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Dear Dr. Kate: Sex Hurts at First

Thu, Jul 16, 2009

Advice, What's Up Doc?

crossed_legsphoto by doug88888

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

I’ve been with my boyfriend for a year now and we tried having sex. For the first two times we did it, it hurt really bad…but only the penetration. After that I was fine. What can I do to make myself less tight and actually enjoy sex? I am afraid of the pain and don’t want sex to be a thing I don’t look forward to.

All Clenched Up

Dear Clenched,

I totally agree with you — sex should never be dreaded, and should never cause you pain. Here are a few scenarios that can cause the kind of pain you’re describing:

  • An STD or some other kind of vaginal infection.
  • Vulvodynia, a fancy-pants way of saying “pain in the vulva.” Other signs that you may have vulvodynia: Does it hurt if he puts a finger inside you? If you use a tampon? If you wear tight jeans or pants? Often, women with vulvodynia have pain on any contact to their vulva, not just intercourse. If you think this describes you, there are treatments available — most often a combination of oral medication and a topical anesthetic cream — so talk to your gyno.
  • Tightening in anticipation. The vagina is a powerful muscle. If you’re not fully relaxed before intercourse, you can feel a lot of pain with penetration. It takes the average woman 20-30 minutes of good foreplay to become both aroused and lubricated enough for intercourse. (And I don’t mean him feeling up your boobs — that’s foreplay for him — unless that happens to work for you as well!) Especially once you’ve had pain with sex, it’s natural to “tighten up” when a penis is approaching you.

Here’s what you can do:

  • No matter what you think the cause is, you should definitely go to your gynecologist, get a pelvic exam (including STD testing) and discuss your concerns with her sooner rather than later.
  • If you’re diagnosed with vulvodynia, there are treatments available — most often a combination of oral medication and a topical anesthetic cream that your gynecologist can prescribe.
  • Assuming the results of your pelvic exam all come back normal and it’s not vulvodynia, then make sure you get lots of playtime first (his fingers, or going down on you, or a vibrator). In fact, try having an orgasm before penile penetration which can help with blood flow, lubrication and relaxation.
  • Use a water-based or silicone lubricant — and lots of it — on his penis and your labia before he enters you. Reapply as necessary.
  • Make sure he enters you really slowly, to give your vagina a chance to adjust. Better yet, you be on top, so you can control how quickly he enters you.
  • In fact, you should try different positions to see if some are more comfortable than others. Perhaps you have a sensitive G-spot that doesn’t like the direct attention it gets from some positions (like doggy style).
  • Do kegel exercises regularly — strengthening them gives you greater control over your pelvic floor muscles which means not only can you contract them more easily, you can relax them more effectively too.

Whatever is happening, pain is your body’s way of telling you to stop what you’re doing. Once you can figure out why you’re hurting, you can figure out ways to make sex more enjoyable — and something that makes you shiver in anticipation, not dread.

All the best,

Dr. Kate
Gyotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

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12 Responses to “Dear Dr. Kate: Sex Hurts at First”

  1. Elizabeth Says:

    You know, the first few times I had sex (like… 8 – 10 times, to be exact), it hurt me, too. It wasn’t from lack of foreplay, or STDs and as it eventually stopped, I’m guessing its not the other thing. For me, I honestly think I was just too small and didn’t have a lot of experience uh, stretching. At that point, I didn’t even use tampons. But, after I got myself used to it, sex is perfectly enjoyable.

  2. Emily Says:

    sometimes sex hurts for me, too, but what’s worse is this: whenever i go to the doctor (i have endometriosis and interstitial cystitis, or so they say)–and i have been to many doctors, because no one can ever diagnose my abdominal pain– anyway, i’ve had several doctors stick things in me (normal gyn. exam, catheter) and most of the time, doctors ask me if “i’m sure that i’m sexually active,” just because usually it hurts so bad i cry. it is so insulting! i want to tell them that when i am having sex i am aroused, not worried. i try to relax, i’ve taken ibuprofen, but every time i have an appointment like that it just hurts too much. and i love sex…i find the more i have sex with the same person, the less it hurts with that person.

  3. Dr. Kate Says:

    Emily, that’s awful – I can’t stand when doctors are so disrespectful of someone’s pain. And an exam is NOTHING like a romantic interlude – one has nothing to do with the other. Grrrr. Consider finding a new doctor – I know that it’s not easy, gyno-shopping, but you deserve someone who treat you with more care.

  4. Dee Says:

    Hi just looking for some advice as sex hurts for me too. Ive been going out with my boyfriend for nearly 4 years and have practically no sex life. Whenever we have sex after a couple of minutes it starts to burn and sting even after he has taken it out for a while after it still hurts. We thought it maybe the condoms so we tried the non-latex ones but it still hurt even without a condom it still hurts please help.

    Thanks Dee

  5. Lee Says:

    Dee, I had the SAME problem! Are u using KY, by any chance? I had a sensitivity to it that caused horrible, get-away-from-me burning every single time. Try astroglide or mineral oil (the latter is bad for condoms)

  6. Dee Says:

    Hey Lee we dont use ky but ill give the other 1 a go anyway thanks if any1 else can help please juat drop a comment

    thanks

  7. sara Says:

    hi i am 23 years old and have had sex plenty of times i do not have a std i am check reguraly since i am sexually active. the olny problem is it hurts bad i mean real bad i want to please my partner but what can i do i have had intercoruse at least 30 times and it still doesnt change what is wrong with me. Tampons dont hurt me , finging myself feels great yet it still hurts with a convential sexual intercourse agian what is wrong with me

  8. Madamoiselle L Says:

    sara, if it hurts “really bad” when you have sex, something is wrong. It may not be an STD, but it could be a yeast infection (it can be VERY painful) or bacterial vaginosis, and those need to be diagnosed by a GYN or at least an Internist the first time. (After the first time of having a yeast infection, you will KNOW what it is, and you can buy over the counter meds, but the FIRST yeast infections should ALWAYS be diagnosed and treated by a physician or Nurse Practioner.)

    If you have had sex 30 times, your body should have adjusted, but if you are not lubricated enough, it’s gonna hurt. Make sure you get enough sexually stimulating play before he enters you (oral sex is a GREAT way to not only help you lube up, but it feels great, and most of us learn to cum with a man with this method) and use a NON glycerin based sex lubricant. (I like either KY Gel, or Astroglyde-Glycerin free, the one with the GREEN cap, the purple cap has glycerin and can cause both UTIs and vaginal infections in some women.)

  9. Bryn Says:

    Oh man, thank you for addressing this! I hadn’t found any information on this kind of thing anywhere else on the web. I’ve tried vaginal intercourse with my long-term BF four times, and sometimes we can’t even get his penis in without an hour of foreplay, AND he still had to pop my cherry (we were both virgins). Both of us felt disappointed and concerned, and didn’t know what to do.

  10. britt Says:

    The same thing is happening to me. I really want to with my boyfriend of a year but I get tight and I tear up when he starts to put it in. Is there any tricks I can do to really arrouse me or get me ready for the pain

  11. Nevous Says:

    It’s nice to see articles like this around. I have a similar problem. I have been with my boyfriend for over 4 years and been sexually active for 3, I do not know why but this entire time whenever he first penetrates me or moves out to reposition I feel pain, as if I was tearing. Every time, without fail I find blood in my discharge afterwards and I am still sore for days afterwards. I have not seen any tearing but it definitely feels like it.

  12. Emma Says:

    I am also looking for a good explaination as to why it hurts so much. Me and my boyfriend have been having sex for quite a while now. We do it alot. Obviously the 1st time hurt alot, second time, same thing. But it has been so many times now i’ve lost count (never really keeping count) but it hurts so much when he puts it in. EVERY SINGLE TIME. After maybe 5 minutes of doing it after he gets it in the pain goes away and its enjoyable. but when it hurts in the beggining its unbarable. hes usually on top. It feels like im being ripped open all over again, and it burns. My friends said its probably because we do it so much but im freaking out because from what iv heard its not suppose to hurt, and it hurts me ALOT. I haven’t gone to see a doctor or anyone yet but i do have a pat test in february. Could it just be me? Am i just sensitive down there? Nothing else like tampons, finguring, or wearing tight pants hurt, only sex.


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