Ask SHINE SA: Pain and Sex, What is the Cause?

“I’ve been with my partner for a while but lately when having sex there’s a pain on penetration like sharp blades inside me. At first, I thought I could just push through but even with lube it’s impossible. It’s making me avoid having sex what can I do?”

Many people experience pain during sex at some point in their lives. It can be confusing and upsetting when this is a regular occurrence, especially when we want to focus on the fun and pleasure of sex. There are many reasons why people can experience pain during intercourse and a common reason is Genito-Pelvic Pain/Penetration Disorder (GPPPD).


What is GPPPD?

GPPPD is an umbrella term for a number of names and causes of painful vaginal sex. It is a medical diagnosis made when there is ongoing pain or difficulty with vaginal intercourse or penetration attempts, tensing or tightening of the pelvic floor muscle during intercourse and/or fear and anxiety around having pain during sex due to this.

Primary GPPPD is when you have experienced pain ever since your first attempt of vaginal penetration e.g. first time having intercourse or inserting a tampon.
Secondary GPPPD means that previous experiences of penetration were pain-free, but pain has developed at a later stage.

Having pain during sex is not something that is caused by being uptight about sex so it’s important to know about the physical causes of painful sex. It is possible to have more than one type of painful sex happening at the same time.


What is vaginismus? 

Vaginismus is the name for difficulty during vaginal penetration resulting from the involuntary tightening of the pelvic floor muscles, causing discomfort, pain, penetration problems, or even the complete inability to have intercourse. People experiencing vaginismus may experience discomfort inserting a finger, a penis, medical instrument, tampon, or sex toy into their vaginal canal. These involuntary contractions can make the vaginal entrance extremely tight or feel like it is impossible to enter.


What is vulvodynia?

Vulvodynia is a term that means the vulva (or outer genitals) are sensitive to any touch and people can feel burning or stinging even with the lightest touch or just from clothes/underwear touching the vulva. The pain can also be constant, and no touching is needed to cause it.


What are the symptoms of GPPPD?

Typical symptoms can include:

  • discomfort or pain during vaginal penetration
  • inability to have pain-free sex or a pelvic exam due to vaginal muscle spasms/pain
  • inability to achieve vaginal penetration
  • decreased sexual desire
  • difficulty with using tampons
  • fear or anxiety about attempting penetration due to pain
  • burning or stinging of the vulva on contact/touching
  • vulva looking red or swollen

The degree of pain and symptoms experienced can vary depending on the individual.


What are the causes?  

Anyone with a vagina can experience GPPPD. There isn’t always a single cause and may be a result of a combination of physical and non-physical causes. For some people there isn’t an obvious cause at all.

Contributing factors can include:

  • medical conditions such as repeated urinary tract infections (UTIs), yeast infections, experiences of chronic pain, endometriosis, pelvic inflammatory disease
  • hormonal changes such as while breast feeding, on contraception or after menopause
  • overactive pelvic floor muscles which can be spontaneous or due to the pelvic floor muscles have been held tightly for a long time e.g. during gymnastics, pilates or dancing
  • previous experiences of abuse and trauma around sex
  • fear of penetration causing pelvic muscle tightening
  • anxiety and stress including general anxiety, previous unpleasant sexual experiences, emotional traumas
  • allergies or sensitive skin
  • repeated use of over the counter vaginal creams/soaps/washes including treatment for thrush

Although thrush can cause pain during sex if you are self-treating for repeated episodes of thrush it’s important to be examined by a health professional.


How do experiences of GPPPD impact individuals?

GPPPD can create a kind of cycle of pain for those experiencing it. When there is an anticipation of pain the vaginal muscles tighten which makes penetration/insertion even more difficult. With vulvodynia the nerve endings can become even more sensitive with repeated episodes of pain. This can make people avoid intimacy and further reinforce the cycle of pain by creating fear and anxiety about future pain.  Pain can also go from just with touching/penetration to becoming constant and chronic.

In addition to physical experiences, people with GPPPD often report feeling embarrassment or shame. It can impact self-esteem and for some people and can contribute to experiences of anxiety and depression. Some people may avoid building any type of intimacy with the fear that it will lead to sex and what they may feel is an uncomfortable discussion.  All these experiences can make people feel isolated intimately and can have a negative impact in their intimate relationships.

Nicole Lane shares her story of overcoming vaginismus and the barriers she faced when dating:

Dating with Vaginismus (Note: gendered content).

What’s important to remember is that GPPPD is nothing to feel shameful about, it’s common and is highly treatable.


What can you do about painful sex? 

If you’ve experienced painful sex or feel afraid to have penetrative sex then it is important to speak to your doctor to work out what might be the cause. GPPPD is a common condition and there are treatments available to help. It’s important not to try and push through the pain by continuing painful sex as this can make GPPPD worse.


What can I expect when seeing a doctor?

To treat and understand your experiences, your GP will likely ask you about your medical and sexual history. It’s a good idea to find a doctor that’s sympathetic and understanding. You can speak to SHINE SA about referring you to doctors experienced with GPPPD.

A pelvic examination may also be performed with your consent but is not essential to be diagnosed and treated.

Treatment for GPPPD can involve factors that address the physical and psychological causes. Although GPPPD is not necessarily caused by psychological issues the anxiety that can develop from repeated painful sex often needs to be supported.  This means your GP may provide a referral to other services including physiotherapy and counselling.


What treatment is available?

Your GP may suggest the following types of treatments:

  • pelvic floor therapy – a physiotherapist can teach you how to relax and control your pelvic floor muscles
  • insertion and dilation training – pelvic floor therapy can be used in conjunction with vaginal dilators which stretch the vaginal muscles and get them used to the sensation of penetration
  • counselling or therapy -a psychologist or counsellor can support you to understand your thoughts, emotions and behaviours surrounding GPDD
  • medications – these can be taken orally or applied to the skin to reduce the sensitivity of the vulva/vagina

GPPPD is treatable, so remember to speak up if you feel like something isn’t right.


Can I still be intimate with my partner/s?

If you’re struggling with GPPPD, then it’s a good idea to talk about what intimacy means to you and your sexual partner/s. Sex is (and can be) a lot more than penetration/genital contact, being intimate can include mutual masturbation oral sex, massage, sexting, kissing or cuddling. Remember, penetration doesn’t equal ultimate satisfaction.

It is understandable to feel frustrated with your body when you want it to act in a certain way. Talking about your desires and open communication with your partner/s is key to working out what is safe, pleasurable and respectful for all involved.