What's REALLY Causing Painful Sex for Women?
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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 emotional pain of a 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.
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 use vaginal dilators to stretch the muscles, but that felt like I was trying to force open something against its will.
I was also told to masturbate, as if masturbating would open things up, like a magic key to everything.
I tried to fix it on my own, and the thing is that all of these made me more frustrated with myself, shut down, isolated and disconnected from my husband. We were stuck, 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 some comfort and relief. But that was not even close to being enough.
It gave me no information on how to change things around — and I wanted things to change. While everyone looked for things that are wrong with me (was it vaginismus, vulvodinia, tumors?), no one — not a single person — ever asked meaningful questions that would have revealed information about to do instead.
Is what you’re doing leading up to sex enough for your body to want to open up for it?
No one ever asked:
Do you get enough sensual touch that your body enjoys? And if not, what might you enjoy more of?
Do you give yourself permission to take time for your pleasure and to receive?
Do you feel safe with each other to share your desires? And if not, what would make you feel safer?
Do you feel connected, understood and met by your partner? And if not, what might help you feel more so?
Do you give yourself permission to speak up about what need in the moment?
And is your partner listening?
Everything I was told was focused on what is wrong with me. No one dared to ask the questions about what might I need for the situation to be right — for the conditions in the sex I was having to really work for me. And no one provided the step-by-step guidance and a roadmap to creating that.
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Pain in sex is extremely common for women — but it’s not normal
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 physical source shifts the pain during sex.
But for many millions of women, painful sex is a persistent reality — every time they have sex — with no clear physical cause or trigger. It just is painful. Many women experience it — too many.
It can look like:
Tightness and pain upon entry
Pain against the cervix when being thrusted into
Tearing and bleeding
Painful cramps and spasms
Extreme sensitivity
Inner soreness and rawness if penetration happens for more than 1-3 minutes
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.
Come to think of it, that’s a lot of “sexually broken” women.
Pain or even mere discomfort during sex doesn’t just ruin the moment. There are deeper consequences: disconnect from your own body, fear of sex, anxiety around touch, lowered libido, as well as consequent loss of intimacy and closeness with a partner.
Many women choose to continue to have painful sex to “save the relationship”, convincing themselves to bear it. That creates an inner battle between needing to avoid pain and yet enduring it. It can take a deep psychological toll on self esteem and sanity: being out of integrity with yourself makes us all a little crazy. It robs us of our inner power. And it saps life energy and any sexual desire.
This one paradigm shift about painful sex can change everything
Instead of only looking at what’s wrong with women who experience painful sex medically and blaming it on sexual “dysfunction,” we should be asking a set of different questions:
What is it about the sex that we’re having — the way it’s supposed to be done — that’s not working for so many women?
What if we’re systematically taught to approach sex in a way that causes women pain?
And, what if women’s pain during sex is a healthy response to an unhealthy approach to sex that’s widely sold in our society?
We need to stop fixing women’s pain in sex to enable them to continue having sex in a way that hurts them. We have to take time and learn what truly nourishes and feeds her body so that sex becomes pleasurable, not just free of pain.
Stop looking at the pain as a menace.
Start looking at it as a messenger.
What is the pain trying to tell you?
That’s the questions I ask my clients (and myself) all the time. As a Somatic Experiencing Practitioner (SEP), I treat the body like a being, with its own language of communication and a need to be listened to, respected and honored. Pain is the body’s signal that something is off alignment, or something is missing, or something needs to be corrected. It’s telling us to slow down, pay attention, look deeper, get curious, change something. It’s our job to learn to understand its communication, like a mother learns to understand the needs of her newborn.
One woman experienced most pain when she and her husband had sex in the evenings, while mornings are less painful and Sundays not at all. What we learned is that her body responds much better to stimulation and arousal after a good night of sleep, than after a long and tiring day. The pain was conveying that sleep is very important to her and ability to enjoy sex.
Another woman’s pain during sex completely went away when they had sex on vacation, while morning quickies that her husband loved so much led to near-excruciating pain. What did we learn here? That taking time to linger with each other sensually, with no agenda or goal, they way they did on vacations, worked really well for her body. Her body rejected with their regular 5-minute quickies with pain but was thrilled with hours of sensual exploration.
Another woman’s pain was consistent with harboring resentment and anger at her partner. She also got UTI’s every time they had sex. They did little to repair the loss of trust in their relationship due to an affair, and her body knew that she did not feel emotionally safe with him. She overrode those subtle signals, and her body responded with pain. It was a call to action to look at the underlying issues, but it went ignored for years.
Anger was also the reason why this former client’s libido shut down altogether, making sex feel painful and forced. Read this couple’s full case study and transformation story here.
The challenge is that when we chronically ignore and override our pain’s messages, the pain becomes chronic. More than that, it gets mixed up with painful emotions of resentment, shame and anger, often times turning into a tangled mess that’s hard to untangle on your own.
The pain is not wrong or random. It is a messenger. In each of these cases, it had information that was systematically ignored in the old paradigm but that eventually helped every single of these couples find solutions that helped to eliminate pain.
5 “Sex Commandments” to follow to avoid the pain and create pleasurable sex
If there is one theme among women who experience painful sex (myself included), it’s this: we have sex too early, too quickly, and without more-than-adequate arousal. (I intentionally use “more-than-adequate” phrasing here, and I explain why later).
When it comes to painful sex, our bodies are simply protesting against too much, too fast, too soon.
The solution is NOT to fix yourself. Because YOU’RE NOT BROKEN.
But you do have to change the sex that you’re having (and how you get to it) to work for you.
Here are five causes that we dare not speak about that are actually contributing to painful sex for many women and the “commandments” that your body is begging for you to commit to.
Cause #1 of Painful Sex: Not having enough physical arousal and engorgement before having intercourse
Sex Commandment #1: Respect your body’s need to build arousal
What is arousal? It’s the body’s response to pleasurable stimulation. It’s as much of a journey of getting excited as it is of opening up and revealing yourself, akin to a bud opening up into a flower.
For men, arousal looks like this: the penis gets hard and swells up to 200% of its flaccid state. On average, that can take anywhere from 30 seconds to 3 minutes. At that point, the man is ready and able to have pleasurable intercourse and an orgasm.
For women, arousal looks like this: she might go from a hurried state to a more relaxed state without any signs of wanting sex yet; then with touch and connection, her muscles relax, and she becomes less preoccupied by her worries and more present to her body and partner; her senses become heightened; her skin receptors become more sensitive; she starts to welcome more stimulating touch; she starts to feel more in her body — more tingling, for example; her nipples start to get engorged, her genitals start to get wet; she is more eager to reach out and touch and be touched; her mind becomes more focused on pleasure than on the to-do list; her clitoral shaft and arms start to swell (up to 300% of their relaxed size), her vagina lengthens from 2-4 inches to 4-8 inches; her cervix tilts up; her emotional state opens. Then and only then does a woman reach more-than-adequate arousal and becomes truly ready and able to have pleasurable intercourse and an orgasm.
For a woman who has pleasurable sex on a regular basis, the scenario I describe above takes on average 45 minutes to an hour.
For someone who has occasional sex (once a month) or sex that is consistently lacking pleasurable, that first time for her to achieve high levels of arousal can take weeks of rewiring her body with playful connection, touch and adoration. At that point, she can engage in what will be a pleasurable experience.
For women who’ve only experienced painful sex, that journey of rewiring her body with pleasurable experiences can take much longer.
Juxtapose this to the fact that on average (across all continents), a couple spends 15 minutes on sex — and that includes foreplay — it’s not hard to see the glaring problem.
The way sex is portrayed in the media, how it’s presented in porn, and how we as a culture think about it teaches couples to have sex the way a pair of teenagers might approach it: fast and furious. The 15-minute sex remotely resembles the way a woman really experiences sexual desire — not to mention what makes it possible for her to experience the full extent of her sexual potential. It misses the mark.
In these situations, painful sex is a healthy response to an unhealthy scenario. The reality is that even in the most loving relationships, women have penetration on men’s timelines, when men are ready, which means they’re having sex before her arousal levels are adequate enough to pleasurably welcome a man inside.
If both men and women really listened to what women’s bodies truly need, sex would look very differently: slower, longer, relaxing, sensual, less doing and more being with each other. It’d be more Connection Sex, less performance sex. Slower sex, rather than “race to orgasm” sex.
Sexual arousal is not just good for pleasure. It literally reduces pain. It creates an anesthetic effect, 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.
Based on my own experiences, working with hundreds of women, and speaking to thousands more, I estimate that most women experience sex with less than 30% of what their body is capable of in terms of arousal.
If you’ve never experienced the full 100%, it might not feel like you’re missing something. But make no mistake about it: the body knows that it’s not supposed to have sex at 30% arousal — and it’s protesting.
Lack of adequate arousal is responsible for:
Tightness upon entry (even though you might be wet)
Extreme sensitivity
Not being able to last in penetration for more than 1-3 minutes without becoming raw inside
Penetration feeling numb
Pain against the cervix because it has not been able to get out of the way in time
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)
Without arousal, sex is reduced to a chore that the woman has to emotionally “work yourself up to”, rather than a pleasurable journey to go on.
Sexual arousal is built through sensuality and connection, play and exploration. It grows with attention. It takes more than what we think about as foreplay and it must be cultivated daily, not once you’re on vacation.
Daily pleasurable sexual connection — on your terms and at your pace — rewires how your body reacts. These are essential to avoiding pain — and increasing pleasure — in sex.
Cause #2 of Painful Sex: Penetration happening too fast and too soon — and the body sees that as a violation
Sex Commandment #2: 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. If you’re not ready, you’re not ready — and the body knows it.
The body registers early penetration as an invasion and a violation.
And it responds by shutting down the physical gateways the next time there is any suggestion or hint of sex, creating downward spirals where each subsequent time feels worse than before.
Less lubrication.
Less engorgement.
More anxiety.
More tightness.
More pain.
More anticipation of — and bracing for — pain the next time around.
Even if there were positive aspects of your sexual experience, all that the body remembers is the pain. Once that pain association is reinforced, it can become a downward spiral that’s very difficult to break.
Having sex too early, before your body is aroused is responsible for repeating cycles of:
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
Pain against the cervix because it has not been able to get out of the way in time
How can you tell when you’re ready to have penetration (or even oral sex)?
First, your body will tell you. There will be signs of engorgement as I’ve described in the point above. At the least, your pussy will be throbbing with pleasure.
Second, you’ll know when you’re craving it. Like you know when you’re craving an apple or that tasty treat you love. You just know. It’s a body thing, not a mental guess. If you need to talk yourself into it, you’re not craving it — you’re rationalizing why you should override your body’s need for something else.
If that’s the case, it’s important to look deeper of what you are actually wanting in that moment. Underneath the rationalization is the real desire. It will likely speak in a soft whisper, or manifest as a gentle nudge from the body telling you “I want that instead”. Listen to it.
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 out.
What does your want now … and now … and now … and now?
Is it wanting slower touch or faster ?
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?
Looking at the sexual experience moment by moment, sensation by sensation, you gain control over how it works for you. You can change each small movement and make it interesting, nourishing and arousing. These are essential to avoiding pain — and increasing pleasure — in sex.
Cause #3 of Painful Sex: Sexual touch is goal-oriented, geared towards penetration and orgasm
Sex Commandment #3: Sexual connection and pleasure are the real goals of being sexual
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 sexually has the pressure to have penetration sex and orgasm associated with it, all that stuff that we call “foreplay” becomes just an annoying detail on the way to the real thing.
For women, those “annoying” details are what make sex pleasurable. They’re what makes sex worth wanting and worth having.
These things are:
Attention on her body.
Exquisite touch and play.
Awakening her senses.
Sensual exploration.
Opening of the hearts to each other while you open your genitals.
All of these things we think of as “foreplay” are not meant to be the means to an end.
They need to be the end goal — with sex being the cherry on top. When you engage in these for their own sake and enjoyment, they nourish and arouse the woman and make her come alive sexually, which leads her to want sex in a genuine way.
Sensuality, exploration and play have to be treated as the main act — the thing that you are there to enjoy with each other. Make each kiss, each make-out, each time you touch each other the most delicious, the most fun, the most relaxing and most exciting experience WITHOUT the pressure to follow up with sex … and believe me, you’ll want to move to sex naturally.
Cause #4 of Painful Sex: Little to no emotional connection with partner leading up to sex
Sex Commandment #4: Your emotional and connection needs matter
Seeing your partner 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 and emotional openness, you once again 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 Sex is path to pleasurable sex.
Cause #5 of Painful Sex: Feeling completely and utterly alone in dealing with your experience of pain
Sex Commandment #5: 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.
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, which leads to Friction Sex
Having penetration too early
The body refusing to respond to arousal
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 and sexual in a relationship is a couples issue — even it’s only one person who’s struggling with it. Because we’re taking about 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.
Honor Your Body With Your Voice
Pain during sex is real. The symptoms are real. And the messages that they carry is real too.
Painful sex is the body’s cry for help.
We have to learn to understand its language and how to work with it to bring it to safety, relaxation and openness on its own terms.
Most women have what’s called responsive sexual desire, which means that we are highly sensitive and responsive to what happens around us. It’s the reality. That’s important to understand and work with.
But that’s only circumstance.
The other, equally important, reality is that you come into this world with a voice — your voice — which gives you the ability to shape the circumstances to work for you. That applies to sex too.
You don’t have to grin and bear the circumstances.
From the evolutionary and biological perspectives, and from practical ones too, 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. You shape your life to work for you.
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 to create the contexts that work with your body, not against it.
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. That’s part and parcel of my Connection Sex framework that is a powerful antidote to the “I don’t want to have sex” problem.
You have the power to take care of yourself by being your biggest and staunchest advocate. That is a boost to self-esteem and incidentally to the female libido.
Your voice will put you back in charge of your experience to shape it to work for you.
Incidentally, a woman’s voice and her vagina are inexplicably linked. They’re both connected and function as a sphincter that requires opening. Fear makes it close down; trust, safety and inner power allow it to open. Inner power and sexuality need each other. They also happen to be the keys to unlocking your libido on your terms … and allies in getting you what you desire.
Looking back at my marriage, I did not have that inner power to use my voice — nor the permission to use it. To be honest, I had no idea that I could speak up about what I wanted and needed. I had never had anyone model that for me. I’ve seen my fair share of women complaining about what’s not working — and that I got really good at. But knowing myself, knowing what I want and need, and advocating for it? I had no idea how to do it. Nor did I have the words for it. As a result, I felt trapped in an experience of sex that wasn’t working without any means to get out.
The truth is that what saved me from enduring sex that wasn’t working for me was … painful sex. The pain saved me from continuing to betray myself in having sex I did not enjoy. It was a gift, not a menace.
Deep down, I always knew that there was more to sex than I was experiencing: more than mere friction, more pleasure in my body, more connection with my partner. And that knowing led me to go on a journey to find it. It led me to experience sex, sexual connection, and arousal in ways that nourished my body and made it come alive — and my body welcomed sex with desire (a lot of it).
On the rare occasions I experience painful sex, I treat it as a warning signal. I pause and listen to it. It always tells me that something is not working: we’re going too fast, or I am not giving myself permission to take time, or I am not asking for what I want, or worse, I am betraying myself by having sex out of obligation. Painful sex keeps me honest and reminds me to stay in integrity with myself. It’s one of my greatest teachers and it always has my back.
Pain is not the only thing that causes lack of libido. There are actually (at least) 29 reasons why you might have low libido. Check out that article here.
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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.