Contrary to the narrative that many of us have grown up with, sex is not meant to be painful, and perpetuating this myth can be incredibly harmful to women. Indeed, when we’ve been told that sex is supposed to hurt, we accept this as normal – just a normal part of the pains of being a woman. However, that shouldn’t be the case for anyone.
If you’re someone who, like us, was raised in a culture where sex is shameful – 3eib – and where it’s reprehensible to think of or talk about it before marriage, experiencing painful sex can be a very difficult and isolating experience. It may feel like you have no one to talk to or no resources to help you make sense of what is happening. It may also be that this very culture is at the root cause of the pain you’re feeling. We’re here to validate that pain, and to shed some light on the potential causes behind it.
Let’s start by understanding the factors at play. Painful sex can be caused either by a physical condition or by a psychological condition that leads to physical manifestations. In this resource, we will break down the most common ones.
Physical Causes of Painful Sex
Common physical causes include the following:
- An overactive pelvic floor or hypertonic pelvic floor muscles
- Endometriosis
- Painful bladder syndrome also known as interstitial cystitis
- Skin conditions of the vulva
- Chronic vaginal infections
They can be nerve-related, muscle-related, skin-related, hormonal, or inflammatory. In some cases, there can also be no identifiable root cause.
Some of the most common physical conditions or manifestations of pain include vulvodynia and dyspareunia.
Vulvodynia is chronic pain in the vulva, the area on the outside of a woman’s genitals. It is usually described as a sensation of burning, stinging, itching, or rawness. Vulvodynia is defined as pain that lasts more than three months and doesn’t have a clear identifiable cause, such as an infection or a skin disorder.
Provoked Vestibulodynia (PVD) is a subset of vulvodynia, where the pain is triggered by touch or pressure to the vestibule, the area surrounding the entrance to the vagina.
Dyspareunia is the term for recurring pain in the genital area or within the pelvis before, during, or after sex. The pain can be sharp or intense, and it can be superficial (e.g. the entrance of the vagina) or deep (e.g. in the pelvis). It has many possible causes, but it can be treated. Vulvodynia, Provoked Vestibulodynia (PVD), and Vaginismus (more on that below) are all medical conditions that can cause Dyspareunia.
"Imagine a house alarm that is triggered when the wind blows as opposed to when an intruder breaks in. This analogy is helpful for understanding how a woman experiences vulvar pain when only a slight touch is applied to the vulva – a stimulus that most women would not perceive as painful, and some may not even notice at all."
Dr. Lori Brotto, Psychologist
She continues: "But the brain of a woman with [dyspareunia] registers the light touch as a painful stimulus… In other words, the brain reacts to the light touch [or penetration] as if it was a sharp object.”
This kind of response from the brain and body is due to the central nervous system becoming "hyper-reactive" and less able to differentiate pain types. Over time, these conditions can have immeasurable effects and perpetuate feelings of shame and guilt.
Psychological Causes of Painful Sex
Painful sex can also be attributed to psychological conditions or causes. Social conditioning and cultural narratives around sex can make it difficult for women to have intercourse, even after marriage. They translate into a fear of penetration, a psychological block that manifests physically during intercourse.
Since sex starts with the brain, this organ can be responsible for causing the body, or specifically the vagina, to react in a way that it believes is self-protective.
One of the most common of the psychological conditions – which happens to also be one of the leading causes of unconsummated marriages in the Middle East – is called vaginismus.
Vaginismus manifests as a recurrent or persistent involuntary spasm of the vaginal muscles, where the vagina “locks" (closes up), making penetration extremely painful or even impossible. The contraction is often associated with anxiety or fear of penetration. It is possible for a woman to develop vaginismus later in life, even if penetration was previously painless for her, in instances like post-childbirth.
While vaginismus manifests as a physical symptom, it is a psychological condition.
Many studies have shown that insufficient sexual knowledge is a major potential risk factor to developing vaginismus. Other factors that predispose women to vaginismus are a history of sexual abuse, fear of pain with intercourse, familial, religious, and cultural taboos, generalized anxiety, and other traumas.
This condition can have a huge impact on a woman’s life, her relationship with herself and her partner, and her ability to conceive.
Treating Painful Sex
Regardless of the cause of your pain, whether it’s physical or psychological, it’s important that you consult your healthcare provider — a gynecologist, a doctor specializing in sexual dysfunction, a pelvic floor therapist, or a sex therapist — who has a deeper understanding of these conditions and who can provide you with the best treatment possible.
Your doctor will be able to perform a proper physical examination to determine the root cause of your sexual pain and recommend the right treatment accordingly. There are solutions, so don’t be afraid to speak up and ask for help.
If you’ve experienced sexual trauma in the past, sex might feel emotionally or even physically distressing. Discussing your boundaries with your partner before engaging in any sexual activity, and then slowly building up to penetration over time may help. Don’t underestimate the power of your support system when going through this. Find someone you can confide in, whether it be your friend, family member, or therapist.
1. Brotto, Lori A., and Emily Nagoski. Better sex through mindfulness: How women can cultivate desire. Vancouver: Greystone Books, 2018.
2. Dr. Nina Brochmann and Ellen Stokken Dahl, The Wonder Down Under, Quercus, 2018.
https://www.goodreads.com/book/show/37934484-the-wonder-down-under
3. Tarfah Muammar, Patricia McWalter, Abdullah Alkhenizan, Mohamed Shoukri, Alia Gabr,and Abdulaziz AlDanah Bin Muammarb, “Management of Vaginal Penetration Phobia in Arab Women: A Retrospective Study,” Annals of Saudi Medicine, March 2015.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074138/
4. Stephanie Watson, “The Sexual-Response Cycle: What Happens to Our Bodies During Sex,” WebMD, June 24, 2021.
https://www.webmd.com/sex-relationships/features/sexual-response-cycle
5. Hushlak, Dr. Anna. “Pillow Talk,” May 24, 2023.
