Sex should always feel good — and when it doesn’t, your body could be trying to tell you that something is seriously wrong.
If you felt a sharp pinch, pressure, tightness, soreness, or cramping during your last romp, you’re not entirely alone: About 30 percent of women report feeling pain during vaginal intercourse, according to a 2015 study published in The Journal of Sexual Medicine. That number skyrockets to 72 percent during anal sex (if you prepare correctly, anal sex should not be painful.)
This can cause issues outside of the bedroom, too. “Pain during sex not only ruins the moment, it can have much greater consequences: fear of sex, lowered sex drive, and overall loss of intimacy,” says doctor Debra Herbenick, a professor, director, and researcher at Indiana University’s Centre for Sexual Health Promotion.
Just because it’s common doesn’t mean you should have to put up with it. You might feel awkward speaking up, but you’re doing yourself a disservice if you dismiss the pain.
“Women need to know that pain is real, no matter what its ultimate cause,” says sexual health expert Dennis Fortenberry. There are plenty of things that could be messing with your time in between the sheets. Here are eight reasons sex might hurt—and exactly what you can do make it feel good again.
You skipped foreplay
Women are slower to get aroused than men, and there’s a grain of truth in the stereotype that women need more foreplay—but figuring out what works for you is half the battle.
“Foreplay needs to be exciting to you,” says Herbenick. That might mean kissing and rolling around with our partner, giving or receiving oral sex, or even watching porn together. Everyone is different, and what gets you going won’t always work for someone else.
Understanding what feels good is key to starting the natural process of blood flow to your genitals, which increases lubrication (an absolute must for pain-free sex). Herbenick points out that some women don’t actually know when they’re aroused, which can be a major hurdle. In this case, staying focused on the moment can be helpful. “Notice how it feels to touch your partner and be touched,” she advises. On a broader scale, she says that mindfulness practice may help people who have trouble recognising arousal. “You might try walking meditations, and then apply those skills to sex,” she says.
You didn’t use lube
You can be ready to go, but if you’re not sufficiently slippery, penetration is going to be a pain. Plus, your vagina doesn’t become sufficiently wet until 5 to 7 minutes after your brain is already in the game.
Other factors can also slow your flow. Warm showers and baths can lead to vaginal dryness, says Herbenick. “Allergy pills have the same effect on vaginal tissues as they do on other mucus membranes, and low-dose hormonal birth control pills can also dry you out,” she adds.
The fix? Be sure you have a tube of lube ready for action. You might not need it most of the time, but having it on standby means you won’t need to go searching for it in the middle of things (which is sure to ruin the moment).
You’re super stressed
You have a million things to do in a day, and you take that tension to bed with you. “Relaxation is an important part of feeling ready for and interested in sex,” explains Herbenick.
The best thing you can do is de-stress before you get busy. Herbenick suggests that couples give each other massages. If rub-downs aren’t your thing, there are other ways to help your mind—and thus your body—prepare for sex. “Try a yoga class—a lot of people also find meditation or mindfulness useful,” she says.
Your partner is... too big
For a small number of people, “genital fit” can be a cause of pain—meaning your partner’s quite large, and you’re extra petite.
Lube can help in some cases, but “in situations where the penis is hitting the cervix, or causing an uncomfortable level of stretch, it can help to change sex positions," says Herbenick. “A lot of times women don’t feel confident saying, ‘slow down’ or ‘be more gentle.’” Try switching things up with positions like woman-on-top, since it gives you more control over the speed and depth of thrusting.
You have an infection down there
A number of genital infections—most commonly, genital herpes, trichomoniasis, and yeast infections—can make sex uncomfortable. Even women who don’t experience any symptoms or are unaware of their infections can have small changes in their vulva or vagina that can contribute to pain.
The good news is, most genital infections are easily controlled or curable, and the tests are simple. If you’re experiencing pain, the most important thing is to communicate with your doctor and get tested appropriately, advises Dr. Fortenberry.
You might have endometriosis
This condition, where the tissue that lines the uterus starts growing in other areas, affects about seven percent of women. “It can lead to pain with intercourse and vaginal penetration, and can be really intolerable,” says Dr, Fortenberry.
Unfortunately, endometriosis may require laparoscopic surgery, but identifying the source of pain is a big part of the battle. If you have painful periods and pain during sex—and, because endometriosis tends to run in families, if you have female relatives who have experienced similar symptoms—you should ask your doctor for an ultrasound screening.
Your IBS symptoms are making things worse
True, very few people like to contemplate sex and poop in the same thought, but IBS is another common but sneaky possible cause of painful sex. Fortenberry suggests that if you have the most common signs of irritable bowel syndrome—periods of intestinal cramping, and cyclic constipation, or diarrhea—in addition to pain during sex, the two might be linked.
Talk to your primary care physician about how you can manage your IBS—there are many ways to reduce symptoms, including changing your diet, medication, stress reduction, and behavioral therapy. “No one knows why, but it appears that when IBS is treated, vaginal pain during intercourse gets better as well,” says Dr. Fortenberry.
You’re going through menopause
Changes in the vagina during menopause involve more than just lubrication, especially after menopause is completed. “Parts of the vagina and vulva may become additionally sensitive,” says Dr. Forteberry, which can explain why something that used to feel good can now just plain hurt.
“There are many ways to mitigate the unwanted symptoms of menopause,” says Dr. Fortenberry. “Start by having a conversation with your primary care provider or your gynecologist about the possible causes and treatments that may help.”
This article originally appeared on Prevention