Everything you wanted to know about painful sex… but were too embarrassed to ask

Painful sex: one in five women experience it and it's a topic that women want to know more about, but for many of us it's a private subject that's too embarrassing to bring up in conversation or ask your doctor about.

We sit down with Jean Hailes for Women's Health gynaecologist Dr Elizabeth Farrell and ask the questions that you've been wanting to know.

What are some of the common causes of painful sex?

There are many causes of painful sex in women, but some of the most common causes are:

• when there isn't enough vaginal lubrication, for example if the woman isn't 'turned on' enough or because of the hormonal changes that come with menopause or after childbirth
• when the skin of the vulva (the external parts including the labia) is damaged, irritated or there is a skin disorder such as eczema
• some women can experience a condition called vaginismus where the pelvic floor muscles in the vagina spasm creating tightness and narrowing
• other health conditions such as endometriosis, irritable bowel syndrome or adenomyosis can also cause painful sex

The most important thing to remember is that if you are experiencing painful sex, make an appointment with your GP. There are many causes of painful sex and getting the right treatment depends on getting the right diagnosis.

What does the pain in painful sex usually feel like?

The pain can feel like a stinging, burning, tearing or aching sensation. The pain can be felt at the entrance to the vagina when sex or penetration is just starting, or the pain could be felt deeper at the top of your vagina, in the abdomen. Often this deeper pain is experienced in the middle of sex when there is deep thrusting.

The level of pain can vary a lot. For some women the pain can be so severe that it makes sex impossible and unbearable, for others the pain can be mild, or it can be somewhere in between.

Is it better to keep going during sex, or stop, if you have pain?

If you are experiencing any pain during sex, you should always stop. Pain can be a bit like a messenger, calling our attention and telling us there might be something wrong – so it's important to listen to the message and work out what your body is trying to say.

Try to explain to your partner why you had to stop. Afterwards, when you have some time, think about what might have caused the pain. Ask yourself: what has changed in my situation? Have I felt this pain before? Don't just ignore the pain and hope it will disappear on its own.

Who is the best person to speak to if you are experiencing painful sex?

Your first port of call when it comes to painful sex is always your GP. If you don't feel comfortable talking to your GP about this topic, find a GP who you do feel comfortable with and make sure your concerns are being heard.

Seeking help early on or when you have just started to experience painful sex is important. It puts you in the best position for effective treatment and can reduce the risk of further impacting your relationship.

Your female friends and family members can also be great sources of support and comfort in what can be a confusing and frustrating time – and you never know – they may have experienced painful sex themselves and have their own story to share with you.

Do you have any tips on how to discuss painful sex with your partner?

Try to be as honest as you can and take the time to talk it through with them so they can understand. You may need to expand your horizons in the bedroom with your partner and do things a little differently to help or avoid the pain. You might need to have more time for foreplay or explore different ways of getting turned on or having sex, so it's important to involve your partner in your journey and aim for open communication lines.

What does treatment usually involve?

The treatment really depends on what is causing the pain. If the pain has a physical cause, then treatment may involve improving the underlying condition. If the pain is caused by psychological factors or relationship issues then your GP might refer you to a psychologist, counsellor or sex therapist. For some women, the solution to the pain could be a change in sexual technique, using a lubricant or having longer foreplay.

Pelvic floor physiotherapy can also be used to treat some causes of painful sex. Watch a video of Jean Hailes pelvic floor physiotherapist Janetta Webb explaining what's involved in the first appointment with a pelvic floor physiotherapist and how this form of therapy can help.

If you could tell all women experiencing painful sex one thing, what would it be?

You are not alone and there is help available. Painful sex does not have to be kept in the bedroom and behind closed doors. It's a common condition that you don't have to suffer in silence.

Find out more about painful sex on the Jean Hailes website.