Spine-chilling. Sheet-twisting. Mind-blowing. Sounds like the stuff of an especially exciting sexual experience, right? Unfortunately, those adjectives aren’t always an orgasmic given. In fact, the American College of Obstetricians and Gynecologists (ACOG) reports that 75 percent of people with vulvas will have sex in their lifetime that’s just the opposite: pain-inducing. Because pain during sex, or dyspareunia, can happen for a whole variety of different reasons—ranging from lack of desire to a medical diagnosis, like endometriosis—there are just as many different ways to resolve it.

First things first, though: You wouldn’t be alone in wondering whether pain during penetrative sex might not be a you problem at all. Could it be that your partner’s penis just…doesn’t fit? Theoretically, yes, a penis can be too big for a vaginal canal, says somatic sex expert Kiana Reeves. “There are different depths and shapes of vaginal canals, so it’s possible anatomically for a partner to be a tight fit,” she says. If this is the case, though, all hope is not lost. “The vagina does stretch depending on the size of the penis,” gynecologist Sherry A. Ross, MD, previously told Well+Good. “But, it may take time, patience, lubricant, and lots of open communication.”

But (but!), Reeves caveats, the majority of the time, penis size is not the reason you feel as though your partner doesn’t “fit.” Usually, she says, it’s an underlying medical issue, like hypertonic (or tight) pelvic-floor muscles, vaginal scarring from traumatic and/or non-lubricated sexual experiences, post-birth pelvic-floor changes, or vaginismus, to name just a few.

As a result, your first step for nixing painful sex is to speak with a sex-positive health-care provider, like a gynecologist or a pelvic-floor physical therapist (and if you’ve suffered from sexual assault or abuse, one who’s also trauma-informed). Depending on the diagnosis, the doctor may prescribe a variety of different strategies to help, like pelvic-floor therapy, vaginal suppositories, or medication. In the meantime, though, there are a few steps you can take yourself to mitigate certain common causes of pain during sex, however it may show up.

Here are the 4 most common categories of pain during sex—and expert-backed solutions for managing them

1. Vulvar pain

If you’re feeling a burning, stinging, or itching kind of pain in the vulva, that is “nine times out of ten, secondary to an acute infection, like a yeast infection, bacterial vaginosis, or sexually transmitted infection,” says internal medicine physician Monique White-Dominguez, DO, who heads up the sexual wellness program at Sameday Health. While any of the above could certainly cause pain outside of sex, any sexual act can aggravate or worsen it.

Even if you rule out an infectious cause, though, it’s still possible for the vulva to feel raw, red, or irritated during sex as a result of either vulvodynia or vulva vestibulitis (i.e. pain at the vestibule or vaginal opening), which can occur from past infections or persistent inflammation.

Solution: Though there are over-the-counter solutions for common infections (including anti-fungals and antibiotics), you’ll definitely want to see your gyno to determine if the cause of your pain is, in fact, an infection, and if so, what treatment you might need, says Dr. White-Dominguez.

Because even slight penetration can really set off this kind of pain during sex, you can also work to deemphasize vaginal penetration as the goal of your sexual acts. Reeves recommends a whole repertoire of sexual outerplay that involves no penetration at all, from licking, kissing, and touching to massaging, humping, and grinding.

2. Vaginal pain (that gets worse with deep penetration)

Though certain health conditions like endometriosis, fibroids, and a ruptured ovarian cyst can cause pain during sex that gets worse with penetration and thrusting, pain in the vaginal canal is also commonly tied to tightness or dryness. While arousal tends to prevent both of those things from getting in the way of good sex, some folks just tend toward the dryer or tighter side, or experience more dryness or tightness due to aging, menopause, or certain medications.

Solution: A good lubricant can help things glide along more smoothly; gynecologist and sexual-health specialist Angela Stoehr, MD, recommends silicone-based ones, as they’re extra-slick and unlikely to cause allergic reactions because they can’t absorb into the vagina.

If that doesn’t seem to provide enough relief, Reeves—who works with Foria, a cannabis company that creates products intended to reduce pain and increase pleasure during sex—suggests giving CBD lube a whirl. “CBD can help the pelvic-floor muscles relax and can draw blood to the area, which is essential for experiencing arousal and wetness,” she says. While there’s not much by way of research on CBD lube, a few studies have connected CBD in other forms to decreasing anxiety, which can lower stress and sometimes pain.

Another possible solution? Vaginal dilators, which are like dildos that are meant to be inserted into the vagina for an extended period of time. “They’re a medical device designed for people with vaginas who experience painful penetration for many different reasons,” says sex therapist Angela Watson, creator of Doctor Climax. Usually, they come in a package of five or six dilators of increasing size, with the smallest being the size of a pinky and the largest resembling the girth and length of a penis.

The idea is that the body adapts to having something inside of it and learns to relax around a foreign object, says Watson: “Over the course of weeks and months, the first dilator will be easier to insert and remove. Then you ‘graduate’ to the slightly larger dilator where the process begins anew.” Dilator sets are available online, but before clicking add to cart, speak with a health-care provider. “They’ll let you know if you’re a good candidate for the product, and if you are, guide you on how to best use—and how often to use—them,” she says.

3. Pelvic pain 

Your pelvic floor, or that sling of muscles running from the pubic bone to the tailbone, isn’t just an essential muscle group for holding your pee. Flexibility of those muscles is necessary for pain-free sex—and when they’re too tight (aka hypertonic) or experiencing spasms, it’s common to feel cramping or discomfort in the lower abdomen or pelvis during sex.

“Those muscles have to be able to lengthen and relax to allow penetration into the vaginal canal,” says pelvic-floor physical therapist Marcy Crouch, DPT. And when the muscles remain contracted, they take up real estate in the vaginal canal, leaving little room for a penis or sex toy, for that matter.

Solution: “You want to release and lengthen those muscles as much as possible to decrease muscle pain and spasm, nerve up-regulation, and soreness,” says Dr. Crouch, who suggests diaphragmatic breathing, deep squatting, and practicing the “happy baby” yoga pose. But, in general, getting evaluated by a pelvic-floor physical therapist who can assess your pelvic floor with a biofeedback device is the best way to determine the kind of pelvic-floor stretches and exercises that’ll work for you.

In the meantime, if you find that you’re prone to tensing up with penetration, regularly masturbating can help (yes, really). “For folks with real vaginal tightness, this is a powerful way to retrain the body to experience pleasure and allow insertion,” says Reeves, who encourages the use of vibrators and hands.

Given that pelvic pain tends to get worse with deeper penetration, penis bumpers can be an adaptive solution, too. Consider the Ohnut, which looks like four stackable doughnut-shaped rings that hug the base of a penis. The effect is to shorten the length of the penis, such that only the portion that’s peeking out from the toy can enter the vaginal canal (making this a prime solution, as well, for situations where penis length is really the issue causing the pain in the first place).

4. Discomfort that seems to include all of the above

A lot of times, it’s tough to pinpoint where in the genital region pain is happening during sex. Sometimes, you may even feel pain in your stomach after sex if you have female reproductive organs. “In the pelvic region, the nerves get all jumbled, and the pain signals mix and match throughout the process,” Dr. Stoehr previously told Well+Good. “Once these signals reach the brain, it literally has to guess where the pain is coming from.”

Over time, that pain also tends to start a vicious cycle, reinforcing itself—particularly if you begin to associate any sexual act with pain or have experienced emotional trauma linked to sex. “There’s imaging to support actual changes in the central nervous system and the brain real estate that is dedicated to the genitals in the presence of persistent pain,” says Dr. Crouch. And these physiological shifts can cause pain even without a current medical trigger within the vagina, vulva, or pelvic floor. “The brain starts to have trouble distinguishing those areas or what is truly ‘danger’ and begins to interpret everything as painful,” she says.

Solution: Sharing your discomfort with a sexual partner can go a long way toward breaking the cycle of sexual pain. “In a healthy relationship, [your partner] is going to want to do everything they can do to make the sex less painful for you,” says sexual-wellness expert Emily Sauer, founder and CEO of Ohnut. And if you’re worried your partner may get defensive and assume that you’re casting blame for causing the pain, consider opening the conversation by dispelling that notion. By getting on the same page, you can work together toward the mutual goal of pain-free sex.

If the pain persists, Dr. Stoehr recommends seeing a certified sex therapist, who can help you get to the root of the issue and prevent the pain response from leading to sexual aversion. From there, they can also work with you to reframe your thoughts around sex in order to cultivate the kind of sex-positive perspective that centers giving and receiving pleasure, full stop.

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