Breaking the silence of pain
In many conversations about female intimacy, there is one topic that remains relegated to a whisper: pain during sexual intercourse. Sometimes it is downplayed, other times it is hidden behind a smile, and often it is normalized as if it were the price some women must pay to “comply” within the relationship.
Gynecologist Rina Cuadros, with almost two decades of clinical experience, is blunt: “Pain during sexual intercourse is not normal and should not happen.” However, the majority of women who suffer from it do not speak up. They immolate themselves in silence, convinced that the discomfort is part of their duty or that talking about it might generate guilt or conflict.
Our co-founder Ursula Pfeiffer summarizes it precisely: “For centuries we were taught that pleasure is a privilege and pain, an obligation. We learned to endure more than we enjoyed.”
Naming the problem: dyspareunia
Medically, the term is dyspareunia, and it describes pain that appears during penetration or in the lower abdomen. It can be superficial, when the discomfort is felt at the beginning of contact, or deep, when it originates inside the body.
Rina explains that the causes are multiple: hormonal, anatomical, emotional, and cultural. But the first thing is to break the denial. “The body is trying to tell us something —she warns—, and silencing it only aggravates the damage.”
More than a physical symptom
Sexual pain is rarely reduced to a single cause. Sometimes it is due to a lack of lubrication, a product of insufficient stimulation or natural hormonal changes—such as lactation or menopause—that decrease estrogen levels. Other times it is linked to medications, such as contraceptives or antidepressants, that alter the body’s response.
But Ursula introduces a deeper layer: the emotional one. “In many long-term relationships, the problem does not originate in the body, but in the emotional distance. Desire fades when intimacy stops being an encounter and becomes routine or resentment.”
Rina agrees: “Sexual relations are almost always satisfactory, but when they are linked to emotional connection, they become sublime.” The body cannot relax if the mind is wounded.
When the relationship hurts
Pain can also be the visible symptom of an unbalanced bond. “If a woman feels criticized, compared, or devalued, her body reacts by closing off,” explains Rina. Comments about the appearance of the vulva or comparison with stereotypes—what she calls “the Barbie vulva fashion”—damage self-esteem and condition the physical response.
This emotional tension can even be expressed as vaginismus, an involuntary and painful contraction of the pelvic floor muscles that prevents penetration. “It’s not a question of willpower —clarifies Rina—, it is a defense reflex of the body.”
Vaginismus does not always arise from sexual trauma; it can appear after an infection, an episiotomy, or even from nerve pressure in women who cycle for prolonged periods. But in many cases, it has an emotional origin: fear, shame, or unconscious rejection of the partner.
The burden of imbalance
Ursula points out that in many couples, the pain is exacerbated by power dynamics. “In certain cases, sex becomes a tool for control. For some men, resolving a conflict with sex is reaffirming dominance, not reconciliation. But for a woman, that doesn’t heal: the emotional wound remains open.”
Rina confirms that this pattern is more common than it seems. “The man believes that sex erases the argument; the woman, on the other hand, needs emotional repair before giving herself again. When that doesn’t happen, she gives in, but her body does not respond. Her desire disconnects.”
The body does not forget what the mind tries to ignore. The unspoken manifests itself in the form of tension, dryness, or pain.
The invisible causes
Sometimes, dyspareunia hides serious medical conditions. Rina mentions endometriosis as one of the most frequent causes of deep pain. “It is the presence of endometrial tissue outside the uterus, which generates chronic pelvic inflammation and pain. Many women confuse it with normal cycle discomfort.”
Other times, the pain may be due to recurrent infections or pelvic inflammatory disease resulting from untreated infections. Therefore, she insists, it is crucial to see a gynecologist and demand an accurate diagnosis.
But beyond the physical diagnosis, both agree that sexual health requires a comprehensive view: body, mind, and relationship must be addressed together.
Disinformation as a cultural wound
“We live in a macho society where neither women nor men are educated about anatomy or physiology,” states Rina. The lack of information perpetuates assumptions: that lack of lubrication is a sign of disinterest, that pain is normal, or that only penetration counts as sex.
Ursula adds: “Silence not only disconnects us from our body, it also disconnects us from the other. Educating is a form of love.”
Both agree that sexual education should not be limited to the female sphere. “Men must understand that satisfaction is for both —says Rina—. It’s not about complying, but about sharing.”
Medicine must also listen
Not all barriers are cultural. Some come from the medical system itself. Rina recognizes that there are still professionals who minimize female discomfort or attribute it to stress. “Sometimes we forget that we don’t treat diseases, but people,” she admits. “And we don’t have to know everything. Saying ‘I don’t know, but I’m going to investigate it’ is also a form of respect.”
That medical honesty, says Ursula, is a way of humanizing the consultation: “We are not looking for perfection, we are looking for empathy.”
Recovering pleasure without guilt
Overcoming physical pain is possible, but it requires more than just treatment. It demands recovering complicity, honesty, and patience within the couple. “Saying with love: I desire you, but it hurts, and seeking help together, should be the starting point,” proposes Rina.
Ursula adds: “Pleasure is not recovered with resignation, but with knowledge. When we understand that pain is not a destiny, we begin to write a new story with our body.”
In that story, desire ceases to be a test or a punishment and returns to being what it always should have been: a shared space of tenderness, trust, and freedom.
Watch the complementary episode “When Pain is Mistaken for Love” on our YouTube channel: https://youtu.be/FDCXMRO4IMQ
