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Suggestions for Painful Sex Playlist: https://www.youtube.com/playlist?list=PL_zdi3TflN9IXasj71WNjjuwZi5DTGxAY

If you are experiencing painful sex it is okay to talk to a medical provider about your body and learn what may or may not being going on for you. Sometimes the causes are psychological and for that you can reach out to a therapist. There a many reasons sex hurts but there are also many solutions to mitigate this pain. Stay curious.

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Statistically, most people will experience some sort of discomfort or pain during sex at one point or another in their lives. I'm Dr. Lindsey Doe, and this is a Sexplanation of why.

[intro]

Dyspareunia, from dys-, meaning "difficult" and pareunos, meaning "lying beside," is the clinical term for pain during intercourse. I experienced severe dyspareunia just after college that felt like having sex with a jagged sword lit on fire. I went to at least a dozen healthcare professionals looking for answers but no one knew why sex had become so unmanageable for me.

Even though this episode may seem like a WedMD page or wiki summary of genital torture as I go through more than 40 possible causes of sexual stress, it's important for me to make something that a past Lindsey would have appreciated, and hopefully those of you struggling now can find useful. This is my best effort at a complete list of why sex hurts across all bodies and behaviors.

Starting with one of the most common causes: too much friction, which could be from changes in hormones, like menopause, use of medications such as antidepressants, sedatives, and antihistamines, chemotherapy because it can dry out mucus membranes including the vagina, circumcision which removes the very tissue designed to reduce friction, and insufficient stimulation. There's not enough lubrication.

Other causes of pain? Injury or trauma to the genitals. That's botched circumcisions, abortions, genital affirmation surgeries, botched cosmetic surgery, and episiotomies for childbirth. All of these can cause temporary or long-term pain with intercourse.

Peyronie's Disease, one I've talked about at length, is usually the result of severe or repeat trauma that leads to scarring in the penis and pain during sex.

Vaginismus is clenching of the vagina (usually in response to trauma) that makes penetration difficult or impossible. One woman describes it to the author Alexa Tsoulis-Reay, "It's like you are trying to pound your fist against the palm of your hand. It's just not going in. There's absolutely no give. And as for the pain, it's a combination of the fear of how much it could hurt and a burning sensation." Fortunately there's a treatment – for most of these.

Vaginal agenesis – where the vagina isn't fully developed – hurts! And imperforate hymens also make penetration difficult and painful. Eugh.

Balanitis, or inflammation of the penis from poor hygiene, excessive hygiene, and infection or irritation doesn't feel good during sex.

Neither does a Bartholin's abscess, when one or both Bartholin's glands on either side of the vaginal opening become blocked and sore.

Hydroceles are fluid build-ups in the scrotum that ache. A study by Babu and colleagues found out that 87% of patients with this condition reported pain in their scrotums during intercourse. Eugh! This is different than testicular torsion where cords connected to the testes get twisted and cut off blood flow but it's still a sharp, sharp pain in the scrotum.

Priapism is an erection that won't subside for hours. If left untreated it can lead to impotence (not being able to get erections), other sexual difficulties, or infection. So get that checked out!

Endometriosis is a disorder where the lining of the uterus (the endometrium) grows where it's not supposed to: in, and on, the fallopian tubes and ovaries. Wonder what that feels like? A study by Ballard and colleagues of people with endometriosis got the following descriptions: throbbing, gnawing, dragging pain to the legs, shooting rectal pain, and a sense that their insides are being pulled down.

Other agonies include tears in the ligaments that hold the uterus in place, cysts in the ovaries, cysts on the cervix, fibroids (which are growths in the uterine walls) and hemorrhoids (pissed off veins in the rectum).

Frenulum breve is one I just learned about. Basically, the frenulum (where the foreskin was or is attached to the glans of the penis) is more taut than usual, so it can tear over and over and over again during sex. I've talked in past episodes about something similar called Phimosis where the whole foreskin of a penis or clitoris can't move fluidly back and forth because it's too tight or it's adhesed to the glans. Some people aren't bothered by this during sex. Others definitely are.

Irritable bowel syndrome is another cause of pain during intercourse, especially with penetration of the vagina or anus because pressure on the intestines can agitate IBS.

This actually goes for constipation too. A big old fecal congestion can compress the whole area, the vagina, intestines, and rectum, so that some forms of sex do not feel good.

Pain for pleasure that's consensual and intentional? Great. Suffering, though? No, thank you. And all of these sound awful physically and emotionally. They're confusing and disheartening. Really!

Overgrown yeast is super common but I'm still not okay with it. It's itchy and it's irritating during sex. Same with infections in the urinary tract which are especially painful after ejaculation. And Prostatitis, or swelling in the prostate, that affects half of males and can hurt for a whole day after doing it.

There are so many afflictions. Pain from an allergy or sensitivity to an ingredient in your birth control, lube, or partner's semen. Pain from infections passed through sex such as chlamydia, gonorrhea, HIV, Herpes, HPV, and Syphilis – some of which lead to Pelvic Inflammatory Disease or PID, another big cause of pain during sex. This one is from an infection in the fallopian tubes, ovaries, and or uterus. The infection creates an inflammation which can cause scarring that can block sperm which can make it harder to get pregnant. And it hurts!

Like collision dyspareunia, which is another type of deep pelvic pain, except with this one something is whacking the cervix, causing the uterus to collide with the tailbone and its nerve endings.

Sexual hypersensitivity refers to pain when genitals are touched because they're so sensitive.

Dermatitis encompasses a lot of the skin problems like eczema that get triggered by contact _ such as the sexual behavior of bodies rubbing on each other.

Vulvodynia, an umbrella term for pain in the vulva (so your clitoris, labia, vestibule), doesn't always have a clear cause but it takes many forms: all of these are versions of vulva pain associated with sex.

Finally, though there are many many disorders and ways the body signals something is wrong, there's the psychological beast. Anxiety, depression, stress, fear, PTSD, abuse, dysphoria, dysmorphia, and distrust. The mind is capable of expressing repressed emotions through medical symptoms such as nausea, headaches, and pain during sex. Freud called it somatization. I've heard it referred to as body or genital armoring. It's the mind's way of protecting the body by creating a physical deterrent toward things that are harmful.

In my case this was the cause. The pain was my vagina's way of communicating and once I heard it, sex became exponentially comfortable. Listen to the pain. Your body is whining because you need to change something or get help. Go to the doctor, the clinic, the emergency department, seek out online forums, do your own research, keep logs of what's happening and how you feel. Get a third, fourth, and fifth opinion. And stay curious.

I've made a playlist of treatment suggestions here and have linked to it in the description. One is about choosing a professional to guide you through the process, there's a episode on regaining a healthy sex life, another on overcoming sexual injustices like pain, and a play by play instruction on how to use the three dimensional model of sexual health to sort through some of these culprits on your own.

Thanks for supporting Sexplanations and the other channels that are part of the Complexly team. If you check out youtube.com/SciShow, they have a video all about why we experience pain and how to kill it.