Dear Dr. Myrtle,
I have difficulty with vaginal penetration. When I try to have intercourse, it hurts and I just don’t want to try again. Is there anything I can do on my own, or do I need professional help?
For some, vaginal penetration can be uncomfortable or impossible, and can cause difficulty with intimate sexual penetration or hamper your ability to be examined by your healthcare provider. The answer to your question is that you need to understand more about what causes the pain, and you may need a health care provider to help you determine the cause.
What causes uncomfortable vaginal penetration?
There are a variety of causes of difficult penetration, so although we can give you some guidance, you still might need a physical exam to move forward with therapy. It often helps to consider exactly what the circumstances are when you experience discomfort or pain, because where/when this occurs can help in identifying the problem, and moving on to the solution. For example, read through this detailed progression of vaginal penetration, and consider where your experiences might overlap.
Pain right at the surface of the skin of the vulva:
- I experience pain all the time, no matter what I'm doing.
- I don't have pain all the time, but if something is touching my skin I begin to feel pain. The thing touching my skin might be:
- my underwear. (Underware cloth itself, or where the underwear binds, or just the latex strap part? Does different type cloth change this problem?)
- a lubricant, lotion, soap, water (cold or hot), anything else?
- a finger, anywhere, any pressure. (Describe the type of pressure or rubbing motion that causes discomfort.)
- a finger, on this * area. (Copy the diagram of the vulva above, and put a * where ever the pain is. Is is only on one side? Is it only in one spot? Is it only on a sore or scaley patch? Where ever it is on you, mark it with a *.)
- I don't have pain all the time, because something (in THIS spot) swells up sometimes and causes pain. When the swelling is gone, the pain is gone.
- I don't have pain, I have numbness or changed feeling in the skin. (Draw out the area of numbness/changed feeling.)
Pain with some specific structure of the vulva:
- Touching the skin of my vulva is fine, but massaging deeper past the surface causes pain (where?).
- It seems like when I touch deeply enough to feel bone (pubic, pelvic, hip), that's where the pain is.
- It feels like I've pulled a muscle or something, and it aches with massage.
- I don't have pain, aching or bone pain on my vulva. But when I touch anywhere on the (fill in the area below)...
- head of the clitoris
- legs of the clitoris
- paraurethral gland openings
- major vestibular glands
- minor vestibular glands
- opening area of the vagina
- perineum (area between the vaginal opening and anal opening
- anal opening...
- (continued) ... I feel pain (deep pain or burning pain, or sharp lancing pain, or ...?...) soreness, irritation or ripping pain.
Pain with early vaginal penetration:
- I don't have pain at this spot until (fill in the blank) happens.
- Nope, I'm good with all of that. But the second a small finger is inserted just at the opening of vagina, I can't push in any further. It's like a door shuts tight.
- I have never been able to insert a tampon into my vagina, even when it's lightly lubricated and I use the smallest size.
- Nope, I'm good with all of that above. What happens is only after penetration of the first inch or so of the vagina. Then, it's like my partner runs into a wall.
- I had pain with vaginal penetration some time ago, so frankly I'm so terrified of the pain returning I don't let anything come near my body.
- I had pain with vaginal penetration some time ago, and even though I want to be penetrated now, it's as though a door shuts tight and won't let anything in.
- I'm uncomfortable with the idea of vaginal penetration for my own personal reasons, and it's as though a door shuts tight and won't let anything in.
Difficulty with deeper penetration only:
- I'm good with all of that above, and penetration of the first inch or so is ok. But there's this spot (right where?) where there seems to be excessive rubbing.
- If I can relax or massage that spot before we start, I seem ok.
- No amount of massaging makes that spot feel better.
- It never seems to go away at that spot.
- A vibrator makes that spot much harder and more painful.
- The spot is more like any time something comes near my urethra, I feel extreme pain or burning. We can move to different positions and it's ok, but sheesh.
- I seem to have multiple spots that hurt inside.
- I feel like my tailbone or anus or something is going to pull out. The longer we go, the more it hurts.
- Actually, there isn't any spot or spots. It seems like if we go on too long, my vagina gets rubbed raw, and that's what hurts.
- I don't notice any pain exactly. It's more like deep discomfort. The deeper the penetration, the worse the discomfort.
- I'm completely fine during penetration. It's the aching pain and fullness afterwards that is so bothersome.
- I feel like I'm ok with vaginal penetration, but if I'm in (describe the position), then it feels like something is bumping (describe what you think is being bumped).
Although it seems like a lot to think about, really take the time to think about your answers to these questions, and highlight the parts that seem to fit your experience. I surely have not asked all of the questions that could be asked, so by all means add in the circumstances that are yours that I didn't ask about.
Now, make an appointment with your health care provider, or get a referral to someone who works with people with genital pain. Take your questions (and answers) because each of these questions actually lead to specific investigations so that the cause of your discomfort can be discovered. Without a thoughtful assessment, you can't begin to work on the therapy that will help you. Hoping that the pain will just go away isn't an effective solution, either.
I hope this helps you begin or continue your journey towards comfort and pleasure.