Introduction & objectives: While much research has
examined correlates of pain during sex, far less research
has examined why women have sex despite having pain
and why they avoid telling their partner. The purpose of
our study was to examine women’s reports of painful
sex including location of pain, whether they had told
their partner, factors associated with not disclosing their
pain, as well as their reasons for not disclosing.
Methods & Sample: We used data from the 2018
National Survey of Sexual Health and Behavior, a probability-
based online survey of Americans aged 14 to 49.
We limited our sample to adult women who reported
that their most recent sexual experience was painful
(n = 382, or 23.2% of the sample). The primary outcome
in quantitative analyses was whether women told their
partner they experienced pain during sex. Associations
with social identities and sexual health were explored in
logistic regression. Those who did not tell their partner
about painful sex were asked why; their accounts were
coded and analyzed qualitatively.
Results: Of those reporting pain during sex, most
said it was “a little painful” (81.6%) and occurred at
the vaginal entrance (31.5%), inside the vagina (34.4%),
or at/around the cervix (17.4%). Overall, 51.0% told
their partner about their pain. Adjusting for age and
wantedness, women who reported little to no eventlevel
sexual pleasure had nearly 3-fold greater odds of
not telling a partner about painful sex (AOR 2.57;95%
CI:1.17-5.67). Normalizing painful sex, pain as inconsequential,
prioritizing the partner’s enjoyment, and gendered
interactional pressures were the predominant
themes in women’s narratives.
Conclusions & recommendations: Many women do
not discuss painful sex with their partners, and lack of
pleasure is significantly more likely among this group.
Gender norms and cultural scripts are critical to understanding
why. Implications for education, practice, and
subsequent research are discussed.
Keywords: sexual pain, sexual pleasure, sexual rights
Source of Funding: Funding for the National Survey
of Sexual Health & Behavior (NSSHB) is provided by
Church & Dwight, Co., Inc. (Debby Herbenick,
Principal Investigator). The funders had no role in
data collection and analysis, decision to publish, or
preparation of the manuscript.
Conflict of Interest and Disclosure Statement: None