Wednesday, July 15, 2009


Dear Dr. Kate,

I've been with my boyfriend for a year now and we tried having sex. For the first two times we did it, it hurt really bad...but only the penetration. After that I was fine. What can I do to make myself less tight and actually enjoy sex? I am afraid of the pain and don't want sex to be a thing I don't look forward to.

All Clenched Up

Dear Clenched,

I totally agree with you - sex should never be dreaded, and should never cause you pain. If you've been to see a gyno, and had a normal pelvic exam, there are two scenarios that can cause the kind of pain you're describing:
  • Vulvodynia, a fancy-pants way of saying "pain in the vulva." Other signs that you may have vulvodynia: does it hurt if he puts a finger inside you? if you use a tampon? if you wear tight jeans or pants? Often, women with vulvodynia have pain on ANY contact to their vulva, not just intercourse. If you think this describes you, there are treatments available - most often a combination of oral medication and a topical anesthetic cream - so talk to your gyno.
  • Tightening in anticipation. The vagina is a powerful muscle. If you're not fully relaxed before intercourse, you can feel a lot of pain with penetration. It takes the average woman 20-30 minutes of good foreplay to become both aroused and lubricated enough for intercourse. (And I don't mean him feeling up your boobs - that's foreplay for him - unless that happens to work for you as well!) Especially once you've had pain with sex, it's natural to "tighten up" when a penis is approaching you. So make sure that you get lots of playtime first (his fingers, or going down on you, or a vibrator)...use a lubricant on his penis and your labia before he enters you...and make sure he enters you really slowly, to give your vagina a chance to adjust. Better yet, you be on top, so you can control how quickly he enters you.
Whatever is happening, pain is your body's way of telling you to stop what you're doing. Once you can figure out why you're hurting, you can figure out ways to make sex more enjoyable - and something that makes you shiver in anticipation, not dread.

All the best,
Dr. Kate

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