Muscle spasm (my dinner diagnosis) is one of the most common diagnoses, but other common causes include nerve pain, skin conditions, low estrogen and endometriosis. There are psychological factors, but that does not mean that it is in your head. Ever.

If sex hurts, many women begin to anticipate the pain, which increases the pain response and diminishes lubrication and libido. If every time I offered you the finest chocolate in the world I hit you with a hammer at your first bite, you would soon learn to dread and fear chocolate. You may also reflexively flinch at the smell of chocolate, or even when I walked into the room, and lose your taste for chocolate altogether. For some women sexual trauma can also be a factor and start a cycle of pain.

Getting facts ahead of fallacies in medicine is hard enough, but with sex there are many more layers. Most people receive a less than adequate sex education, and many do not learn how to talk about sex. When I ask a woman if she has discussed her pain or her sexual needs with her partner, it is not uncommon for me to hear, “I can’t.” That many doctors do not feel comfortable discussing sex only compounds the issues.

There are also some other solutions:

Addressing the sex itself. Treating pain with sex involves addressing the physical aspects, making sure technique is appropriate, discussing emotional consequences, and, of course, looking at the relationship. If you are deeply unhappy, you may not get the kind of sexual stimulation you need or be able to mount an adequate sexual response. No medical therapy can compensate for not liking your sexual partner.

Lubricant can help many women who have pain with sex, and no, it does not mean there is something wrong. The other myth that I frequently dismantle is this idea that women should achieve some kind of fantasy wetness. I have heard many women tell me that lubricant helps their pain, but their male partner does not like it or judges them for it. That, my friends, is messed up. No one thinks you are less if you need glasses. Some people have always needed glasses, and some of us, ahem, need glasses as we age. Who cares as long as you can see?