of the 7-course menu has raw beef.

But you don’t like your beef raw.
It makes you gag. 
And it causes a major stomach ache for you.

But you grin and bear it.
You swallow, even though every part of your body is screaming for you to stop.

But it’s supposed to be good, you reckon. 
It’s a high-ranking restaurant and everyone loves it, I should appreciate it too, you rationalize to yourself.

Gulp. Another bite, another swallow.

Given this experience:

  • Will you ever want to have more of this food again?

  • Would you crave going to this restaurant ever again?

  • Will you be just as in love with the restaurant and the chef just like before, if you continue eating this beef and feeling nauseous and sick?

The likely answer is no.

And,

  • Would you blame yourself for not liking your beef raw?

  • Would it be your responsibility to like it just because it’s served?

  • Would it be a personal rejection of the chef if your body rejected raw beef?

I know back when I was struggling with painful sex, I would have just been happy to “grin and bear” it in the restaurant too.

I was doing it for the same reason I was doing it in sex.

I didn’t know how to use this one thing that would have made a world of difference.

And it became a paradigm shift that changed everything when I learned to use it. It changed my relationship to my body, my relationship to my partner, and my ability to enjoy sex.

The “it” that I am talking about is knowing, believing and acting as if I have a voice — a say — in what happens to my body.

Instead of grinning and bearing it, then swallowing the consequences, I have power to speak up and ask for what I want.

In a restaurant, I could ask for beef that’s cooked, to my liking. Because then, I’d be raving about it — guaranteeing amazing reviews from me and recommendations to all my friends (and what more could a restaurant ask for?!).

And in sex, it’s:

  • Using my voice to share with my partner what I was experiencing

  • Conveying what my body was craving for

  • Expressing what didn’t work and asking to explore what did

That voice would have been my guide to change — and to feeling in charge of my own body.

I have it — and you do too!

Because that’s what our voices do.

Using your words allows you to shape the experience of what happens to your body to work for you.

And there is a very important reason for doing it.

Pain or even discomfort during sex doesn’t just ruin the moment. There are far deeper consequences: fear of sex, anxiety, lowered libido, further disconnect from your own body, as well as loss of intimacy and closeness with a partner.

Worse of all, continuing to have painful sex and convincing yourself to bear it takes the biggest toll on self esteem.

We feel bad about ourselves and are powerless to change it.

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And that powerlessness has the biggest impact on our libido. It kills it.

Feeling out of integrity with ourselves saps all life energy out of us.

Ignoring our own inner knowing that we need something more, even though we don’t know what it is or have words to explain it, diminishes our confidence.

And the truth is: you cannot be empty on life energy and experience libido, which is life energy at its core.

Your voice and your vagina are inexplicably linked. They need each other. The vagina and the throat are doorways into the body from the outside world as well as instruments of self-expression in relationships.

They are the keys to your libido … and allies in getting you what you desire.

………..

Committing to these “sex commandments” will allow you to avoid the pain (and find your life force too)

The real reason why so many women experience persistent painful sex — when it’s something that carries so much potential for pleasure for us — is that we’re allowing ourselves to have sex too early, too quickly, and without proper arousal.

Our bodies are like a fruit waiting to be ripened, only to be picked green and cause a stomach ache.

When it comes to painful sex, our bodies are simply protesting against this.

The solution is not to fix yourself.

Because you’re not broken.

But you do have to fix the sex that you’re having and it starts with your commitment to your “no.”

It’s not a “no” to sex. 
It’s a “no” to painful sex. 

And it’s a “no” to these five behaviors that actually worsen painful sex.

Here are five causes that we dare not speak about that are actually causing painful sex for many women and the “commandments” that your body is begging you to commit to.

 

Cause #1 of painful sex: Not having enough physical arousal and engorgement when having intercourse

Commandment: Respect your body’s need to build arousal

What is arousal? It’s the body’s way of getting ready for sex.

For men, the penis gets hard and can swell up to 200% its flaccid state. On average, that can take anywhere from 30 seconds to 3 minutes. At that point, the man is able to have pleasurable intercourse and an orgasm.

For women, arousal looks like: her muscles getting relaxed, her senses becoming heightened, her skin receptors becoming more sensitive, her nipples getting engorged, her genitals getting wet, her clitoral shaft and arms swelling up to 300% its relaxed size, her vagina lengthening (or deepening) from 2-4 inches to 4-8 inches when aroused, her cervix tilting up, her emotional state opening, and her mind turning off.

This takes on average 45 minutes to an hour for a woman who has pleasurable sex on a regular basis. For someone who has occasional sex or sex that is not entirely pleasurable, that first time for her to achieve high levels of arousal can take several days of playful connection, touch and adoration. At that point, she can engage in what will be pleasurable penetration sex.

See the difference?

It’s no wonder that most women experience painful sex. Women have penetration on men’s timelines, when men are ready, which means they’re having sex before their arousal levels are high enough to pleasurably welcome a man (or a toy) inside.

When it comes to pain, sexual (physical) arousal is more than just for pleasure — it creates an anesthetic effect across the body, reducing pain and making things that are typically painful enjoyable. Imagine pinching your nipples in the middle of the day. Ouch! But that might be super pleasurable at high levels of arousal during sex.

Arousal literally removes pain.

Based on my own experiences, working with hundreds of women, and speaking to thousands more, I estimate that most women have never experienced sex with more than 20% of what their body is capable of in terms of arousal.

And the body knows it too.

Lack of adequate arousal is responsible for:

  • Tightness upon entry (even though you might be wet)

  • Not being able to last in penetration for more than 1-3 minutes without becoming raw inside

  • Penetration feeling numb

  • Not desiring to engage orally with a partner and feeling the gag reflex (part of what also gets aroused during sexual arousal is the throat, while the gag reflex relaxes)

  • Pain against the cervix because it has not been able to get out of the way in time

More than that, lack of profound sexual arousal is responsible for sex not being really pleasurable for the woman. It feels like a chore and work, rather than a pleasurable journey to relish.

Sexual arousal is built through connection, kissing and touch — and in that order. You have to be ready to receive sexual touch. Most of us know this, but unfortunately, we skip out on the connection and the length of touch that our bodies really need.

It’s not enough to be kissed, massaged all over your body, or have your breasts sucked to create arousal in the genitals. The clitoris has to be involved — and adored and pleasured. The clitoris is the main source of arousal in women. It must be stimulated sensually (not just rubbed for orgasm) and playfully and lovingly for sexual arousal (and awakening) to occur.

There are several lessons on arousal in my online program Feed Your Libido where I go in depth into all these areas, with specific ways to build arousal.

The main take-away here?

Arousal is what makes sex enjoyable. It IS the process of the body enjoying sex and responding in kind. It’s not a nice-to-have to skip to the end, but the meal in itself. And like with the meal, it IS the nourishing part of the experience.


Cause #2 of painful sex: Penetration happening too fast and too soon and that is seen as a violation

Commandment: Listen to your body and respect its pace

When penetration happens before the body is aroused to the point of craving it, it’s simply too early.

However much we want to deny that intellectually, how much we want to tell ourselves that ”it’s ok, I can do it now, I am ready,” the body knows otherwise.

There is no such thing as “just start it and you’ll like it when you get into it” for the body.

It registers early penetration as an invasion and a violation. 

And it responds in kind, shutting down the physical gateways the next time there is even a suggestion of sex.

Less lubrication.
Less engorgement.
More anxiety.
More tightness.
More pain.
More anticipation of — and bracing for — pain the next time around.

Regardless if there have also been positive aspects of your sexual experience, the body remembers the pain. It can become a downward spiral that’s very difficult to break.

Having sex too early, before your body is aroused is responsible for:

  • Bracing for pain when you’re being touched by your partner (even innocently, without any suggestions to having sex)

  • Feeling violated when penetrated (and feeling confused as to why, since you trust your partner and they have good intentions in their heart)

  • Not being able to last in penetration for more than 1-3 minutes without becoming raw inside

  • Penetration feeling numb

  • Feeling like sex is a chore and a job

  • Pain against the cervix because it has not been able to get out of the way in time

Back to our restaurant analogy: just like you wouldn’t go along with the advice that “once you start eating that raw beef, you’ll like it,” you should not follow this advice in sex.

How can you tell when it’s time to have penetration (or even oral sex)?

First, your body will tell you. There will be signs of engorgement as I’ve described above.

Second, you’ll know when you’re craving something else.

How do you know that you’re craving an apple or a specific thing to eat? You know.

The key is to learn to listen to your body to be able to discern the different ways your body communicates. It’s like learning to decipher the subtle — and not so subtle — cues of a newborn baby. You listen, attune and try something.

The entire Module 3 of my Feed Your Libido program is all about exploration and finding the words to describe your experience and the experience of your body to know when it’s ready.


Cause #3 of painful sex: Sex is goal-oriented, geared towards the orgasm

Commandment: Sex is a journey for your pleasure

Now, don’t get me wrong. Orgasm is a wonderful thing, and we should all have more of it.

But when everything that you do in sex is just an annoying detail on the way to having an orgasm, you lose interest in getting there.

For women, those annoying details are what make sex pleasurable.

Attention to her body.
Exquisite touch and play.
Awakening her senses.

All of these are ways to nourish and arouse her and make her come alive.

Sex without these elements is what I call “Friction Sex” — nothing more than two bodies rubbing up against to create friction and a climax.

And it will get boring over time. (And incidentally, it’s the kind of sex that leads to many sexless marriages.)

Women need variety in the sexual repertoire.

But you don’t have to be create about it. It’s not about folding your body into a pretzel or having you hang off the ceiling to the most erotic position (yes, that is a position).

It is about listening to your body in that moment … and in the next … and in the next … to know what it’s wanting.

Is it wanting slower touch or faster in that moment?
Is it wanting more or less of it?

Do you want to kiss your partner or do you want them to kiss you?
Do you want to laugh or stay still?

These are the moments that make the entire sexual experience interesting, nourishing and arousing. And these are essential to avoiding pain — and increasing pleasure — in sex.


Cause #4 of painful sex: Little to no emotional connection with partner leading up to sex

Commandment: Your emotional and connection needs matter

Seeing them at breakfast for a whole three minutes doesn’t count.

I am talking about veritable sense of feeling connected and known by your partner. Feeling heard and understood by them. Feeling like you’re there with them as lovers — not just a partner in raising kids, running a house, paying the bills.

Not just generally in your relationship, but today and every day.

We deeply underestimate how much emotional connection we really need as women to access our desire for sex.

And not just emotional connection — it’s also openness, play, and engagement with us. We need to feel safe with our partners to open up emotionally — and not by accident, physically too.

When we have sex without connection, you resort to “Friction Sex” — nothing more than two bodies rubbing up against each other to create friction.

It can feel like a performance.
It can feel like a duty or a chore.

But it’s not out of desire.

You might have walls up to protect yourself.
You might have walls up so your partner cannot see what’s actually going on inside of you.

The thing is that if you’re starting off from this position of contraction and closing off, arousal has no chance. Without arousal, your body will register the act of sex as an invasion — however much you want to believe otherwise.

Connection is the gateway to having sex out of desire — and giving the body what it needs to get aroused.

Connection is the prerequisite to pleasurable sex.


Cause #5 of painful sex: Feeling completely and utterly alone in dealing with your experience of pain

Commandment: Sex is something we do together — and address together.

Think about it: if you feel like it’s your responsibility alone to figure out and fix this pesky pain thing, you won’t feel particularly close to your partner. Or actually want to come closer. Would you?

Feeling alone and responsible for having to “fix” this situation on your own is a powerful way to shut your body down.

A woman with a supportive partner might feel empowered by their sharing of the responsibility and compassion and that empowerment could build her courage to use her voice and learn more.

When faced with a partner who blames her for the predicament, or by placing all the blame on herself, a woman will feel defeated.

This then feeds into all the causes I just outlined (from the bottom to the top):

  • Feeling disconnected from her partner

  • Having sex with a goal - friction sex

  • Having penetration too early

  • Not being aroused

But the biggest culprit here is powerlessness — feeling powerless to affect change in a situation where it takes both people to do it.

I see so many women attempting to fix themselves on their own, so that they continue to have sex the way it used to be. And I watch them fail every single time — then beat themselves up for it.

In sex as in partner dance, it takes two to tango.

Sex in a relationship is a couples issue. Because it’s having sex with your partner, not just some solitary act. And your partner’s availability, support and trust matter.

It’s important to take the responsibility off your own shoulders and instead invite your partner on board. This will not be easy, but it’s a step towards building the kind of closeness and connection that would create a cascading effect into other areas.

That’s why Module 5 of the Feed Your Libido program is all about bringing your partner on board. It’s about learning to use your voice to start the conversation and progress to learning about each other.

You get to practice using your voice to shape the sexual experience to work for you by inviting your partner on board.


 

Honor Your Body, Use Your Voice

When it comes to painful sex, all of these reasons add up to one thing: the woman becomes starved of the things that would help her to feel aroused and open to sex. And pain follows.

Her body closing off is the healthy response to being starved and not getting what she needs — or knowing how to get it.

Painful sex is the body’s cry for help.

How do you break this cycle?

With our responsive sexual desire, we are highly sensitive and responsive to what happens around us. It’s the reality.

But that’s only circumstance.

The other, equally important, reality is that you come into this world with a voice — your voice — to shape the circumstances to work for you.

You don’t have to grin and bear it.

From the evolutionary and biological perspectives, your voice is your power. You use your voice to ask for what you need and want, to build relationships and allyships, and to ward off dangers.

Your voice is only solution that’s sustainable and empowering — and benefits all.

  • By learning the vocabulary to describe your experience, you gain a way to advocate for what you want.

  • By practicing speaking up, you get the confidence to ask for what you need.

And your voice is key to growing intimacy with your partner. Real intimacy, not just an illusion of one.

That intimacy starts when you can use your voice to convey your truth and invite your partner on board to experience pleasure in sex together. By being honest about where you are and what you need, you get to be the courageous one to bring you two closer together.

Most importantly, your voice is about you feeling empowered because you get to be an agent of your own life, not just a passive passenger.

You have the power to take care of yourself by being your biggest and staunchest advocate.

And that is a huge boost to the female libido.

…………..

Pain is not the only thing causing your libido to diminish. There are actually (at least) 29 reasons why you might have low libido. Check out that article here.

For now, comment below what spoke to you in this article or what you see changing going forward. I can’t wait to read your comments.

…………..

Legal Disclaimer: I am not a doctor, claim to be one or have any formal medical background. I do not claim to cure any cause, condition or disease. This guide and the website are the opinion of myself, a certified coach. All information here is generalized, presented for informational purposes only, not medical advice, and presented “as is” without warranty or guarantee of any kind. Readers are cautioned not to rely on this information as medical advice. As with any kind of pain, check with your OB/GYN or family doctor to rule out other issues such as infections.


P.S. When you’re ready for more, here are a few options for you.