When penetration stops feeling good, the problem almost never lies solely in the act itself. According to gynecologists Beatriz Tupinamba and Rafaela Britto, in an interview with Metropolisesdiscomfort can come from physical, emotional and hormonal causes – and, in many cases, a combination of all three.
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The commonality, they both say, is that sex should never hurt and that there is treatment for virtually every scenario.
1. Physical causes: pain, lubrication and gynecological conditions
For Beatriz Tupinamba, the main physical cause of lack of pleasure is simple and very common: lack of lubrication. “This is one of the main causes. After menopause, especially without hormonal replacement, vaginal atrophy appears and causes pain, burning and difficulty achieving orgasm,” he explains.
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Rafaela Britto reinforces this observation and adds that insufficient lubrication is also common in the postpartum period, during breastfeeding and with certain medications, such as certain antidepressants or contraceptives.
But the causes go beyond lubrication: the two experts highlight the presence of gynecological diseases. Tupinambá mentions endometriosis, vaginismus, pelvic floor hypertonia and even less talked about conditions, like lichen sclerosus, which causes pain and reduces pleasure.
Britto expands the list to include adenomyosis, ovarian cysts, infections such as candidiasis and vaginosis, as well as anatomical factors such as rigid hymen, fissures or birth scars. “All of this can make penetration uncomfortable and directly impact the feeling of pleasure,” he explains.
Both are adamant that any sensation of pain, burning or tearing reduces pleasure and should be investigated.
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2. Emotions, stress and trauma: the brain also participates
“Women sometimes forget that the main female sexual organ is the brain,” says Beatriz. As a result, stress, anxiety, mental overload, and depression can interfere with everything from arousal to orgasm. “If you’re trying to solve problems, if you’re worried or tense, the body doesn’t relax. This reduces desire, lubrication and even blood flow.”
Britto agrees and points out that the mind and body work together in sexual response: “Stressful or anxious situations put the body on alert. The body doesn’t understand that it’s time to feel pleasure.”
Trauma also has a profound impact. Tupinamba talks about unconscious blockages and muscular tensions caused by painful experiences or sexual abuse. Britto adds that abusive relationships, conflict with partners and lack of intimacy can be as harmful as an obvious physical cause.
3. Hormonal fluctuations: postpartum, cycle, premenstrual syndrome and menopause
The two gynecologists emphasize that hormonal changes constitute one of the pillars of female sexuality. According to Tupinambá, the decline in estrogen and testosterone – which occurs after childbirth, during breastfeeding, during the premenstrual phase and at menopause – directly affects desire, lubrication, sensitivity and vascularity of the genital area. This explains symptoms such as vaginal dryness, burning during and after penetration, decreased libido and difficulty getting aroused.
Britto points out that during the menstrual cycle, particularly during PMS, increased body tension can reduce sexual comfort. During menopause, the vaginal mucosa becomes thinner and less elastic, leading to pain, burning and irritation.
To identify the hormonal origin, Tupinamba advises observing whether symptoms appear in specific phases of the cycle or at specific times of life, and reinforces: “There is treatment for all of these phases. None of this needs to be normalized.”
Sex education is essential to busting myths, eliminating guilt and helping women learn about their own bodies.
4. When to ask for help? Sooner than you think
“Women normalize a lot of things they shouldn’t do, including pain during sex,” says Tupinamba. For her, it is enough that penetration causes persistent pain, burning or causes fear and anxiety to be grounds for evaluation.
Britto adds that women should seek help if they experience recurring or progressive pain, bleeding, a tearing sensation, inability to penetrate due to involuntary contraction, or suspected conditions such as endometriosis, vaginismus, or severe dryness. And remember, the lack of pleasure that affects self-esteem and relationships is also worth addressing.
The message from both experts is unanimous: sexual discomfort should never be considered normal.
5. Possible treatments: a path from office to personal care
Treatment always depends on the cause, but the options are varied.
From a physical point of view, Tupinambá highlights hormonal therapies (local or systemic), the treatment of vaginal dryness and even technologies such as the CO₂ laser, very useful in cases of atrophy. Britto reinforces the use of lubricants and moisturizers, as well as medications to treat infections, chronic pelvic pain, or endometriosis.
The two gynecologists highlight pelvic physiotherapy as a key tool in cases of vaginismus and hypertonia.
From a physical point of view, hormonal therapies (local or systemic), the treatment of vaginal dryness and even technologies such as the CO₂ laser, very useful in cases of atrophy, are highlighted.
In the emotional domain, Britto highlights the positive effects of sex therapy, psychotherapy and relaxation techniques. Tupinamba reminds us that sex education is essential to busting myths, eliminating guilt and helping women know their own bodies.
Both also emphasize: communication with the partner, more time for stimulation before penetration and the exploration of forms of pleasure beyond coitus.
And Tupinamba specifies:
“If you reach orgasm only with direct clitoral stimulation, you’re fine. It’s neither minor nor bad. What you can’t do is feel pain.”
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