Because everyone knows that sex is supposed to feel good, it can feel sort of weird and awful when it doesn't.
But pain during sex isn't something to be ashamed of—especially since it's a complaint that Alyssa Dweck, M.D., gynecologist based on Westchester County, New York, assistant clinical professor of ob-gyn at Mount Sinai School of Medicine, and author of V is for Vagina, hears all the time. "It's more common than you'd think, and there's a lot you can do about it," she says.
Typically, there are two culprits: Vaginal dryness or infection. (Note: Neither have to do with your "small vagina" or his large endowment. Men!)
Here's why you might be experiencing pain during sex, according to Dr. Dweck—and her advice on what to do about it (besides see your own doc, who's best suited to diagnosis you).
1. You use hormonal birth control.
The hormones reduce fluid secretion so your vagina is naturally drier.
The fix: Lubricant can go a long way. Make a water-based brand like KY your go-to; rely on a longer-lasting silicon formula for water play; and try the very effective coconut oil if you use a method besides condoms for birth control and STD protection. (Otherwise, oil-based lubricant will break down the condom and render it useless.)
2. You're a week away from ovulating.
Your vagina's natural secretions vary throughout your cycle and dip after your period but before your mid-cycle egg drop.
The fix: Use lubricant or wait until you ovulate (about two weeks before your next scheduled period). Mid-cycle, you'll have more mucus-y discharge, which reduces friction for better-feeling sex.
3. You skimped on foreplay.
Taking your time getting to the main event gives your body a chance to lubricate itself so painful dryness isn't an issue.
The fix: Use lube or patience. Both should work.
4. You're taking antihistamines.
The daily allergy meds you take to dry up sinus secretions can dry out your vagina too.
The fix: Ask your doctor about alternative treatments so you can wean off the meds.
5. You did the worst job shaving.
Depending on the wound placement on the vulva or labia, and the sex position you're working with, infected hair follicles and shaving rash can make sex feel preeetty awful.
The fix: Treat the infected area with an antibiotic or hydrocortisone cream, and lay off sex until it's cleared up.
6. You have a yeast infection.
While yeast infections tend to be more itchy than painful, they alter the pH in your vagina, which can inflame vaginal tissue, causing pain upon penetration.
The fix: Abstain from sex until your yeast infection is resolved. (Topical OTC remedies can be a total a godsend.)
7. You have chlamydia.
Frequently asymptomatic, this STD can cause scaring and inflammation that makes thrusting uncomfortable.
The fix: Abstain from sex until you can see your doctor to get tested.
8. You're bloated AF.
If you have IBS or colitis, or just wolfed an entire burrito, bloating can make sex feel particularly uncomfortable. Especially if you washed down said burrito with half a pitcher of margarita—sex with a full bladder is The Worst.
The fix: Wait until you digest or—at the very least—pee before penetration.
9. You have a uterine fibroid.
This benign, non-cancerous uterine growth is made of muscle tissue. It's miniscule and most people never even notice it—unless it grows large enough to get jostled around during sex.
The fix: An ultrasound can confirm this diagnosis, which is either left to go away on its own or surgically removed.
10. You have an ovarian cyst.
This non-cancerous, fluid-filled growth on the ovary can cause pressure during sex—or acute and sudden pain, if sex causes the cyst to pop or leak. (The fluid is usually clear so you might not even notice.)
The fix: Diagnosed by ultrasound, there are a few treatment options: Relax and do nothing—cysts often go away on their own; have it surgically removed; or take birth control to suppress ovarian function and prevent cysts from growing (this last one is the best option for women with reoccurring cysts).
11. Your sex position isn't working for you.
The tilt of your uterus affects your comfort level during sex: Say yours is pointed backward, you'll feel pain in missionary position and pleasure on top.
The fix: Switch positions—and try girl-on-top, which gives you more control in terms of depth and angle of penetration.
12. You have endometriosis.
It's when the cells that typically line the uterine (and do the whole shed-and-bleed thing every time you get your period) grow elsewhere—like on the fallopian tubes or on the tissue that lines the pelvis. While endometriosis has been linked to fertility issues and pelvic pain plus over-the-top cramping, the bleeding isn't necessarily dangerous, just uncomfortable, particularly when scarring occurs.
The fix: See a doctor for diagnosis and treatment, which can include going on birth control or (sometimes) surgery.
13. You're really pregnant.
The closer you are to your due date, the heavier your uterus. When you lie directly on your back, the weight can compress a large blood vessel, causing discomfort that some interpret as painful.
The fix: Avoid lying on your back. Women who are further along in their pregnancies tend to be far most comfortable in doggy-style or side-by-side positions.
14. You use spermicide.
Lots of women are sensitive to the stuff. If you're one of them, the irritation can increase your risk of infection and microtears in the vagina. Ouch.
The fix: Use regular condoms to contain sperm instead of kill it.
15. You have vaginismus.
This involuntary clenching of the vaginal muscles makes penetration painful if not impossible.
The fix: Sometimes triggered by psychological trauma or fear, treatment often involves therapy, so talk to your doctor.
16. You're breastfeeding.
Lactating and breastfeeding lower estrogen and make vaginal tissues more delicate.
The fix: Use a lubricant during sex and a vaginal moisturizer the rest of the time.
17. You're going through early menopause.
You'll have low estrogen levels that cause dryness and thin vaginal tissues, making your vagina especially delicate—and susceptible to tears.
The fix: Use lube or talk to your doctor about estrogen pills.
18. You ODed on indoor cycling.
Your regular cycling session can put pressure on the nerves and bruising on the vulva, which can to cause general discomfort that reveals itself in the form of pain during sex—particularly if you set your bike up incorrectly.
The fix: Use a padded saddle or wear padded shorts. Then raise your handlebars and/or lower your seat to change your positioning and alleviate the pressure.
19. You have vulvodynia.
It's a rare but miserable syndrome that causes chronic pain throughout the vulvar region—so not just during sex.
The fix: Because this is believed to be a neurological condition, there's no go-to fix—your doctor might prescribe estrogen, steroid cream, or antidepressants to isolate the offending agent.
20. You have Sjogren's syndrome.
It's a rare immune system disorder characterized by dry eyes and dry mouth and—yep—dry vagina.
The fix: Lube. It's like magic!
21. The last time you had sex was Hard. Core.
Rough, vigorous thrusting can cause microtears in the vagina that lead to scarring and sensitivity.
The fix: Abstain from sex until pain goes away, and make sure you're properly lubricated the next time you have sex.
WHEN PAIN WARRANTS A DOCTOR'S VISIT
Any time you experience a sudden and acute onset of severe pain unlike anything you've felt before, get it checked out—especially if the pain outlasts the sex.
Your doctor can rule out the worst-case scenarios so you can get back in the saddle—and make it a more *~pLeAsUrAble~* ride.
This article originally appeared on Cosmopolitan.com. Minor edits have been made by the Cosmo.ph editors.