Feeling pain during sex? It usually has less to do with your body and more about how you were brought up

When Natasha (not her real name) got married eight years ago, she was looking forward to having sex for the first time. Her husband would be her first sexual partner.  

She was then in her late 20s and after a lifetime of hearing about sex from her peers and relatives – some good but mostly bad – she was finally going to experience it for herself.  

However, the couple’s first attempt at consummating their marriage was a “nightmare”, Natasha said. She tensed up and there was excruciating pain when they tried penetrative sex. 

Despite their best efforts that night, which included using a lubricant and a condom, nothing worked.

The pain persisted through the couple’s attempts to have sex, years into their marriage. Believing the pain was normal, and for the sake of her marriage, Natasha endured the discomfort.

Occasionally, she and her husband would try to have penetrative sex, and Natasha would bravely plough through the pain. But mostly, they resorted to alternative methods for sexual satisfaction.

Still, Natasha dreaded having any type of sex at all. This eventually led to sexual frustration and a sense of defeat in the bedroom.

There was no one to turn to, she said. She was too embarrassed to confide in her relatives or friends because it would mean having to talk about sex in the first place. The conversations she had had around sex barely touched on intimacy or pleasure and were instead about getting pregnant. 

The couple dealt with the issue for eight years, hoping the pain would go away but it didn’t. Natasha finally sought help from a general practitioner who specialised in women’s health and sexual wellness.

Natasha’s experience with painful sex is not uncommon, and she isn’t the only woman who delayed seeking help. Dr Jessherin Sidhu, the medical director of InSync Medical, a clinic that focuses on women’s health, said most of her female patients who struggle with pain during sex often tolerate it for at least five years.

“Painful sex is awfully common,” the general practitioner said. “Around one in five women have vaginismus, and that just accounts for the number of women who speak up.”

Vaginismus is a condition where the muscles in the vagina tighten involuntarily and prevent any objects from entering it, causing pain during sex.   

“As for general pain amongst sexually active women in midlife, the number is much higher and it is incredibly widespread,” Dr Sidhu said. “Roughly, at least one in two women experience uncomfortable pain during sex at least once during their lifetime.”

DON’T IGNORE IT WHEN SEX IS PAINFUL

Dr Sidhu observed that everywhere in the world, and not just in conservative communities, women approach sex as an act of sacrifice for their partners. Even if sex is not enjoyable and painful, they agree to it.

It’s an ‘I’m happy as long as he’s happy’ mindset, she said. 

However, mutual sexual pleasure is crucial in a relationship and leads to better affection and longevity of love between partners, Dr Sidhu said.  

If pain or discomfort goes unaddressed, couples may even resent each other, she added.

In Natasha’s situation, she thought that giving in to her husband, despite how painful and unenjoyable it was, would solve the problem. But because she wasn’t feeling any pleasure, her husband didn’t enjoy sex either. 

This eventually led to a breaking point in her marriage.

SOCIAL AND CULTURAL FACTORS CONTRIBUTE TO DISCOMFORT

Often, the causes of pain during sex may have little to do with biology. A woman’s social and cultural experiences of sex can influence her even before she gets into bed with her partner, Dr Sidhu said. 

When Natasha was growing up, mere talk about romance between a boy and a girl would lead to disapproving looks from the adults at home. When she had her first crush as a teen, she felt guilty and quickly tried to find ways to hide or get rid of her feelings.

“In a conservative society like Singapore, where women are often taught to avoid sex and relationships when growing up, their cultural upbringing can inadvertently cause women to see intimacy as something to be shunned and avoided,” Dr Sidhu said. 

“After years of hearing how dirty and dangerous sex is, the change is too sudden for there to be a healthy mindset shift,” said Dr Sidhu. 

“The negative ideas don’t just go away, they remain in the subconscious and influence bodily reactions – like making the whole body tense or the vagina to close up – when she is engaged sexually for the first time.” 

Dr Sidhu clarified that this does not mean adults have to talk about sex freely in their households. “There are cultural, religious and even personal values we must respect,” she said. 

“What’s most important is nurturing ideas about intimacy that encourage curiosity and awareness about one’s own body and acknowledge attraction and affection,” Dr Sidhu said. “Not dismissing any type of talk surrounding intimacy as shameful.”

HOW COUPLES CAN ADDRESS PAINFUL SEX 

Dr Sidhu stressed that open communication between a woman and her partner about their sexual experiences is needed.

For Natasha, even though things appeared fine on the surface, there was an underlying resentment in her marriage because of the couple’s troubles in the bedroom.  

The core issue wasn’t about the painful sex. Rather, it was their difficulty in expressing their emotions and frustrations when it came to it.

“A helpful step is reflecting on one’s sexual history during their upbringing,” Dr Sidhu said. 

She added that understanding personal experiences and potential triggers, whether they come in the form of physical sexual encounters or thoughts about sex that have stuck throughout the years, can help in approaching intimacy more mindfully.

In some cases, even partners with good intentions can become over-protective or defeated when the woman feels pain during sex, Dr Sidhu said. 

The partner may decide to avoid sex altogether to shield the woman from pain, or because seeing how his partner is in pain may lead to him feeling disappointed or frustrated.

Dr Sidhu recommends another approach: For the partner to demonstrate more willingness to try, even if the attempts may still be painful. 

This gesture tells the woman that her partner cares for her and prevents her from feeling neglected. It also communicates that the pain and lack of sexual enjoyment between the couple is not her fault. This care can ultimately pave the way for her to enjoy having sex, Dr Sidhu said.