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
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 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.