A Doctor Explains Why Sex Can Be Painful Sometimes, & It Makes So Much Sense

Sex is so often depicted in movies and on TV as this hot, magical thing that always goes well for all parties involved. Everyone finishes at the same time in the same way (seriously?!), and no one seems to worry about things that real people have to deal with when they hook up IRL, like why sex can be painful sometimes.

To get more insight into why some people experience pain during sex, I reached out to Rachel Gelman, DPT, branch director of the San Francisco Pelvic Health and Rehabilitation Center. And first thing's first: If you are feeling pain during sex, you're not alone.

"I always want people to know that they are not alone," Gelman tells Elite Daily. "It is estimated that 75 percent of women will experience pain with sex at some point in their life."

So, what are some of the reasons sex can be painful, and how do you deal with it if it happens to you? The answer is that there are multiple things that can cause pain during sex, and any combination of these factors is a possibility, too — which means dealing with it varies from person to person. But regardless of the cause, the good news is that there are plenty of ways you can still enjoy having sex. Here's what you need to know.

It can be caused by various medical conditions & infections.

According to Gelman, there are a variety of medical conditions that can cause pain during sex — namely, endometriosis, polycystic ovary syndrome (PCOS), fibroids, and irritable bowel syndrome (IBS), all can cause pain during sex. One common issue, Gelman says, is pelvic floor dysfunction. "The pelvic floor is a muscular bowl in the pelvis and it supports the pelvic organs (bladder, colon, uterus or prostate)," Gelman explains. "Just like any muscle in the body, the pelvic floor can become restricted, spasmodic or hypertonic. This can lead to pelvic pain in general or difficulty inserting anything in the vagina, including tampons, dildos, or a penis."

Along with medical conditions like these, sometimes an infection (be it a UTI, a yeast infection, or an STI) can be a factor in painful sex.

"Certain STIs [and] STDs can also contribute to pain with sex, along with things like urinary tract infections, and yeast infections," Gelman says.

Hormone levels & birth control can cause pain, too.

Another thing that can contribute to experiencing pain during sex? Your hormones.

"The vulva, primarily the vestibule (vaginal opening), clitoris and urethral tissue are all mediated by hormones, both estrogen and testosterone," Gelman explains. "So, certain life events like menopause and childbirth lead to a decrease in estrogen, which can lead to these structures not getting enough estrogen — which can lead to vaginal dryness and pain with sex."

And that means that birth control methods like the pill can impact how sex feels for you, too, since they affect your hormones.

"Things like oral contraceptives can also impact hormone levels by leading to a decrease in the same hormone levels, which again can lead to the structures mentioned becoming irritated, atrophic, and less supple which again can lead to pain," Gelman says.

And it can be due to any combination of these things.

As Gelman points out, there could be a combination of factors at play, and a person who experiences pain during sex might have more than one of these conditions.

"It is common for me to see someone that had multiple yeast infections, [has been] on the birth control pill for 15 years, and has endometriosis and pelvic floor muscle dysfunction, so pain with sex often requires a team of providers to address the different components," Gelman says.

Another thing to note is that some things that might seem like standalone issues, like vaginal dryness, could be due to a bigger problem.

"Things like vaginal dryness can also play a role," Gelman says. "A good quality water-based lubricant can help, but it may not be addressing the root cause of why that is happening."

What should you do if you're dealing with painful sex?

Because any number of medical conditions could be contributing to painful sex or penetration, it's important for people who are experiencing it to talk openly about it to their doctors.

"If possible, talk to a healthcare provider ASAP," Gelman says. "I know patients report that providers don’t always ask about sexual function, but it is important to bring this up to a clinician because there are a lot of options to help pain with sex."

It's also important — always, but especially when it's an issue like painful sex — to find a provider who will listen to you, be understanding, and take your pain seriously.

"There are many treatment options and providers who can help," Gelman says. "So, if your provider dismisses you or tells you to 'drink a glass of wine,' find a new provider. And as frustrating as our healthcare system can be, don’t give up!"

Gelman also recommends asking your doctor for a referral to see a pelvic floor physical therapist, and finding a therapist to help you cope with how your pain symptoms could be impacting your mental health.

"Many patients also benefit from working with a therapist because pain with sex can be emotionally draining and having that kind of support is key," Gelman says.

And what about having sex you can actually enjoy?

The good news is, even if you're experiencing discomfort with penetration or other painful issues during sex, there are still other ways to have sex and be intimate.

"I often remind people that sex is so much more than a penis in [a] vagina," Gelman says. "Sex can be digital or oral stimulation, it can be mutual masturbation, it can be anything that feels good."

Not to mention, the genitals aren't the only part of the body that can be stimulated, Gelman notes. It's all about finding what works and feels good for you. And if you want to make sex with penetration feel better, you have some options.

"If someone really wants to still be engaging in penetrative sex, using a good lubricant and communicating with their partner is important," Gelman says. "[And] certain positions may be better than others."

In the end, when it comes to sex, all that really matters is that you have consent, enjoy yourself, and put your health first — no matter how you do it.