How to have an orgasm, even when sex hurts
Sex Education
%20(2).png)
Picture this: you’re in bed with that person you’re really into, and things are getting… heated. Suddenly, without warning, you’re overcome with pain. Maybe it’s just a twinge, or a deep ache through your whole pelvis, or maybe it’s a sharp pang, like being stabbed from the inside out. If you’re saying “it’s me!” right now, you have our sympathies, because we’ve been there!
The American College of Obstetricians and Gynecologists (ACOG) estimates that about 75% of people with vaginas experience pain during intercourse. Some people experience pain in their labia or vaginal opening, while others feel pain inside their vagina, cervix, pelvis, or abdomen. For some, pain happens when their partner’s penis, fingers, or a sex toy tries to enter the vagina. For others, pain only occurs with deep penetration. The pain may feel like a dull ache, cramping, sharp and stabbing, throbbing, burning, or muscle spasms.
Pain during sex, especially penetrative sex, has both physical and psychological causes, according to the experts at the Cleveland Clinic.
Physical causes of painful sex can include:
- Vaginismus
- Ovarian cysts
- Endometriosis
- Pelvic inflammatory disease (PID)
- Other infections including sexually transmitted infections (STIs)
- Fibroids
- Interstitial cystitis
- Pelvic floor injuries or dysfunction
- Scar tissue in the pelvis
- Previous or current ectopic pregnancy
- Previous childbirth
- Vaginal dryness caused by hormonal changes
- Vaginal atrophy
- Vulvodynia
- Skin conditions that impact the vulva
Of course, this isn’t an exhaustive list. A wide number of medical conditions can cause painful sex, and your medical history is essential to figuring out the cause for your individual body.
Your mental and emotional states also contribute to painful sex. When you aren’t very interested in sex, your body doesn’t become aroused, and if you have sex when you’re not physically aroused, vaginal dryness makes sex painful. Even if you do really want to have sex, your body can still react in ways that make sex painful. If you’re anxious or stressed about having sex, going through relationship issues, or have past sexual trauma, you might have trouble getting aroused, leading to painful sex. Your feelings and beliefs about sex can manifest as physical symptoms as well, like the painful muscle contractions associated with vaginismus.
Just because sex is painful now doesn’t mean it always will be, though. There are lots of ways to improve your sex life, find pleasure, and even work toward pain-free sex.
The interplay between pain and pleasure
Of course, painful sex can make having an orgasm really difficult. One 2017 study published in the Bjog, found that about 40% of people who experience pain during sex struggle to orgasm, which makes sense given the fact that pain basically hijacks your body and brain.
When you’re in pain, several areas of the brain activate to process the sensation, which makes it difficult to focus, think critically, problem-solve, make decisions, and recognize and regulate your emotions. With all that brainpower devoted to pain, there’s not a lot left for pleasure, and according to researchers at Rutgers University that analyzed brain function during orgasms, pleasure actually requires a lot of brainpower. Orgasms activate many of the same parts of your brain that are activated during pain. So, when your brain is busy processing pain, it’s really difficult for it to process pleasure.
Research by Dr. Lori Brotto, who studies the connection between mindfulness and sex, shows that it’s also tough to orgasm when you’re distracted. Having an orgasm requires a lot of focus and attention on the pleasurable sensations in the body, and when all you can think about is the pain you’re experiencing during sex, you literally can’t focus enough to have an orgasm.
Your body’s reaction to painful sex makes finding pleasure even harder. In “Clinical Management of Vulvodynia: Tips and Tricks,” Dr. Alessandra Graziottin, a researcher and expert on pelvic pain, explains that having painful sex can create feelings of fear, anxiety, or even panic about sexual activity. These emotional responses activate the nervous system, which signal the body to prepare for pain. The body responds by shutting down the arousal process, including natural vaginal lubrication, and tensing the muscles of the vagina and pelvic floor, which makes sex even more painful.
Both Brotto’s and Graziottin’s research shows that people who’ve experienced pain during sex hyperfocus on their fear, anxiety, and panic around sex, which makes the body’s response even stronger. They also hyperfocus on painful sensations instead of pleasurable sensations during sex, which can prevent them from experiencing any pleasure during sex.
The bottom line is pain disrupts sexual pleasure in a major way.
Navigating pleasure amidst pain
When you’re in pain nearly every time you have sex, it can feel like pleasurable sex is basically impossible. Luckily, that’s not true. There are plenty of ways to approach painful sex and rediscover pleasure, even if you’re still experiencing pain.
Effective communication with partners
One of the most important strategies for navigating painful sex is open, honest communication with your partner. Unfortunately, many people with vaginas are hesitant to tell their partners that sex is painful.
A 2019 study published in the Journal of Sexual Medicine found that only half of the participants told their partners about their pain. When asked why they didn’t speak up, the most common responses were that they thought their pain was normal, they were focused on their partner’s pleasure, they didn’t want to make their partner uncomfortable, and they didn’t feel comfortable discussing their pain with their partner. A survey conducted by Ohnut, a company that makes products to reduce pain with deep vaginal penetration, found that shame prevented people from talking about their pain as well.
Another Ohnut survey, over 75% of respondents said that their partners responded “very well” or "well" when they told them sex was painful. They also shared their suggestions on how to bring up painful sex in the moment. Over 55% said that the best thing to do is make your voice heard in the moment. Simply saying, “Ow” or even just making a sound can be enough to alert your partner to the fact that something’s not right and you need to take a pause. Asking your partner to switch positions, try a different tempo, or do something else can allow you to adjust without directly addressing the pain in the moment.
You can also talk to your partner when you’re not actively engaged in sexy times, which can make the conversation a bit easier. Tell your partner about your pain, and even if it’s uncomfortable, get specific. Let them know exactly what hurts and when it hurts, so that they know what to avoid next time. You can also enlist their help in figuring out different positions or sexual activities that might feel better and decide on a comfortable way to communicate during sex.
Relaxation and breathing techniques
The pain you feel during sex is not all in your head. It’s a very real, physical experience that has a real, physical cause. But it has a mental and emotional cause as well. Since the experience of pain involves a complex interplay between the body and the brain, addressing painful sex needs to involve physical, mental, and emotional approaches. Relaxation and deep breathing techniques are particularly effective because they address both the physical and mental aspects of pain.
Rebecca Maidansky, a pelvic floor physical therapist, explains that deep breathing, particularly diaphragmatic breathing, can be used to address the fear and anxiety that exacerbate pain as well as relax and stretch tight pelvic floor muscles that often contribute to painful sex. Progressive muscle relaxation and visualization meditations are similarly effective.
Dr. Brotto’s research shows that practicing mindfulness can also be a game changer. She teaches people how to stay present during sexual activity and focus on all the physical sensations without thinking about whether they’re good or bad. When pain does happen, Brotto suggests bringing the focus back to the physical sensations of sex, so you don’t get lost in negative thinking, fear, or anxiety.
Exploring different positions
We’re not saying you should bust out the Kama Sutra and start experimenting, but we are saying that position really matters when you’re having painful sex. Dr. Ashley Rawlins, physical therapist who specializes in pelvic pain, suggests trying sexual positions that allow you to control the pressure on your labia and vaginal opening as well as the intensity and depth of penetration to reduce the likelihood of pain.
For example, positions where your partner is seated and you’re on top work well because you can use your legs to control the depth and angle of penetration. They also allow you to easily adjust these factors when needed and put minimal pressure on your labia and vaginal opening. Positions where you’re on top, facing away from your partner, also work well because they give you lots of room to lean forward or back to change the angle and depth of penetration.
While you’re experimenting with these new positions, make sure you have plenty of lube within arm’s reach. Even if you’re aroused, you might not be wet enough to prevent irritation of the vaginal tissues, so lube up! And if deep penetration hurts, you can explore the Ohnut rings, which can be used to limit the depth of penetration.
And if every type of penetration causes pain, remember that outercourse is always a good option.
Exploring outercourse
Though penetrative sex is often portrayed as the epitome of sexual activity, sex does not have to involve any penetration at all. In fact, research has shown that only about one third of people with vaginas can orgasm from penetrative sex alone.
A 2022 study of 388 women published in the medical journal Sexuality Research and Social Policy found that the participants only had orgasms during penetrative sex without clitoral stimulation 25% of time. That’s only one orgasm for every four romps in the sack! The same study found that participants were more than twice as likely to orgasm with clitoral stimulation, and about 70% of participants regularly included clitoral stimulation in their partnered sexual activity. So, if you’re experiencing painful penetrative sex, clitoral stimulation of all kinds can be a pain-free route to mind-blowing orgasms.
There are so many ways to explore outercourse with your partner that are just as, if not more, intimate as PIV sex. The experts over at Kinkly suggest experimenting with oral sex, rubbing your bodies against each other, using your own fingers to stimulate your clitoris while your partner watches, letting your partner stimulate your clitoris with their fingers, letting your partner rub their penis (if they have one) on your clitoris, or using sex toys that focus on clitoral stimulation, like suction or air vibes.
Sometimes, the pressure of feeling like you need to have penetrative intercourse when you’ve been struggling with painful sex can psych you out so much that you don’t even want to do it. Playing with outercourse can take all that pressure off, and ensure you and your partner are still having an awesome time in bed.
When further treatment might be needed
If you’ve tried everything to have pain-free, pleasurable sex and it’s just not happening, then you might be dealing with an underlying medical condition, like vaginismus. People with vaginismus experience painful, involuntary spasms in the muscles of the vagina and pelvic floor during sexual activity, usually before or during penetration. Sometimes, the muscles contract so much that penetration becomes impossible.
When people experience pain during penetrative sexual activity, the body responds by tensing the muscles in the vagina and pelvic floor. When pain during sex occurs multiple times, the brain starts to associate sex with pain and begins to trigger the vaginal and pelvic floor muscles to contract to prevent the pain that comes with sex. Unfortunately, this triggers even more pain, which causes a stronger association between sex and pain, which understandably creates a ton of fear and anxiety about sexual activity. These feelings and the anticipation of painful sex can become so intense that even thinking about sex can trigger painful muscle spasms in the vagina and pelvic floor.
Vaginismus is more common in people who’ve experienced trauma, specifically sexual trauma, but trauma definitely isn’t the only cause of vaginismus. Co-occurring gynecological conditions like endometriosis, polycystic ovarian syndrome, adenomyosis, and uterine fibroids, as well as pelvic floor dysfunction, scarring from previous gynecological surgeries, and childbirth can all contribute to vaginismus. The condition also has a major psychological component. People who have a lot of complicated feelings about sex – maybe because of the way they were raised, their beliefs about sex, negative body image, or difficulties in their sexual relationships – can develop vaginismus in response to their overwhelming emotions about sex.
If vaginismus is the reason you’re having painful sex, the situation won’t improve until you treat the vaginismus. Luckily, vaginismus is treatable. Though a doctor, gynecologist, or pelvic floor therapist can definitely help, many people have successfully overcome vaginismus with self-treatment, for example by using digital treatment options like HelloGina. The HelloGina program, which is available on any Internet-capable device, offers you a holistic program addressing the mind and the body with a mix of videos, audio, articles and practical exercise designed by psychotherapists and leading sexual health experts. It connects you with a personal coach who can help you identify treatment goals and walk you through evidence-based treatment techniques to help you achieve them. You can reach your coach any time via the program’s chat function, which means you’ll have dedicated support through your whole treatment journey. Do you wonder if this might be for you? Take HelloGina’s assessment to find out and get help.
Reclaiming pleasure in intimacy: A journey
Realizing that you don’t have to “grin and bear it” through painful sex is a monumental step toward pleasurable and enjoyable sex. Pain during sex is a multifaceted issue that requires multifaceted treatment. To reclaim the pleasure in your sex life, you’ll need to tune into your body, recognize what it’s telling you, and try different solutions.
While you’ll need patience and perseverance as you communicate with your partner, try new approaches to sex, and take care of your mind and body throughout this journey, keep in mind that the destination – pleasurable and enjoyable sex – is totally worth the time and effort.
MAKE SPACE FOR PLEASURE
HelloGina is a self-powered digital program for overcoming pain & anxiety during sexual intercourse.
Take our assessment and discover if HelloGina can work for you.
Recent Articles
.png)
%20(1).png)
.png)
