What Causes Pain During Sex? Common Causes of Chronic Pain (Part 1 of 3)

What Causes Pain During Sex? Common Causes of Chronic Pain (Part 1 of 3)

Chronic pain in the vaginal area of women is, sadly, pretty common. About 25% of women suffer at some point in their lives from a chronic burning, “knife-like” rawness of the vulva and vestibule called provoked vestibulodynia (PVD) or vulvodynia.

The vestibule is that area between the labia minora, the inner lips of the vulva (outside our body) and the urethra (inside our body). It is the part of the “vagina” that women would see if they spread the lips of their vulva open and looked inside themselves with a mirror.

I had PVD when I was in my 20s after starting on oral contraceptives. It made having an orgasm (something previously pretty natural for me) into more of a challenge as I had to work through the pain I experienced at intercourse.

Difficulty getting a diagnosis and treatment

This chronic pain condition has had several names in the past, but we will call it PVD. It is also oddly treated by an array of doctors from ObGyns, to Psych people, to Dermatologists which can make it even more confusing.

More than 90% of women with this condition will have pain for years (7 years is the average-ouch!). At least 6 million women in the US are currently suffering from PVD – for comparison there are 4.5 million Americans wearing orthodontic braces right now.

It usually starts when women are between the ages of 18-25 years. And over 60% of women with the condition can not have sex without pain. They also experience non-sexual pain (burning, irritation, rawness) that compromises their quality of life with pain when they sit, walk, or exercise.

Shockingly, a recent Harvard study found that most women with PVD sought professional advice from 3 or more physicians, with 40% remaining incorrectly diagnosed even after their third opinion!

What causes pain during sex?

The genital pain and redness of PVD can be “provoked” by contact with many different common items such as: the penis, vibrators, saliva, tight clothes, and any number of feminine hygiene products. Most of these are hyperosmotic, meaning they have more salt in them than ocean water, so they cause burning irritation on contact. Almost all lubricants are hyperosmotic, with up to 20% of users of leading lubricants reporting severe irritation. This irritation can make the PVD worse, even though docs almost always recommend lubricant use for these women.

PVD appears to be a type of allergic reaction in the genital tissues causing pain. There may also then be an overstimulation of the pain receptors in this area, so that after awhile any sensation “down there” can trigger a pain feeling.

Again there is likely a  link between the use of hormonal contraceptives (like the pill) and subsequent development of PVD.

PVD is not a “mental health issue," however, cognitive behavioral therapy and mindfulness meditative techniques have been reported to help manage the condition. In the past I have had a negative reaction to reading about “therapy” approaches to PVD pain, because it felt like it was trivializing the symptoms.

In spite of having PVD, 75% of women with PVD are sexually active. Having PVD doesn’t mean you don’t like sex. 

Keep Reading Part 2: More Causes of Pain During Sex and Part 3: Common Sense Ways to Manage Pain During Sex

- Dr. E

Science can help us nurture and enjoy our sexual selves. 


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