If sex doesn't always feel so pleasurable, you're not alone. According to the 2009 National Survey of Sexual Health and Behavior, 30% of women reported pain during their last sexual encounter. But just because it's common doesn't mean it's okay.
"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 Debra Herbenick, a sexual health researcher. "Pain is your body's way of signalling that something is wrong. It's a cue to take a step back and figure out what's happening."
You may be tempted to dismiss sexual pain as "all in your head"—but don't make that mistake. "Women need to know that pain is real, no matter what its ultimate cause," says sexual health expert Dennis Fortenberry.
See if any of the following situations sound familiar. And if so, don't worry—we have the solutions.
The Culprit: Jumping the gun
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.
The solution: "Foreplay needs to be exciting to you," says Herbenick. "For some women, that might mean kissing and rolling around with their partner; for others it might be watching porn together. For someone else it might be oral stimulation." Understanding what feels good is key to starting the natural process of blood flow to the genitals, which increases lubrication (more on that below). Herbenick points out that some women don't actually know when they're aroused, which can be a major hurdle. In this case, Herbenick says that 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.
The Culprit: Lack of lube
You can be rarin' to go, but if you're not sufficiently slippery, penetration is going to be a pain. Plus, vaginal tissues don't become sufficiently lubricated for penetration for 5 to 7 minutes after your brain is already in the game. And other factors can also slow your flow. "Warm showers and baths can dry vaginal secretions," 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."
The solution: 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 not having to go searching for it in the middle of the action—and ruining the moment.
The Culprit: Stress and tension
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 solution: De-stress before getting busy. Herbenick suggests that couples give each other massages. But 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."
The Culprit: It's a tight squeeze
For a small number of people, "genital fit" can be a cause of pain—i.e., your partner's quite large, and you're extra petite.
The solution: 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 a configuration, like woman-on-top, that gives you more control over the speed and depth of thrusting.
The Culprit: Genital infections
A number of genital infections—most commonly, genital herpes, trichomoniasis, and yeast infections—can make sex uncomfortable. Even women who are asymptomatic or unaware of their infections can have small changes in their vulva or vagina that can contribute to pain.
The solution: 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 Fortenberry.
The Culprit: Endometriosis
This condition, where the tissue that lines the uterus starts growing in other areas, affects about 7% of women. "It can lead to pain with intercourse and vaginal penetration, and can be really intolerable," says Fortenberry.
The solution: 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, especially if you have female relatives who have experienced similar symptoms—you should ask your doctor for an ultrasound screening.
The Culprit: Irritable Bowel Syndrome
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 IBS symptoms—periods of intestinal cramping, and cyclic constipation, and/or diarrhoea—in addition to pain during sex, the two might be linked.
The solution: 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 Fortenberry.
The Culprit: The Change
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 Forteberry, which can explain why something that used to feel good can now just plain hurt.
The solution: "There are many ways to mitigate the unwanted symptoms of menopause," says Fortenberry. "Start by having a conversation with your primary care provider or your gynaecologist about the possible causes and treatments that may help."
This article originally appeared on Prevention