Why Do Only Half of Women With Sexual Pain Tell Their Lovers?

Attention gentleman: Many more women than you probably imagine experience pain during sex. But a recent study shows that unless the pain becomes severe, only half of women ever mention it. Why do they remain silent? Sexual martyrdom. Some women believe sex is for men's pleasure, not theirs.

The Study

Researchers in Australia and at several U.S. universities—Columbia, Purdue, and Indiana—reviewed data from the 2018 nationally representative U.S. National Survey of Sexual Health and Behavior. They identified 382 adult women who'd reported at least one painful sexual experience during the previous year and asked them three questions:

• How painful was it?
• Did you tell your partner?
• And if not, why not?

Of those reporting pain, only half (51 percent) told their partners.

The women were most likely to speak up if their pain felt severe, but 82 percent said theirs was "only" mild to moderate, not sufficiently agonizing to warrant discussion. However, even mild pain significantly interfered with these women's erotic pleasure and satisfaction. Their silence cost them—and their lovers—but many grew up believing that sex should hurt and that they should subordinate their erotic pleasure to their men's.

Many Potential Causes

Some women believe sexual pain is the result of extra-large erections. Actually, very few men are significantly larger than average, and the vagina is quite elastic. It expands way larger than any erection as newborns enter the world.

Pain is a complex, highly individual, mind-body experience, but the cause of sexual pain usually falls into one or more of these categories:

• Men rushing intercourse: In pornography, boy meets girl, and moments later, he's hiding the salami. In fantasy, that's fine, but in real life, rushed intercourse often hurts women. In addition, in porn, many men treat women roughly, subjecting them to jackhammer intercourse. Big mistake. Unless the two of you specifically negotiate rough play, your default position should always be an erotic touch that's very gentle. Don't move any faster than half-speed. With all due respect to the occasional quickie, the best, most comfortable sex is leisurely, playful lovemaking that includes at least 20 minutes of tender, mutual whole-body caressing before the focus shifts to the genitals.
• Lack of lubrication: Even with extended love play, poorly lubricated intercourse is a major cause of women's sexual pain. Many perfectly normal women of all ages don't produce much natural lubrication. Never insert anything into a vagina that feels the least bit dry. When in doubt, apply lots of saliva by hand or cunnilingus and/or use a commercial lube.
• Men inserting too deeply: If you're the rare guy with an unusually long erection, your length may hurt women in any position. But rear-entry (doggie style) intercourse is most problematic. Extra-long penises may bang into the cervix (the mouth of the uterus) and cause pain. Gentleman: To enjoy pain-free doggie intercourse, remain still and invite your lover to back onto your erection to a depth that feels comfortable for her. Notice her comfort limit, and don't push in deeper.
• Relationship turmoil: If you fight a lot and resentments fester, one possible consequence is the woman feeling sexual pain. Consider couples counseling or sex therapy.
• Gynecological issues: Many medical conditions may cause sexual pain. Ladies, if you suffer pain, consult your primary care physician or gynecologist.
• Imperforate hymen: At birth, a thin membrane, the hymen, partially covers girls' vaginal openings. It often wears away during childhood and causes no discomfort on tampon insertion, fingering, or intercourse. But in some women, residual hymen tissue may cause sexual discomfort or pain.
• Vaginismus: This involves muscle spasms that constrict the vaginal opening or clamp it shut, making any insertions painful or impossible. Vaginismus affects around 10 percent of women.
• Sexual infections: Chlamydia, genital warts, and pelvic inflammatory disease may cause pain on intercourse.
• Vaginal infections: Vaginal yeast infection or bacterial infection (vaginosis) may cause sexual pain.
• Menopause. After 40, vaginal dryness and tissue thinning (atrophy) become increasingly prevalent. They may make intercourse uncomfortable or painful.
• Vulvar skin conditions: Many women's genitals are sensitive to irritation from douching, pubic shaving, latex allergy from barrier contraceptives, or contact dermatitis from perfumed soaps, bubble baths, feminine hygiene products, or underwear made from synthetic fabrics. Wear cotton underwear. Don't douche. Don't use perfumed soaps or bath items. Get evaluated for latex allergy. Consider taking a break from shaving.
• Vulvar vestibulitis (VV): This condition involves inflammation of the tiny vestibular glands just inside the vagina. Q-tip pressure causes sharp pain. Various treatments are available. Work with your doctor(s).
• Oxalate irritation: Oxalates are compounds found in some foods, among them: spinach, almonds, cashews, beets, and chocolate. Women sensitive to the oxalates may develop urethral irritation and sexual pain.
• Other medical conditions: Pain might result from uterine prolapse, endometriosis, interstitial cystitis, irritable bowel syndrome, gynecological cancers, and other conditions.
• Birth control pills: Andrew Goldstein, M.D., editor of Female Sexual Pain Disorders, says, "Birth control pills are a leading cause of women's sexual pain." The pill increases the release of sex hormone-binding globulin. It binds to vulvar cells, triggering biochemical changes that may cause pain. If you take the pill, consider switching to another contraceptive. After quitting the pill, it may take several months for the pain to resolve.

Ask About Sexual Pain, and Urge Lovers to Speak Up

Ideally, couples should discuss every aspect of their lovemaking, including any pain. But in reality, few couples do. Many, if not most, fall back on our culture's assumption that men should orchestrate sex, with women following their lead.

Gentlemen, before things heat up, say: "I want you to love our sex. If you feel any discomfort at all, please tell me immediately. The last thing I want to do is hurt you."