The questions published in the Sex Matters column are answered by Rebecca Alexander, LMFT, a licensed counselor working with the Outreach & Advocacy: Sexuality Information for Students (OASIS). Questions may be e-mailed to oasis@etsu.edu. Sex Matters’ questions will be published anonymously.

Dear Sex Matters,

I am a 20-year-old woman who decided last summer to have intercourse with my boyfriend. We have a great relationship and it all felt like a good decision until the penetration became really painful. I kind of expected it to hurt the first time, but since then, we have tried several times again, and it keeps hurting terribly. I am scared that I will never be able to have intercourse comfortably … what is going on with me?

Scared & Disappointed

Dear Scared,

Because sex can be painful for many reasons, and several factors could be causing the experience of pain during sex, finding the answer can be a little bit like solving a puzzle. So, let’s look at some of the possibilities.

First, ask yourself some questions:

When does the pain begin? Is it as you’re getting excited, only during penetration, related to orgasm?

Where do you feel the pain? Is it in one specific area, or more general? External or internal?

What kind of pain is it? Does it feel sharp or achy, stabbing through or bumping against?

Are there still things you can do sexually that don’t cause pain?

Now, explore on your own. If you don’t masturbate, now’s the time to start. If you can masturbate without pain, that is a helpful thing to know.

Using masturbation to explore sexual pain is particularly good because you don’t have to worry about your partner poking you in the wrong way.

You can be in control of exploring pressure, penetration, different angles and speeds, widths, lengths and any “area of interest” that feels pertinent to really understanding where the pain is coming from.

Feel free to use a vibrator to safely simulate “real” penetration from your partner.

When you find the pain center, you can then explore what works and doesn’t work when sexually engaged. You can choose whether to include your partner in this process or keep this more private with yourself as you learn.

Use plenty of lubrication. One of the most common reasons for painful sex is lack of lubrication.

If your natural lubrication is not enough, or you simply find it easier with more, using a personal lubricant can be an easy and effective way to treat this problem.

The value of lubrication is highly underestimated, in my opinion – use it liberally.

Even when intercourse is not painful, having a good lube nearby is essential. Be sure the lubricant is safe for sexual intercourse – K-Y products and Astroglide can usually be found over the counter, and a trip to Intimate Treasures can offer even more choices.

Communicate with your partner. You do not need to “suffer in silence”.

Practice foreplay with your partner. Penetration requires arousal. Arousal takes time.

Your body may need extra time to move beyond the fear of anticipating the pain.

Our bodies respond and open most when we are safe, comfortable and relaxed, when we have “warmed up.”

This is also a great way to find other ways to give each other pleasure and enjoy sexual experience.

Experiment with different positions. For some people, pain during intercourse can happen as a result of pressure on particular parts of the body.

It may be putting pressure on certain joints, or that penetration at a certain angle is painful.

Everyone’s physiology is unique – I knew a woman with a ‘tipped uterus’ that experienced painful intercourse in certain positions, but when positioned properly, enjoyed a great sex life.

Speak with a health care provider. There are a number of physical reasons you might be experiencing pain during intercourse, and fortunately, there are solutions for all.

The following are some medical and physiological causes of painful intercourse:

Dyspareunia, which is recurrent or persistent genital pain associated with sexual intercourse. Dyspareunia can develop as a result of infections or surgical procedures, or can reflect some sort of psychological conflict.

Vaginismus, or involuntary muscle spasms of the lower third of the vagina. Vaginismus usually develops as a conditioned response to painful penetration, and can be physically or psychologically based.

Vaginal or urinary tract infections.

Interstitial cycstitis, a chronic inflammatory condition of the bladder

Pelvic pain can be caused by tears in the ligaments supporting the uterus, infections of the cervix, uterus or tubes, endometriosis, or cysts or tumors on the ovaries.

Checking with a medical professional, a sex therapist and/or a counselor is a great place to start.

Make an appointment for a gynecological exam and discuss the pain with your doctor/nurse.

If you have experienced past sexual trauma, or have fears or negative thoughts about sexuality, a counselor can help you heal through the psychological challenges those create.

Talk with your partner and let him know what is going on. There is every reason to believe that you can move forward into a lifetime of happy, healthy, pain-free sexual experience.

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