Why is sex painful for some women – and what can they do?

Sex is painful for nearly one in eight women according to a study in the British Journal of Obstetrics and Gynaecology. Researchers vary in their estimates of how common painful sex is – some studies say it affects up to one in three women – but all agree it’s a neglected problem. Most women never seek help. Some carry on having penetrative sex through gritted teeth.

The medical name for painful sex – dyspareunia – covers a multitude of reasons why intercourse hurts, such as sexually transmitted diseases (chlamydia or herpes), thrush and endometriosis (which causes pelvic inflammation). Then there is anxiety, lack of sexual arousal and/or a previous traumatic experience of sex.

This latest study used survey data from the third annual National Survey of Sexual Attitudes and Lifestyles, on 6,669 sexually active women, and found those between the ages of 16 to 24 and 55 to 64 were most likely to have pain during sex. Women were also asked about other aspects of their sex lives. Those who said sex hurt were four times more likely than other women not to enjoy sex, five times more likely to feel anxious during sex and three times more likely to have difficulty climaxing.

The solution

The strongest link found was between painful sex and vaginal dryness. “In the older age group, this is likely to be due to the hormonal changes in the menopause,” says Dr Kirstin Mitchell, senior research fellow at the MRC/CSO Social and Public Health Sciences Unit at Glasgow University, and lead author of this latest paper. “But in the case of the 16- to 24-year-olds, it may be about young women not feeling sufficiently aroused and therefore not lubricated enough, so that penetration is painful. Young women may then grow up thinking sex hurts.”

Painful sex has often been seen through a mostly medical prism. But Mitchell says that US doctors have moved away from the terms traditionally used to describe it, such as vaginismus (defined as persistent involuntary spasm of the muscles of the outer third of the vagina). Instead, they have come up with genito-pelvic pain/penetration disorder. It’s still a clumsy name for something that affects what Mitchell calls a “significant minority” of women.

But, certainly, there are enough medical causes for painful sex to merit getting checked out by your GP or local sexual-health clinic. “You need to understand what’s causing the pain,” says Mitchell. Menopausal women often find lubricants relieve vaginal dryness. Relationship problems and previous traumatic experiences of sex need more profound help, while infections and inflammatory conditions need medical treatment. Mitchell feels that schools should make sure sex education stresses communication between partners. “Trust and respect are key foundations for good sex,” she says.