It's a dismal fact, but at some point in their sex-having lives, almost all women (75 percent, according to the American College of Gynecologists and Obstetricians) will experience some sort of pain during or right after sex. The vagina is designed to handle a lot (A BABY COMES OUT OF THERE) but something's bound to go awry in years of vaginal action. I mean nothing in this world is made to withstand decades of regular use—it would be unfair to expect this from your human sex parts.
While some slight pain or discomfort could just be a sex position or muscle soreness problem, more severe and frequent pain can be indicative of a greater problem. To help sort out the differences, Cosmopolitan.com spoke with Dr. Cheryl Iglesia, a urogynecologist who deals with women who suffer from painful sex on a regular basis in her practice.
WHEN DISCOMFORT IS NORMAL
Surely you've experienced the sometimes-painful phenomenon of someone hitting you with their boner in the wrong spot, or with too much force. If you haven't yet, I'm sorry, but you probably will. It's just part of the fun, rollercoaster ride experience that is having a cavernous hole as your sex organ!
Iglesia said the test for whether or not the pain or discomfort you experience is normal, or cause to see a doctor, is to see if it goes away with a few hours of rest, a regular dose of ibuprofen, or a combination of the two. If the pain is only happening in one particular sex position, it might be that your vagina just doesn't like it that way and you should mix it up. Or if you occasionally experience cramping post-sex, Iglesia said that's likely just your muscles getting tired—kind of like you get cramps after exercise (sex is exercise, lest you forget).
"The bottomline is I think most sexually active women have had pain during sex at some point in their lives," Iglesia said. "But it's dependent on the level of severity and frequency, so if it's happening every single time, or is a seven, eight, or nine on the pain scale, you should see your doctor."
WHEN YOU CAN'T GET ANYTHING INTO YOUR VAGINA
If the cramping gets so bad that your vagina closes up, you might have vaginismus, one of several disorders that causes vaginal pain. According to the Society of Obstetricians and Gynecologists of Canada, vaginismus is when your pelvic floor muscles involuntarily contract or tighten anytime you try to insert something into your vagina — really, anything. Like a tampon, a penis, a vibrator, a pinky finger, anything. This muscle tightening results in pain that Iglesia said women typically describe as a burning sensation or "like throbbing, or hitting a wall." There haven't been many studies so it's hard to know just how many women are affected by this, but one common estimate is about 0.5-1 percent of women.
The causes are also somewhat mysterious, although Iglesia said it can happen "with a history of any type of sexual trauma and with patients who are just over-kegeling." (So yes, there's such thing as being too tight, and no, we can't ever actually win.) For women who experience vaginismus related to sexual trauma, Iglesia said it's a mental problem—they're anticipating pain, and just reflexively clench those muscles to keep anything from coming in.
But no matter what the cause, vaginismus is totally treatable. "It may require physical therapy to purposely find those muscles and learn to consciously relax them," Iglesia said, but it's doable, and you don't have to live with a vagina that rejects all intruders. With the help of a good diagnostician to sort out the root of your problem, and a bit of patience, you can start having pain-free sex in a matter of time—it varies from patient to patient.
WHEN YOUR VULVA FEELS RAW
Another type of painful sex disorder in women is called vulvodynia, and Iglesia said it's a bit more common than vaginismus. Although it's still hard to know exactly how many women have it (sense a pattern? female sex disorders are historically shrouded in mystery), she estimated that about 1-2 percent of women are affected by this disorder.
Unlike vaginismus, vulvodynia affects the vulva, not just the opening of the vagina, and there are two types: generalized vulvodynia, in which the entire vulva feels painful, and localized vulvodynia, where just one specific part of the vulva feels pain. Also unlike vaginismus, this disorder doesn't affect the muscles as much—so you can physically insert things into your vagina, but may find itincredibly painful to do so. According to ACOG, the pain is typically described by patients as "burning, itching, and rawness." Women with vulvodynia might even have pain from sitting for too long, wearing tight pants, trying to put in a tampon, or peeing.
Iglesia said that a common cause of this is a change in hormones, or low levels of estrogen— like if you're on a low dose birth control. Other causes, according to ACOG, are damage to the nerves in the vulvar area and weakening of the pelvic floor muscles. To cure it, a lot of doctors prescribe hormone creams rich in estrogen that you can apply directly to the vulva, or even antidepressants. Remember in Sex and the City, when Charlotte goes to her gynecologist complaining of "burning and itching," and leaves with antidepressants for her vagina? It's not named in the show, but that was most likely vulvodynia. So no, your vagina can't "get depressed," as Charlotte says, but it can require antidepressants.
WHEN YOU HAVE PAINFUL PERIODS AND PAINFUL SEX
Probably the most common cause of painful sex, according to Iglesia, is endometriosis, which affects about 1 in 10 women. Although it's not classified as a painful sex disorder like vaginismus and vulvodynia, endometriosis—a disorder where a woman's uterine lining grows outside of the uterus—causes painful sex that ranges from discomfort to excruciating for about half of all women who have it.
Endometriosis can be made less painful if you don't have a monthly period, Iglesia said, because you aren't shedding the uterine lining and risking the growth of more cells outside the uterus. She said it's a new, semi-controversial treatment method, but some women with endometriosis find they feel much better if they use a form of birth control that halts periods altogether—like theMirena IUD.
Other options are to try switching positions, or timing sex during times of the month when you're experiencing less pain. So that means, for a lot of women with endometriosis, no period sex.
WHEN YOUR VAGINA FEELS LIKE SANDPAPER
There's a reason your vagina gets wet with arousal—it's damn near impossible to get something like a penis or sex toy up there when you're dealing with Sahara-like conditions. A fairly common reason women might experience painful sex is a lack of natural lubrication.
Lack of natural lubing up is not just a problem that comes with menopause. Iglesia said little things like a change in hormone levels (from things like breastfeeding or a new birth control method), allergy and cold meds that have antihistamines in them, and irritants in soap or perfume can cause problems with getting sufficiently ~*~moist~*~ before and during sex. The incredibly easy/cheap/accessible cure? Go find yourself some good, water-based lube. Or, as Iglesia said, "obviously saliva's fine too."
Lube gets an unfair bad wrap as being just for mature women, but it's actually great for everyone. Have you ever heard a guy complain that you're *too* wet down there? Haha, and you never will. Just be careful picking one out—Iglesia warned that some lubes might be irritating to your delicate vaginal system, and could actually make the problem worse by irritating the skin. Look for lubes that don't contain any chemicals or silicone, and you should be good to go (literally whenever you want, at the drop of a hat).
There's a difference between discomfort and pain, and really, you just have to figure out where that line is for you. As Iglesia said, severe or frequent pain is not normal and is not something you should have to endure every time you have sex. It's supposed to be a fun activity, and all of the painful sex disorders I mentioned are 100 percent treatable. No one's doomed to live a life of painful sex, no matter how hard you might wish exactly that on your mortal enemies.
This article originally appeared on Cosmopolitan.com. Minor edits have been made by the Cosmo.ph editors.