Many women experience discomfort with sexual intercourse. In fact, pain during sexual intercourse affects up to 75 percent of women in their lifetime, according to the American College of Obstetricians and Gynecologists. Sex shouldn't hurt and painful sex isn't something you should accept or "learn to live with".

Discomfort with sexual intercourse can affect anyone. It is not an issue isolated to your "first time", nor is it a case of, "I've had a baby, so I suppose it will always feel uncomfortable". It doesn't only affect young women and in fact is very common in perimenopause and menopausal women.

Pain with sex can vary from significant pain preventing intercourse to a mild discomfort impacting certain positions. Both can be improved, and both are worthy of attention.

Discomfort or pain could be due to hormonal changes. For example, low oestrogen during breastfeeding or in menopause can cause significant vaginal dryness. Other causes include muscular tightness in the pelvic floor muscles, your unique anatomy (some positions may be uncomfortable and need you to adapt), Pelvic Organ Prolapse (though you can absolutely have pain-free sex with POP), scar tissue restrictions (following perineal tearing, a caesarean section or other abdominal and gynaecological surgery), or muscular guarding due to fear of pain or linked to past pain experiences—a common physiological response of your body which causes significant muscle tightness. It may also be a result of infection or inflammation (such as an STI, UTI, allergic reaction, vaginal infection, endometriosis, to name a few) and so, it’s important to see a medical practitioner to help rule out a medical source. 

How to improve your experience physically

• Lubrication and vaginal moisturisers are a great starting point. The act of self touch to apply moisture can be great in reconnecting with your anatomy as well as helping reduce friction as a result of dryness or scar tissue. Experiment with oil-, water- or silicone-based products, but ensure the ingredient list is short, natural and avoids sugars, chemicals and scents. 
• Change sexual position or depth. Sometimes a different position or a towel under your pelvis can alter your pelvic posture and make things more comfortable. The Ohnut, a wearable device designed to allow couples to control penetration, can be especially useful if you feel discomfort deeper inside.
• Manage scar tissue. Whether from vaginal tearing, gynaecological surgery or a caesarean section, it is important to get things moving as these scar tissue restrictions can impact your soft tissue and pelvic floor muscles. Soft tissue massage and stretch techniques can help to de-sensitise these tissues and improve their flexibility.  
• Consider topical oestrogen, particularly if you are menopausal. This medication works locally on the vaginal tissues and will improve lubrication and soft tissue elasticity. Discuss this treatment with your medical practitioner. 
• Get on top of your bladder and bowel habits. Managing and treating constipation is particularly important as it can affect pelvic floor function. Emptying your bladder prior to sex can also alleviate anxiety surrounding leaking with intercourse.
• Get help. If you are experiencing symptoms such as discomfort, pain or if you have other concerns, do not suffer in silence—there is help available.

Physical considerations when it comes to sex are undoubtedly important, however there is increasing understanding of the relevance of the relationship between body and mind. Busy lives, high pressure jobs, changes in home dynamics, concerns around fertility, history of trauma, childbirth, hormonal changes associated with menopause, stress and so much more can impact our physical and emotional capacity to really relax, get in the mood and embrace the moment. 

Living in a constant state of ‘fight and flight’ makes it hard to switch off, connect with our inner self and allow our body to be receptive to the idea of intimacy. Focussing on calming our nervous system can result in improvements in our physical symptoms and the ability of our body to achieve a heightened state of sensation.

How to prepare mentally

• Breathing exercises are a good place to start to reconnect with the body and calm the nervous system. Start with a few minutes of slow deep breath cycles prior to intimacy. The breath cycle should be longer on the exhale, for example a four-second inhale followed by a six-second exhale. Tapping into our breath cycles also utilises our diaphragm and can in turn influence our pelvic floor muscles. These systems work together and can promote pelvic floor relaxation. 
• Spend time away from the hustle and bustle of day to day life. A walk in nature, a relaxed five minutes drinking your coffee or taking a moment to relish in your morning skincare routine are all examples of how we can shift our focus and bring about a sense of calm.
• Take it slow. Whether it's a new partner or the first time post-birth, there is no rush. If it feels a bit uncomfortable, try slowing down and spending more time on foreplay.
• Communicate. Tell your partner how you feel, what your concerns are and why. Share what you both need, how that looks and what feels good, both emotionally and physically.
• Remove the pressure and try non-penetrative sex. Sometimes making this agreement beforehand gives you the freedom and control to explore, enjoy yourself and help you feel more comfortable. As you remove the pressure and build the trust, your body and mind will be more receptive to physical touch. 

Whatever your struggles in the sex and intimacy space, know that help and support is available, whether in the form of pelvic physiotherapy, intimacy coaching, psychological support or simply learning how to be more mindful. You are not alone and there is a world of exhilarating, comfortable and satisfying sexual intimacy out there.