Painful penetration, whether with a penis, tampon, or medical instrument, can adversely affect women’s quality of life, relationships, self-esteem, and emotional intimacy. However, treatment is available to relieve painful penetration and help women regain their confidence as well as their pleasure in sex.
Rather than let the pain or fear of vaginal penetration put you off sex forever, read on to understand why penetration becomes painful, how dilators work, and what they can do to relieve vaginal discomfort during penetration.
What Does Painful Penetration Feel Like?
Some women experience painful penetration as a stinging or tightening sensation of the vaginal opening, while others describe it as a burning or a feeling of chaffing against the vaginal walls.
Painful penetration is not limited to sexual activity and can occur to women of any age. Trying to insert a tampon can cause a spasming of the vaginal opening, for example. The thought of a medical instrutment being inserted during a gynecological exam can be petrifying due to the tightness of the vaginal canal, and for many sex is either extremely painful or impossible.
When Sexual Penetration is Painful
Painful sex, referred to medically as dyspareunia, is known to affect up to 7.5% of sexually active women aged between 16 and 74. In medical terms, there are two types of dyspareunia, each of which resonates in a different part of the vagina.
Superficial or Entry Dyspareunia
Superficial or entry dyspareunia is diagnosed when women report feeling pain in the vulva (outer genitals) or the vaginal opening upon penetration. This type of dyspareunia is typically caused by an underlying vaginal infection, tightening of the pelvic floor muscles (vaginismus), sexually transmitted infections, or vulvodynia.
That said, entry dyspareunia can also be caused by a lack of natural lubrication, or an imperforate hymen.
Deep dyspareunia is diagnosed when women experience pain in the deeper region of the vagina. This type of dyspareunia is more frequently felt during intercourse, especially from energetic thrusting, and is described as a burning feeling or a dull ache around the cervix, ovaries, and womb.
This pain may be driven by tightness of the deep pelvic floor muscles, tender points, or trigger points. When a woman experiences either type of dyspareunia, the mind and the muscle memory often register the pain and associate it with the act of intercourse.
Each time sex is attempted thereafter, the psychological association of discomfort during sex can cause the pelvic floor muscles to reflexively guard therefor making it more difficult or creating more painful penetration. Essentially creating a vicious cycle where the fear of painful sex causes the vaginal muscles to tighten and results in painful sex.
What Causes Painful Penetration?
The reason behind painful penetration varies from woman to woman, but the cause typically comes down to either a physical condition or a psychological issue.
Physical Causes of Painful Penetration
A lack of natural lubrication is considered one of the most common causes of painful penetration. Produced by the Bartholin glands, natural lubrication is plentiful when women are sexually aroused, however, when not sufficiently turned on for intercourse, the vaginal canal can feel dry due to the lack of lubrication.
This vaginal dryness can lead to painful penetration, as well as chaffing and friction during intercourse.
Estrogen also impacts the production of natural lubrication so women who are breastfeeding and those going through menopause might notice feeling a little drying down there as their estrogen levels fall.
Other physical causes of painful penetration include underlying conditions such as; sexually transmitted diseases, vaginismus, vulvodynia, and vaginal atrophy after radiation treatment. In addition, symptoms associated with endometriosis, imperforate hymen, lichen sclerosis, ovarian cysts, pelvic surgery, and vaginal stenosis can also contribute to painful penetration.
Psychological Causes of Painful Penetration
Psychological causes of painful penetration are usually linked to a fear that sex will be painful, so the brain tells the vaginal muscles to tighten up at the thought of penetration.
This type of psychological reaction in the vaginal muscles is medically known as vaginismus. But many women have no control over the automatic spasming of the vaginal muscles until they discover the root cause of their fear.
For young women, the anxiety surrounding intercourse can stem from a lack of sexual education or performance anxiety about their first sexual experience. The involuntary spasming upon penetration could also be associated with previous sexual abuse or trauma.
Fear of penetration can also set in after women have experienced a traumatic birth or pelvic surgery. And it also occurs as a result of low libido during perimenopause or menopause due to fluctuating hormones.
Many women living with stress suffer from painful sex too. This is because when women are tense or under duress, the Bartholin glands are known to produce less lubrication.
How to Treat Painful Penetration
If you are suffering from painful penetration or pain during sex, the first step is to understand what is causing your pain. As mentioned above, the root of painful penetration is either physical or psychological, so scheduling an appointment with your doctor will help you to determine which applies to you. Ensuring the correct diagnosis means the proper treatment option can be advised.
Depending on what your doctor determines during your consultation, they will typically do one of the following:
- Prescribe medication to treat an underlying vaginal infection that was causing painful penetration.
- Advise you to speak with a counselor or therapist if they feel the painful penetration you are experiencing could be psychologically based.
- Suggest a consultation with a pelvic health physical therapist to learn about how dilator therapy, manual therapy, and exercises can relax tight vaginal muscles, improve the production of natural lubrication, and regain your sexual confidence.
- Refer you to a gynecologist if the pain stems from endometriosis, an imperforate hymen, lichen sclerosis, ovarian cysts, or pelvic disorders.
How Dilators Work to Relieve Painful Penetration
Vaginal dilators are tube-shaped medical tools used to relax vaginal tightness, treat pelvic disorders, increase natural lubrication, and reignite a woman’s sexual pleasure after experiencing painful penetration.
Produced from either medical-grade silicone or plastic, dilators typically come in a set of ascending sizes ranging from the width and length of a little finger to a fully erect penis. The ascending dilator sizes are designed to gently relax and gradually stretch tight vaginal muscles over time.
The best size dilator to start with is either the smallest in the set or the size recommended by your pelvic health physical therapist. Once the smallest dilator can be inserted and comfortably left inside the vagina for 10-15 minutes, patients are advised to move to the next size until they feel relaxed using the largest dilator of the set in the same manner.
Guidance on how to use vaginal dilators is sometimes given by a pelvic health physical therapist, healthcare provider, or gynecologist before a patient commences with dilator therapy. However, with approved dilator sets now available to purchase online, many women are practicing dilator therapy at home.
How To Use Vaginal Dilators to Treat Painful Penetration
Treating painful penetration, to the point that you can enjoy pain-free sex, can be done in the privacy of your own home with vaginal dilators. When beginning dilator therapy, most women are advised to start with the smallest dilator in the set for 10-15 minutes up to three times a week, only progressing to the next size dilator once using the previous size is relaxing and pain-free.
The following guide gives clear instructions for treating painful penetration or painful sex with vaginal dilators at home.
1. Always wash your vaginal dilator with warm water and soap before using it.
2. Designate a private place in your home where you feel safe and will not be interrupted.
3. Drizzle or rub a generous amount of water-based lubricant over the dilator as well as the entrance to your vaginal opening. (It is important to use a water-based lubricant to protect the medical-grade silicone of Intimate Rose Vaginal Dilators.)
4. Select the size recommended to you by your pelvic floor physiotherapist, or start with the smallest size.
5. Lie down on your back, on your bed, on a yoga mat, or on some comfortable blankets with your knees bent and feet planted on the floor. Some patients prefer to lie on their sides with the knees bent and a cushion or pillow placed between the knees to support the upper leg.
6. As you inhale, allow your belly to gently expand, and as you exhale, allow your belly to slowly drop. Continue to gently breathe like this for a few more breaths to relax the vaginal opening with each exhale.
7. When you feel ready, bring the tip of the dilator to the vaginal opening, and during the next breath, softly insert the tip. As you continue to breathe gently and slowly, ease the dilator into the vagina with each exhale until the lip at the end reaches the vaginal entrance.
8. Breathe deeply and calmly, relax your shoulders, allow your body to sink into the support beneath you, and keep the vaginal dilator inserted in the vagina for 10-15 minutes, or however long your healthcare practitioner recommended.
9. Once you become comfortable inserting each dilator, it's helpful to practice insertion in different positions to mobilize the organs around the vaginal canal and encourage gentle stretching of the tissues. As well as laying on your back or your side, recommended positions include a deep squat and a table-top position with your hands and knees on the floor.
10. It is also helpful to gently press the dilators against the walls of the vagina by imagining the opening of the vagina as a clock and slowly moving the dilator in a circular position. Pause at each “hour” of the clock, gently compressing the dilator against the vaginal wall in each position.
Why Dilators Work for Painful Penetration
Vaginal dilators work to relieve painful penetration and discomfort during sex by gently stretching and releasing tightness in the vaginal muscles and pelvic floor. By slowly encouraging the release of hypersensitive vaginal tissues over time, pain and tension during sex are relieved in the long term.
Dilator therapy also increases blood flow to the vaginal walls, which helps improve vaginal elasticity and the production of natural lubrication, particularly during menopause or when estrogen levels are low.
Lastly, by gradually accustoming women to the feeling of penetration with incrementally increasing sizes under their own control, dilators help sexual abuse victims, or those fearful of sex to overcome their trauma and enjoy a pleasurable sex life.
Painful penetration is not limited to sexual activity, it can occur when inserting tampons, medical instruments, or a vibrator. And it can happen to women of all ages.
The good news is that vaginal dilators are helping women to relax the vaginal tightness causing painful penetration. Thus allowing them to regain their confidence, enjoy pain-free sex, insert tampons without discomfort and have regular pap smears without trepidation.
If you are experiencing painful penetration, schedule a consultation with your healthcare provider to determine what is causing it, and ask about dilator therapy to help you recover.
Mayo Clinic – Dysapeurnia - https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
Web MD – Vaginismus - https://www.webmd.com/women/guide/vaginismus-causes-symptoms-treatments
The North American Menopause Society – Pain with Penetration - https://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/pain-with-penetration
Science Direct – Vaginal Dilators - https://www.sciencedirect.com/topics/nursing-and-health-professions/vaginal-dilator
University of Iowa Health Care – Vaginal Dilator - https://uihc.org/educational-resources/vaginal-dilator
Oxford University Hospitals - Vaginal Dilator Exercises - https://www.ouh.nhs.uk/patient-guide/leaflets/files/30804Pexercises.pdf
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.