How much should it hurt? (my first period, my first sexual intercourse)

Here's how Prof. Graziottin answers this question from her patients:

• Periods should not hurt much. Usually, in most women, they cause a mild discomfort that does NOT interfere with daily life and personal activities (school, sports, friends, work, leisure). Important! We do have friends microorganisms also within the uterus. Today we talk about the endometrial microbiome and now we understand that the health of this microbiome contributes to painless, so to say, periods, whilst a dysbiotic microbiome may be a contributor also to painful periods and the progression to endometriosis.
• First sexual intercourse can be painless in some women, when the hymen is naturally very thin and elastic we talk about a “complacent hymen” or it has been gradually dilated with the finger during foreplay. In the majority of women, the first intercourse causes a mild pain, that usually fades away after two or three intercourses.

In less frequent situations, the first intercourse is extremely painful and some women cannot accept the penetration at all. In this case, we have a very tight and tightened pelvic floor contraction and this is responsible for the sexual problem called vaginismus, causing sexual pain. In this case, if the woman keeps on, and a couple, keeps on trying to have intercourse, this will damage the mucosa, cause dysbiosis of the local microbiome and this is another cause of vestibulodynia, say, this burning pain that women will have not only during the attempt of penetration but also afterwards.

This requires a very rigorous medical treatment with a competent sexual medicine approach.

So, sexual pain is never in women's head, it has a very solid biological basis, more solid when pain is excruciating.

When pain during periods, dysmenorrhea, interferes with daily activities, it is worth medical attention the sooner the better. It may be the first sign of endometriosis that is still below the visibility threshold of the current imaging diagnostic techniques. 

Vaginismus, a sexual disorder characterized by the phobia of penetration, must be considered when pain is excruciating, up to prevent penetration. The phobia is associated with a variable degree of defensive tightened contraction of pelvic floor muscles. The repeated attempts of penetration may damage the vestibular mucosa contributing to vestibular pain up to vestibulodynia.

Key point: sexual pain is NOT normal. It should be competently diagnosed and treated, the sooner the better.

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