Known in the medical world as dyspareunia, pain that happens during or after sex can happen for all kinds of reasons. According to pelvic floor physical therapist Sallie Sarrel PT, ATC, DPT, who is also the co-founder of the Endometriosis Summit, physical issues such as vulvodynia, vaginismus, endometriosis, pelvic floor dysfunction, uterine fibroids, ovarian cysts, and painful bladder syndrome can contribute to painful sex.
However, hormonal issues, infections (like pelvic inflammatory disease), and postnatal complications can also be the root-cause of painful sex. And so can emotional distress, stress, trauma, and a history of sexual assault.
“Sometimes these physical conditions are compounded with these emotional and mental hurdles,” says sexual wellness expert, Emily Sauer, co-founder of Lady Bits League and CEO of Ohnut. I know, ugh.
If you’re reading this and are currently experiencing painful intercourse, or have previously, Sarrel has an important PSA for you: Painful sex may be common, but it’s not normal. “Sex is not supposed to be painful. If it’s painful for you, please know that it is possible to make sex pleasurable again,” she says. Keep reading to learn what to do next.
Sex is painful…now what?
If you’re experiencing any kind of pain during sex, it’s time to seek expert care. Sarrel says your gynecologist is your first stop. But, she says, “If you feel minimized or not taken seriously by [them], find another one.” A good gynecologist will be able to determine whether the pain is the result of an infection or some other natural cause like postnatal complications.
“If all the medical tests come back negative, the next step is a pelvic floor physical therapist,” says Heather Jeffcoat, a doctor of physical therapy who specializes in sexual dysfunction and incontinence. You can use this online directory to find an expert—but before booking your first appointment, Sarrel recommends chatting with them over email beforehand to get a sense of their bedside manner and approach.
A holistic pelvic floor therapists may prescribe a combination of masturbation, vaginal dilators, weekly pelvic floor therapist sessions, an anti-inflammatory diet, exercise, and stress-relieving practices.
If your PT and gyno have ruled out all physiological complications, Sauer says that’s when you should seek out a trauma-informed, sex-positive, pleasure-focused sex therapist.
Jeffcoat adds, “Sex therapists are also a great way to work on intimacy issues and relationship difficulties that can be exacerbated by the sexual pain.”
Do I have to stop having sex altogether?
Nope! In fact, Sarrel recommend against that. “Your sexual self is a big part of your sense of self,” she says, so shutting down your entire sexual self can increase feelings of sadness, depression, and loss.
The goal is first to find sex acts and positions that don’t cause discomfort or pain and instead, increase pleasure, says Jeffcoat.
That’s why we asked these experts to share sex positions that may help minimize pain during sex. Altering your bedroom strategy won’t get you out of working with a vulva-health expert who can help you get to the bottom of your pain. But still, try some of the below seven positions, with the understanding that depending on the cause and location of your pain, not all will work for you.
The 7 Best Sex Positions For Painful Sex
1Masturbate with a mate.
If you have a partner you love and trust, invite them to watch as you touch yourself. Maybe even ask them to masturbate next to you—mutual masturbation can be H-O-T.
2Engage in oral sex.
Because oral sex doesn’t have to include penetration (unless you want it to), mouth-sex is especially great for folks with vulvadynia, pelvic floor dysfunction, or vaginismus, which are conditions that can make the entrances of vaginas painful. According to Jeffocat, it’s “a great way for anyone experiencing painful sex to maintain intimacy with their partner.” From face-sitting and 69-ing to missionary oral or doggy oral, there are endless positions that are suitable for spectacular cunnilingus. So don’t limit yourself: Try them all.
Oh, and if you and your partner are up for it, add a little oral-anal play into the equation. Trust, those backdoor nerves are sensitive little buggers.
“I recommend every patient I see use lube for every position and sex act to reduce compounding their pain with the pain that might [occur] from dryness or friction,” says Jeffcoat. Her number-one recommendation is GoLove CBD, a water-based CBD lube, which offers the benefit of increasing blood-flow to the genitals, thanks to the CBD, which is a vasodilator.
Lie on your back in the classic missionary position, with your partner positioned between your legs. Either have them apply the lube to your bits, stimulating your clit, labia, and entrance as they do. Or, apply the lube to your own body, showing them how you like to touch yourself as you do (fun!).
Have your partner lower until they’re right at your entrance, then encourage them to remain still. Place your hands on their butt and tilt your hips to accept them into your body, while controlling just how deep they go. Adjust to the sensation before taking them deeper.
Note: If your partner has a penis, they may have a hard time (pun not intended) staying hard at this pace. A vibrating cock ring like the Lelo Tor 2 can help.
Known as *the* position for deep loving, you might be surprised to see doggy-style on this list. But Jeffcoat says that with the help of Ohnut, a donut-shaped, depth-limiting device that goes over a penis or dildo, vulva-owners who have pain at the end of their vaginal canal, near their cervix, like those with endometriosis, are able to minimize pain and increase pleasure.
Sauer tells HelloGiggles, “The Ohnut is wearable and made of modular, stackable rings that allow you to incrementally adjust the device until you find the depth that works best for both of you.” The idea is to “buffer” the penis, to keep it from going all the way in, she says.
Spend some time warming each other up. Then when you’re ready, if it’s part of your safer sex ritual, have your partner put on a condom before slipping the Ohnut on—the ridges of the Ohnut actually help hold the condom in place. Add some water-based lubricant before having your partner slowly enter you from behind, adjusting the Ohnut’s height as needed.
Generally, reverse rider on top is not recommended for folks who find deep penetration painful. But if you love this position and want to give it a try, either use the Ohnut and stack it higher than usual, to reduce depth. Or, tie your partner up with Sportsheets Under The Bed Restraint System so you can maintain full control over how deep they’re able to go.
Of course, if your partner doesn’t want to be cuffed to the bed, you can always ask them to lie perfectly still and let you do all the work.
Spice up your cuddle-session with this super-intimate, skin-on-skin sex position. Get into a little spoon position with your partner behind you. Reach between your legs to lube-up your entrance and have your partner apply lube to their shaft. Then, while you touch your clit, have your partner press against your entrance. “The vulva-owner in front has a lot of control of their pelvic angle, and can adjust and tilt their pelvis in different directions based on what feels good,” according to Jeffcoat. So instead of letting your partner initiate the depth, take control by tilting your hips to invite your partner deeper.
If you have a hypertonic pelvic floor, it’s possible anal penetration is just as painful for you as vaginal penetration. If it’s not, however, this position works well for backdoor play, too.
Low in effort but high on return, this sensual position entails lying in a sidecar 69 position, so that you’re both on your sides and in a head-to-toe orientation.
This allows you to explore each other’s erogenous zones in a low-pressure way, which allows you both to find pleasurable sensations outside of traditional penetrative sex, she says.