Breaking the Silence on Sexual Pain Disorders

We're often told that sex should be enjoyable, fulfilling, and, more importantly, pain-free. But what happens when it’s not? For some women, painful sex can lead to feelings of confusion, frustration, and shame. Adding to the challenge, many healthcare professionals aren’t well-versed in sexual pain disorders, making it difficult to get the right diagnosis and treatment.

Because these conditions aren’t widely talked about, many women suffer in silence. Sexual pain disorders include more well-known conditions like vaginismus (covered in a previous blog) as well as lesser-known ones such as dyspareunia, vulvodynia, and provoked vestibulodynia. In this blog post, we’ll explore these conditions—what they are, how they affect individuals and their relationships, and the treatment options available.

What is Dyspareunia?

Dyspareunia is a persistent or recurring genital pain that occurs before, during, or after sex. The pain can be felt at the entrance of the vagina, within the vaginal canal, or even deep in the pelvis. It may be experienced as a sharp intense pain, deep aching, or throbbing discomfort lasting hours after intercourse. Many women with dyspareunia experience a decrease in sexual activity and struggle with sexual intimacy because of their pain.

What is Vulvodynia?

Vulvodynia is chronic pain of the vulva. The vulva is the external part of the female genitalia, including the labia minora, labia majora, clitoris, vaginal opening, and urethral opening. This pain typically lasts for more than three months and can present in various ways: burning, irritation, soreness, a pins-and-needles sensation, or discomfort during sex. The exact cause for vulvodynia is not known, but researchers believe it to have biological, neurological, hormonal, and psychological causes.

There are two main types of vulvodynia:

1. Generalized Vulvodynia: Pain occurs spontaneously in multiple vulvar areas. The pain is typically constant, although there may be moments of relief. Pressure-related activities, such as sitting for long periods or engaging in sexual intercourse, tend to worsen the pain.

2. Localized Vulvodynia: This condition involves pain in a specific area of the vulva. For example, pain in the clitoris is known as clitorodynia. The most common type of localized vulvodynia is vestibulodynia, which affects the vestibule (the tissue surrounding the vaginal opening). Women with this condition, particularly provoked vestibulodynia (PVD), experience burning or sharp pain in the vestibule when pressure is applied. This discomfort may occur during sex, gynecological exams, tampon insertion, prolonged sitting, or when wearing tight-fitting pants.

The onset of vulvodynia can be classified into two categories: primary and secondary. Primary vulvodynia occurs when symptoms are present from the first attempt at penetration. In contrast, secondary vulvodynia develops after a period of pain-free penetration.

How Does It Affect Your Life and Relationships?

Many women with sexual pain disorders hesitate to ask for help. Doctors don’t always bring it up which may make it even harder to open up about something so personal. More specifically, for women who suffer from vulvodynia they are often dismissed by doctors who couldn’t find physical cause for their pain. When these concerns go unaddressed, women may feel isolated, unheard, and experience a diminished quality of life.

There’s a strong link between sexual pain disorders and mental health struggles like anxiety and depression. Pain during sexual activity can lead to negative associations, causing fear and anticipation of discomfort to replace feelings of enjoyment. This can result in avoidance of sex altogether, reinforcing feelings of anxiety and distress for both partners. Over time, the fear of pain can create a frustrating cycle where the inability to relax leads to further discomfort. In

relationships, sexual pain disorders can cause confusion and distance. A partner may feel hurt or rejected, even if that’s not the intention. Without open communication and proper education, misunderstandings and frustration can build, making intimacy feel like a source of stress rather than one of connection.

Some common thoughts women with sexual pain disorders might have:

 “This is going to hurt; I can’t handle it.” 

 “Sex will always be painful for me.”

 “Something is wrong with me.”

These thoughts can increase fear and anxiety around intimacy, making the pain feel worse.

When to Seek Help

If you experience persistent pain before, during, or after sex or penetration, and it impacts your well-being or relationship, consider seeking support. One of the most important things you can do is listen to your body.

Sex therapy offers a safe and supportive space to explore the emotional and psychological factors contributing to sexual pain disorders. It combines techniques like education, validation, and relaxation exercises to help ease feelings of anxiety, discomfort, and stress. Strengthening communication between partners can also foster better understanding and support within your relationship. Additionally, therapy helps restructure negative thought patterns and identify behaviors associated with these thoughts, such as “Sex will never be enjoyable for me”, which may reinforce pain and avoidance. By addressing these underlying beliefs and behaviors, sex therapy can play a key role in reducing pain, enhancing intimacy, and improving overall well-being.

Seeing a medical professional can further support your progress in sex therapy. A pelvic floor therapist can address muscle tension and pain, or you may want to consult a doctor about medical treatments such as topical creams, hormone therapy, or medications to help manage the pain.

Healing is Possible

Sexual pain disorders are more common than most people realize, yet they are rarely discussed. If you are experiencing pain, your body is signaling that something isn’t right. You are not broken, and you don’t need to suffer in silence. Healing is possible with the right support and treatment. You deserve to experience sexual pleasure and connection without pain.

Breaking the Silence on Sexual Pain Disorders

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