When my boyfriend and I have sex, it hurts — not all the time but frequently enough to make sex less appealing. I’m too embarrassed to tell him. What should I do? —Ouch


You are not alone. Research shows that 30 percent of women experience pain during vaginal sex, 72 percent report pain during anal sex, and "large proportions of Americans” (whatever that means) don't tell their partners when sex hurts. Why are we so scared to speak up when sex doesn’t feel good? In my clinical experience, I’ve found that often, women do not tell their partners because they are embarrassed, worry that something is wrong with them, are afraid of hurting their partner’s feelings, or are afraid of being perceived as less sexy.

It’s not uncommon for a person in a relationship to consent to sex that they are not really up for in order to take one for the team, so to speak. Research shows that we tend to do this to give pleasure to a partner, increase intimacy, and protect the relationship. While these are all good reasons to choose to engage in an intimate connection with your partner, letting them know when — and stopping — when you’re in pain is crucial. A healthy partner does not want to hurt their lover. And there is a lot that can be done to prevent and alleviate pain if your partner knows it exists.

Here are some of the most common causes of pain and discomfort during sex. Anytime that sex is consistently causing you pain, you must speak with your gynecologist and should be honest with your partner too; I consider reasons 1-5 the typical, everyday stuff that may not always require a trip to the doc, but if you suspect reasons 6-8 may be at play, talk to a medical professional immediately. Knowing what's going on is the first step to healing.

1. Not enough lubrication

I cannot tell you how many people’s lives would be improved by a little lube. Getting started before your body is ready is a common issue when it comes to pain during sex, and while increased foreplay can get your juices flowing or, if you are both too impatient to wait, a good bottle of lube can also do the trick.

2. Incompatible sex positions

Sometimes the wrong sex position for your body or your lover’s can cause you pain. And just because a certain sexual position was your go-to with your previous partner does not mean it will be the right one with this person. If your boyfriend is well endowed or has a curved penis, for example, some positions will make you feel like your cervix is hosting a boxing match. In those cases, you’ll want to avoid deep penetration positions like doggie style.

3. Rough sex

Rough sex or super long sessions can cause pain or injury. These activities can lead to abrasions, tears, or bruises in the area that will leave you sensitive. If you’re into aggressive sex, make sure you’re giving yourself time to heal or change up your routine if you start feeling discomfort.

VIDEO: 5 Real Women Reveal the Sex Positions That Always Make Them Orgasm

4. You just had a baby

Most doctors recommend waiting 4-6 weeks after a vaginal delivery to have intercourse. I have known many women to beg their doctors to tell their partners that the required wait time is 12 weeks, though. First of all, be upfront about when and whether you feel ready to resume having sex. In a study of sexual activity after childbirth, researchers found that more than 85 percent of women experience pain during intercourse the first time they have postpartum sex, more than 44 percent experience pain three months postpartum, more than 43 percent at six months, more than 28 percent at the one-year mark, and more than 23 percent after a year and a half. While any pain you are experiencing should be reported to your doctor, discomfort is pretty typical after childbirth. It takes a while for your body to adjust; investigate but be patient with your body as it heals.

5. Menopause

Menopause, whether triggered by age or a medical issue, brings about changes in your body that can make sex painful. The drop in estrogen can result in dryness and thinning of the vaginal wall, which can make penetration uncomfortable. If this is the case, lube up and talk to your doctor.

6. Infection

Your typical yeast, bladder, or bacterial infection can make sex anywhere from uncomfortable to downright agonizing. Most of these issues can be treated with over-the-counter medication, but it’s always best to get examined by your doctor first to make sure you’re treating the right issue in the right place.

7. STIs

There are a number of sexually transmitted infections that can make sex painful, including Trichomoniasis, Gonorrhea, Chlamydia, and Herpes. Get tested regularly so you can catch them early and get treatment.

8. Gynecological issues

There are several gynecological diseases and issues that can cause ongoing pain and are difficult to identify. Vulvodynia involves chronic vulvar pain with no identifiable cause; Pelvic Inflammatory Disease (PID) is an infection that can spread from your vagina to your uterus and ovaries; Endometriosis is when endometrial-like tissue grows outside of the uterus, which can cause pain and fertility issues; ectopic pregnancies occur when an egg fertilizes and grows outside of the uterus, which can be enormously painful. These issues and others are often challenges to diagnose, so it's important to see your doctor regularly and report any pain or atypical symptoms.

These are some of the most common culprits. Of course, any time you experience pain during sex you should discuss it with your partner, but most importantly, discuss it with your doctor.

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