1.You’re not having enough sex
If you haven’t had sex for two years, it’s going to hurt, says Raquel Dardik, MD, clinical associate professor, department of obstetrics and gynecology at the NYU Langone Joan H. Tisch Center for Women’s Health. “It’s like saying, ‘I’m going to run three miles,’ when you haven’t done more than 10 steps in three years.” Just like any muscle, regular activity can keep your vagina healthy and strong. “If you have regular intercourse, the vaginal walls stay stretched and the vaginal muscles stay flexible,” she adds.
2.You’re stressed out
Stress alone won’t result in painful sex, but it does impact arousal. “If you’re thinking about moving in two weeks or you and your partner were just in a fight—whatever the stressor—it can decrease the amount of lubrication and muscle relaxation,” Dr. Dardik says. A bad case of the nerves has also been linked with pelvic floor muscle spasms and bacterial infections—both common causes of painful sex.
3.You’re going through the change
Perimenopause and menopause top the list when it comes to below-the-belt issues that can affect sex drive. Are you aware of these perimenopause symptoms? Atrophic vaginitis is one of the most common culprits during this time of life. “Atrophic vaginitis essentially means the vaginal area doesn’t have enough estrogen—so the vaginal skin is not as stretchy and there’s not as much lubrication,” Dr. Dardik explains.
4.You’re skipping lubricant
Though menopause is generally blamed for vaginal dryness, many other factors can play a role. “If you’re not as aroused or are taking some medication, you can have less lubrication than you normally have,” Dr. Dardik says. The result: increased friction and pain during or after sex, she explains. If you’re dry down there, a little lube can go a long way. Avoid oil-based lubes like petroleum jelly, however, as they can lead to bacterial infection.
5.You have a bacterial or yeast infection
Once again you can blame those fluctuating hormones. During menopausal years, bacterial or yeast infections are more common. “Often times women don’t know they have an infection,” says Dr. Dardik, “but they know that it feels very uncomfortable and irritated when they do have intercourse.”
6.You have pelvic-floor dysfunction
Pelvic-floor dysfunction (PFD) is hard to diagnose yet surprisingly common. By some estimates, it affects one in three American women. During intercourse, the pelvic floor – the melon-size web of muscles, ligaments, and nerves that support the uterus, vagina, and area around the rectum – can spasm and cause searing pain. Hormonal declines in menopause and loss of muscle mass with age are common culprits.
7.You have digestive problems
For women who have irritable bowel syndrome (IBS) or Crohn’s disease, the bowel is right next to the uterus so any type of movement of the uterus can trigger inflammation and irritation of the bowel. “People may say ‘It hurts when I have sex’ and point to their abdomen rather than their external organs or their vagina,” Dr. Dardik notes.
8.You have endometriosis
According to a recent study by researchers in Italy, more than half of all women with endometriosis (a condition where endometrial tissue grows outside the uterus) experience intense pain during sex. The location of the endometriosis determines the level of pain; for instance, if the endometriosis is behind the vagina and the lower part of the uterus, the pain may be more intense.