Dr. Greene's Answer
Sex hurts? How unsettling! And much more common than you might imagine. Doctors have a name for this; we call it dyspareunia (pronounced dis-pah-ROO-ne-ah). Most women have gone through a stage in which intercourse is painful; in up to a third of women, this has lasted a long time. 1 There are many reasons why having sex can hurt.
Before we look at some of the more common reasons, I’d like to say a word about communication. Sometimes sex is hard to talk about. I’ m very glad you asked your question here. Dyspareunia can be solved, one way or another, for people who are willing to ask about it.
One of the key things to learn during your current difficulties is that it’s important to talk with your partner about what is going on. Tell your boyfriend why you like him and what feels good when you are together. But also tell him when something hurts. Learning to work together is an important part of sex.
Sex Should NOT Hurt
What might be causing the pain depends on whether sex has always hurt or if this is a recent development; whether it hurts every time or only sometimes; and (perhaps most importantly) whether you feel the greatest pain when the penis first enters or once it is in deeply.
If you hurt as the penis first enters, the most common problem is not enough lubrication. Friction in this sensitive area can hurt! Your organs normally get wet and slippery as part of sexual arousal. Taking more time for sexual play before intercourse is often all that is needed to turn a painful experience into a pleasant one. Too fast is usually too dry.
A water-based lubricant (do not use lotion, baby oil, or Vaseline) you pick up at the drugstore can work wonders, but don’t ignore the reason for decreased lubrication, if you know what it is.
Fear, too, can decrease lubrication. Fear of infection, fear of pregnancy, and fear about the relationship are all common. Abuse or incest can leave you dry until the real hurt is healed.
Pain on insertion might also come from inflamed external genitals. The tissue might be inflamed from a yeast infection, warts, herpes, or some other infection. Sometimes the area is tender from a benign cyst called a Bartholin’s gland cyst. All of these conditions require medical treatment.
Intercourse can also remain painful as long as the hymen is partly intact. If you can insert a tampon comfortably, a mechanical obstruction is not likely.
Pain with deep penetration usually comes from the deeper organs being tender. This includes the ovaries, uterus, bladder, and even the intestines. At your age, the most common reasons for deep pain are ovarian cysts, a retroverted uterus (positioned so it gets bumped during intercourse), abdominal adhesions (in people who have had abdominal surgery), and an infection called pelvic inflammatory disease.
Many other, less common conditions (such as inflammatory bowel disease) can also make you hurt. In some positions (such as lying on the side), penetration is not as deep, and sex might be more comfortable.
But if the hurting doesn’t improve quickly, you’ll also need to talk to your doctor about the pain. Be sure to tell them whether the pain has always been there or is new. Describe what hurts most and when. Work together to identify the cause. Don’ t stop asking about this until you understand why sex hurts and until you’ve gotten relief from the pain. Having sex shouldn’t have to hurt.
1 Glatt, AE, Zinner SH, McCormack WM. The prevalence of dysparenia. Obstet Gynecol 1990;75:433.