I have ruled out a physical cause for pain in my vulva: What could be causing it?
It is completely possible to experience pain during sex even if your vulva is entirely healthy. In order to understand why, it is useful to know a bit more about what happens to the body during sexual arousal.
Preparing the body for sex In order for our bodies to become ready for sex, our natural sexual arousal response needs to be activated. This response leads to changes in the body which make sexual touch and penetration more comfortable (and enjoyable). Without this response, our bodies may be unprepared to engage in sex (especially penetrative sex) fully. This response leads to a series of physical changes (internally and externally), which are coordinated by the brain and executed through signals sent up and down the spinal column.
For those with a penis, the main physical change that occurs is in gaining an erection (although other more subtle changes also happen). An erection is easy to see, and therefore an obvious signal that his body is physically ready to have penetrative sex.
For those with a vulva, most of the changes that occur happen internally, and it is therefore far less clear when the arousal response has fully prepared her body for sex. These changes are no less significant than those experienced by men; it’s just that they are more difficult to see.
Changes to the female body during arousal
When you are aroused, your heart rate and blood pressure increase. This in turn, increases blood flow to your genitals. You may experience increased sensitivity around your breasts and nipples, your breasts might get larger and your nipples can become erect. Your clitoris will also become bigger and more sensitive to touch, although this is not always possible to see if it is under its hood. The labia will also swell, and your vaginal walls will start to produce natural lubrication.
There are also changes that occur inside your body. Before arousal, the vagina is relatively narrow with a small opening. Once aroused, the vagina expands internally, and its opening becomes wider. The uterus tilts and lifts up, moving the cervix, and allowing your vagina to lengthen further. The muscles around the vagina will relax and/or contract and you might start to breathe more quickly and deeply. Together, these processes make all forms of sexual contact more enjoyable, and allow a penis or sex toy to fit comfortably inside your vagina.
What do these changes have to do with my pain?
If you are in a sexual situation in which you are not aroused then these physical changes are not likely to happen. It is important to be honest with yourself and your partner about whether you want to be having the sex that you are having.
Even if you are comfortable and enjoying a sexual experience, these changes take some time to occur. It is really important to give your body time to react to sexual stimulation and to respond fully before you attempt penetration. If your body is not ready, it is likely that penetration will cause pain and discomfort and that sex will not be as enjoyable as it could be. Equally it is very important that your sexual partners are aware of this too, so that they can respond to your feedback about how comfortable and aroused you are.
The role of anxiety
When we are feeling stressed or anxious, this can have a direct impact on the way the body responds during sexual arousal. For people with vulvas, anxiety can mean that the vagina may not relax or expand, and the uterus may not tilt to make more room inside. It might also mean there is less vaginal lubrication and muscles around the vagina may actually tighten. This will mean that it is far more likely that sex will be painful, especially when penetration is involved.
What can cause me to feel anxious?
It is very common to feel some anxiety around sex at times in your life. There are lots of reasons why a woman might be anxious before and during sex. These might include:
- Worries about having penetrative sex for the first time
- Feeling anxious that sex might hurt or will be uncomfortable
- Worries about your appearance or what your partner thinks of you
- Anxiety about your sexual performance or being ‘good enough’ in sex
- Concerns about other parts of your relationship
- Not having enough privacy for sex
- Worries about pregnancy or sexually transmitted infections
- Previous unpleasant or unwanted sexual experiences
- Worries about any other part of your life (even if it is completely unrelated to sex)
Any worries that you might be having, whether about sex or not, can affect the way your body responds in arousal. This can have a direct impact on your ability to relax, feel turned on, and enjoy a sexual experience.
For some, if we have experienced pain in the past, it is very normal to be expecting pain when a sexual encounter begins. This is completely understandable, but often leads to feelings of anxiety as a sexual experience progresses (especially towards penetration). This anxiety will then affect the body’s ability to respond to sexually pleasurable stimulation and will mean that sex is more likely to be uncomfortable and painful.
To learn more about the impact of anxiety on sexual function click here