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Crash Course: Sexual Pain

Updated: Apr 18

Woman experiencing vaginismus

"Sexual pain" is like an iceberg. When we say "sexual pain," we're often talking about the tip: women often first notice that something isn't quite right when they attempt penetrative sex, insertion of a tampon, or feel discomfort "down there." But often, the true issue lies under water and may not be as easily noticeable. Because of the elusive and mysterious nature of sexual pain, you may have had trouble describing your experience to your doctor.

Having the language to describe your pain is going to be your superpower.

So, let's get specific. If you're unfamiliar with terminology for different parts of the female anatomy, visit the National Vulvodynia Association's page for a diagram and labeling before you continue.

Give It a Name

In the clinical field, sexual pain is given a name based on which part of the sexual organs are being affected. This is why it's helpful to describe exactly what is occurring. Here are some terms for you to be familiar with:

  1. Vagina is one of the internal parts of your female reproductive anatomy (its internal sisters are your cervix, uterus, ovaries, and fallopian tubes). It is the canal, the passageway. The penis may spend some time there; a tampon; and, when birthing is in action, the baby will pass through this area on its way out.

  2. Vestibule is the tissue that surrounds the opening of your vagina and urethra

  3. Vestibulodynia: pain that occurs in the vestibule

  4. Vulva: the protective external part of your anatomy, and consists of your labia majora and labia minora (the lips of the vulva).

  5. Vulvodynia: pain that occurs in the vulva

Vulvodynia can be generalized (throughout the entire vulvar area) or localized (within the vestibule, then called vestibulodynia). It is either spontaneous (occurs within pressure being applied), provoked (pain is felt when the area is touched), or sometimes both. The body is such a complex system that pain can be triggered by things occurring within your bones, hormones, nerves, muscles, organs, skin, or all of the above! So no, it is not all in your head, and no, it isn't as simple as "just relax." Your body is in distress, and we need to honor it with a multidimensional approach.

Even though pain can have multiple sources, we still use vulvo-/vestibulodynia as a way to identify where the "tip of the iceberg" is showing up, so to speak. Moving forward, I'll be categorizing pain as either Generalized Vulvodynia (GVD) or Provoked Vulvodynia (PVD).

"How can I know if I have GVD or PVD?"

Generalized Vulvodynia

Women with GVD experience constant burning pain, often in both the vulva and vestibule. It seems that GVD is a neurological condition where dysfunctional nerves overreact to normal stimuli. It can be incredibly frustrating, because if you experience GVD, you may not know how to describe your symptoms to your physician.

"When does it hurt?"

"Random times. All of the time. I don't know!"

Provoked Vulvodynia

There are about 10 conditions to be aware of that fall under the category of "PVD." You may identify with one, or perhaps more than one. It's like the proverbial question, "Which came first: the chicken or the egg?" Women with pain may find that the root cause is actually a combination of causes.

Alejandra, for example, may have been on a type of birth control that reduces her free testosterone (which can be associated with pelvic pain), but she also has a semen allergy and experiences inflammation any time her partner forgets to use a condom. Qiao's pudendal nerve may be pinched and irritated, which either causes her tight pelvic floor muscles - or is caused by her tight pelvic floor muscles.

What's important is that you know how your anatomy works and can articulate your sexual and medical history to your doctors. With this information, we can potentially gain some language around what factors are contributing to your specific symptoms.

Avengers, Assemble!

I love this part. There is an entire army of professionals educated in the best ways to help you overcome your pain. You'll have a squad of women's health professionals on your side, working collaboratively to achieve your goal: reduced pain! Here are some names that might be a part of your team:

  • OB/GYN: Sometimes, the OB/GYN is the first time a woman learns she is having pain (i.e. she is unable to complete an internal exam), or the first place she brings up her concerns (because it feels like a safe environment to address sexual difficulties)

  • General Physician: Your doctor may have prescribed antidepressants or has been treating you for recurrent yeast infections. This side of your medical history is equally important in determining your pain, as medications and non-sexual physical ailments could impact your sexual functioning.

  • Sex Therapist: Sexuality is such an integral part of how we see ourselves. For sure, feeling pain - or being afraid that there might be pain during sex - can limit our feelings of sexiness. We may even withdraw from our partner because figuring it out has been so exhausting and so hard. Sex therapists address the emotional, spiritual, and physical impacts. Expect some exercises to complete outside of session.

  • Pelvic Floor Therapists: These are physical therapists that have honed their training to focus on how the pelvic floor can be restored to optimal functioning! If you have hypertonic pelvic floor dysfunction, you'll be meeting with your PT to practice exercises with and without dilators that improve the elasticity of your pelvic floor, thereby reducing your pain.

Wow! Where do I start?

Sexual pain is my niche area of focus. You may have encountered professionals in the past that either did not know anything about your condition, or were not specifically able to dive deeper with you. This will be something new. In our work together, you will:

a) Learn the language behind your specific type of pain

b) Gain understanding of how relationship and mindset may play a part in your pain

c) Improve your ability to lessen the experience of pain and gain new perspective into what your sex life could look like!

We'll take this step by step. This first part is just about meeting someone who understands, who will listen to your story, and who can give you an idea of what to do next. Book your 15-minute consultation here.

Credits: Goldstein, A., Pukall, C. F., & Goldstein, I. (2011). When sex hurts: A woman's guide to banishing sexual pain. Cambridge, Mass: Da Capo Lifelong.


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