Ask A Gynecologist: Why Is Sex Painful Sometimes?

How to tell whether rough sex is the culprit or something more serious is going on.

Finally, we're bringing you very public answers to some of your most private questions. When sexual and vaginal health concerns arise, OB/GYN and nationally known women's health expert Dr. Jessica Shepherd wants to ensure you have the answers you need to feel at ease. As the founder of Her Viewpoint, an online women's health forum, she uses this outlet to focus on addressing taboo topics in a comfortable setting. Prepare to take notes!

Q: What causes vaginal discomfort during sex?

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A: Usually when women complain of pain during sex there are ways that we try and figure out exactly what the cause is. We always try to differentiate if it's with penetration or if it's with the thrusting motion in actual intercourse that causes the pain in sex. Sometimes positions can make that difference, and so if someone experiences pain in one position but not the other, that may just have to do with the way that their pelvis is oriented during that particular position.

There is a difference between painful sex because it's rough sex or pain because it's painful and something is wrong. Something to be mindful of is how often that pain is experienced and the frequency of the pain. If you find that it's every time you have sex or even changing positions doesn't really change the pain that you're experiencing during sex, then more likely then that might be the reason that's happening.

A good indicator is the pain is because of what we call vaginismus, which is like spasms of the vagina. If someone usually had a history of sexual trauma in the past, then that might allude to more of a pain during sex.

If someone has endometriosis, which is a pelvic pain disorder, that can elicit painful sex that needs to be evaluated. Also, fibroids, they can push on the pelvis and cause pain during sex. If someone has a sexually transmitted disease and their cervix is inflamed that could cause some of the pain during sex. 

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In any of these cases, you'd definitely want to talk to your gynecologist to make sure that you're tested and treated for any STIs or any other issues you are experiencing.

Have a question for Dr. Shepherd? Email us now.

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