When Sex Hurts

What can a married couple do when they have sex for the first time (or for many years) and find that it hurts?

This seems more of an issue with women than it is with men. With that in mind, I’d like to focus mostly on what the causes (and solutions) of painful sex are for women, to help the wives understand themselves better and the husbands to know better how to help their wives.

Painful sex can feel devastating to a new bride and groom. This is especially true if it leads to a sexless marriage. Fortunately, the issue is addressed by many professionals today, and painful sex is a challenge that can be remedied. Painful sex doesn’t have to damn an eternal marriage to failure.

In my research, three aspects of painful sex - the physical, the spiritual, and the psychological – were apparent. They interconnect with each other in different ways depending on the couple’s individual circumstances.

Physical and Psychological   

Anytime a marital conflict arises that concerns a couple’s inability to have sexual intimacy, the first thing I look for is an underlying medical issue.

Dr. Christiane Northrup says, “…there can be physiological reasons for sexual desire waning, one of which is pain during sex. If sex is painful, it may simply be because of vaginal dryness – which is easily addressed with lubricants. But it can also be due to repressed anger or trauma manifesting as scarring or vaginal adhesions. These can form after inflammation, infection, and surgery.

In the late 1980s, it finally dawned on gynecologists that women with chronic pelvic pain very often had experienced rape or other sexual abuse. Given that every year one in three women on this planet is raped or abused, it’s not surprising that so many women experience pelvic pain and painful sex.”

She recommends for women who are experiencing symptoms such as “pelvic pain, urinary problems, and sexual pain” that they look into manual therapy, in case there are fascial lesions or any kind of internal scarring.   

“You can learn more at www.thebathroomkey.com or www.obgyn-physicaltherapy.com. [Others include] women’s health physical therapist Tami Lynn Kent (www.wildfeminine.com)...Larry and Belinda Wurn (www.clearpassage.com)... and Jennifer Mercier, M.D. (https://www.wellnessdenver.com/2017/11/14/meet-dr-jennifer-mercier-founder-mercier-therapy-natural-fertility-program/)...” (2015, 176-77)[i] 

These are physical therapists trained in how to do manual therapy and massage for pelvic scarring.

It’s important to note here that lubrication is very important for husbands as well. Vaginal dryness occurs for multiple reasons. Such reasons include hormonal changes, not allowing enough time for the wife to warm up sexually, stress, or even having too much sex. 

Using lubrication can be very important at these times. I usually recommend Astroglide, but there are lots of different kinds to try. Not having enough lubrication can cause painful lesions on a husband’s penis from friction as well.

While it is true that most men can orgasm within two to seven minutes, sometimes it can take longer. This can be especially true as a husband gets older and is satiated more often over time or distracted by stress. It wouldn’t be unusual under these circumstances for a husband to take 20 minutes to ejaculate. This can wear on both the husband and wife’s genitals if there is not sufficient lubrication and/or they have intercourse frequently.

Long bouts of sex can cause friction lesions, so this is where keeping a bottle of lube nearby can come in handy. For your sexual health, if you feel things are getting too dry, apply some lube.

Lack of natural lubrication doesn’t necessarily mean that the wife is not sufficiently turned on. Each woman is different in the amount of natural lubrication she secretes when excited. Some women secrete a lot of natural lubrication, and others not so much. If you find you need more lubrication, use more.

Another physical cause of painful sex is vaginismus.

WebMD gives this description for this disorder:

"When a woman has vaginismus, her vagina's muscles squeeze or spasm when something is entering her, like a tampon or a penis. It can be mildly uncomfortable, or it can be painful.

Painful sex is often a woman's first sign that she has vaginismus. The pain happens only with penetration. It usually goes away after withdrawal, but not always.

Women have described the pain as a tearing sensation or a feeling like the man is "hitting a wall."

Many women who have vaginismus also feel discomfort when inserting a tampon or during a doctor's internal pelvic exam.”

The story of one newlywed couple was relayed to me of the wife having vaginismus. She experienced no discomfort before, but after she was married, her husband was not able to sexually penetrate her.

In a closer examination, her vaginal muscles had squeezed so tight that a pinky finger couldn’t even be inserted. It was a tremendous frustration for both the husband and wife.

After visiting a specialist, a series of special rods (differing in width) were prescribed. Through loving patience, the couple used the rods and were able to help the wife’s vagina expand and relax.

WebMD also explained what some of the causes and solutions could be:

“Doctors don't know exactly why vaginismus happens. It's usually linked to anxiety and fear of having sex. But it's unclear which came first, the vaginismus or the anxiety.

Some women have vaginismus in all situations and with any object. Others have it only in certain circumstances, like ...with sexual intercourse but not with tampons or during medical exams.

Other medical problems like infections can also cause painful intercourse. So it's important to see a doctor to determine the underlying cause of pain during sex.

Women with vaginismus can do exercises, in the privacy of their own home, to learn to control and relax the muscles around the vagina.

The approach is called progressive desensitization, and the idea is to get comfortable with insertion.

First, do Kegel exercises by squeezing the same muscles you use to stop the flow of urine when urinating:

• Squeeze the muscles.
• Hold for 2 seconds.
• Relax the muscles.

Do about 20 Kegels at a time. You can do them as many times a day as you want.

After a few days, insert one finger, up to about the first knuckle joint, inside the vagina while doing the exercises. It's a good idea to clip your fingernails first and use a lubricating jelly. Or do the exercises in a bathtub, where water is a natural lubricant.

Start with one finger and work your way up to three. You'll feel the vagina's muscles contracting around your finger, and you can always take your finger out if you're not comfortable.

For women whose vaginismus is related to fear or anxiety, therapy helps” (2014,1)[ii]

Spiritual and Psychological

From a spiritual perspective, many Latter-Day Saints have a tremendous sexual adjustment period entering into marriage.

It’s a big jump with little to no transition preparation of going from the abstinence-only single state of the law of chastity, to the actively sexual state of the law of chastity (avoiding all sexual relations except with your husband or wife, in a male-female relationship, married legally and lawfully).

For many of us, as we sort out what is okay and what is not okay to do sexually in marriage, this can be a cause of great spiritual anxiety that can lead to the physical manifestations of sexual pain such as those addressed above.

Laura M. Brotherson, in her book And They Were Not Ashamed addresses some of spiritual and societal causes of this sexual pain. One point that stood out to me was how we’re culturally taught in our youth and young adulthood that first-time sex is a painful experience.

This is a myth, not based in any kind of fact. Despite what others’ experiences may tell us, there are many, many others that are able to have sex without any discomfort at all. Pain and discomfort is not a normal result of sex.

Laura shared a similar concern. 

“Another pervasive message about sex is that sex is a painful experience. While there can be some initial discomfort for some brides, the suggestion of pain itself can be a self-fulfilling prophecy. The ability to relax during sexual relations is critical. Sexual consummation and climax require that a woman be at ease mentally and relaxed physically. If a woman is fearful and concerned about possible pain, her vaginal muscles may constrict making penetration difficult. It’s pretty hard for a young bride to relax when her internal programming tells her she is doing something sinful. The concept of sexual pain simply intensifies the fear, shame and guilt already being experienced.

Stories of sexual pain, without medical, physiological and psychological information do little to instill confidence and eager anticipation of the sex act, especially in young people who are uneducated about sexual functioning…”[iii]

I wanted to share these with you in the hopes that, if any LDS couples are finding their marital intimacy to be a painful experience, they can find some hope and some possibilities to explore. Please use and share these tips to help you and others remove the roadblocks that are preventing them from having a happy, lasting and eternal intimate relationship.

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[i] Northrup, Christiane, M.D., Goddesses Never Age: The Secret Prescription for Radiance, Vitality, and Well Being: Hay House, Inc., 2015

[ii] WebMD, Reviewed by Dr. Nivin Todd M.D. Aug. 28,2014, http://www.webmd.com/women/guide/vaginismus-causes-symptoms-treatments

[iii] Brotherson, Laura M, LMFT. And They Were Not Ashamed: Strengthening Marriage Through Sexual Fulfillment, Inspire Book: Boise, ID. 2004. pg 11-12.