Have you been asking yourself the question, “Why does it hurt to put a tampon in?” This is unfortunately a common thing that can occur for people assigned female at birth (AFAB) and can affect up to 60% of people who are first-time tampon users as well as people with different medical conditions like vulvodynia or pelvic floor dysfunction. Sometimes this discomfort can even be described as feeling as though you are “hitting a wall” when putting in a tampon. Let’s chat more about anatomy, common causes of discomfort with tampon insertion and use, and treatment options that are available (because you do have options!)

understanding your anatomy

First things first, let’s go over anatomically where tampons should be inserted. Hopefully, things are better for y’all at this point when it comes to information being more readily available and parents or those who play an important role in your life being more open about things when it comes to the body and human anatomy. I, unfortunately, did not have parents who were super open when it came to sexual health and how to use menstrual products.

So when I experienced my first menses (aka “period”) I was given small tampons, petroleum jelly to use for lubricant, and left to my own devices when it came to inserting the tampon itself. I had no idea what I was doing and am pretty sure that I almost passed out the first time I did things because of the anxiety and discomfort that was present.

I don’t want anyone else to have this experience when it comes to tampon use. So here we go.

It’s really important to understand both your external and internal genital anatomy. If you identify as female or are AFAB there are technically three different holes at the genitals:

Urethra (top hole where pee comes from)
Vagina (middle opening)
Anus (bottom hole where poop and gas come from)

With menstruation or your “period,” you shed the inner lining of your uterus, called the “endometrium.” The narrow portion of your uterus that connects the uterus to the vagina is called the “cervix.” During your menses (aka “period”) the endometrium moves through the cervix and into the vagina. Menstruation usually occurs once a month or every 21 to 35 days and can last anywhere between two to seven days.

This is where tampon insertion comes into play. Tampons are essentially cotton that has been compressed together into a cylindrical tube which allows you to place them into the vagina or vaginal canal where they then expand and absorb the endometrium of the uterus that is sloughed off throughout your period.

It is important to note that although we all essentially have the same parts when it comes to our genitals, things typically look different from person to person, and differences in our anatomy can also play a role in tampon use and comfort. All vulvas (specifically the labia majora and minora), uteri (plural of the uterus), and cervices (plural of the cervix) look different and have different shapes, sizes, and lengths and, likewise, can impact the comfort of tampon use and insertion.

why does it hurt to put a tampon in: common causes

So beyond the fact that discomfort during and following tampon insertion is incredibly common among the general population (although, no, it is not normal and there is treatment available!), there are also common causes behind discomfort during tampon insertion including:

Dryness of the vaginal and/or vulvar tissues and not having enough lubrication during tampon insertion or at the tissue itself
When the tissues at the vulva and vagina are dry, or there is insufficient lubrication present to coat the tampon, this can cause friction which can result in discomfort with tampon insertion. Because of this, you want to use a water-based lubricant that doesn’t cause your tissues to have any burning or stinging during use.
Slippery Stuff, which is a water-based lubricant, is one of my go-to brands that I recommend to my clients who are struggling with vaginal dryness with different types of pelvic activities including tampon use.
Not inserting the tampon in the right place or hole (or just not having or knowing a great technique for insertion)
Frequently with first-time tampon users, there can be difficulty with knowing where exactly to place the tampon. I always recommend to clients who are attempting to use tampons for the first time to take a mirror to their vulva so that they can look at their anatomy to ensure that they are placing the tampon in the correct place…meaning in the vagina vs the urethral or anal openings.
When inserting a tampon, you want to make sure you are in as relaxed of a position as possible, like sitting on the toilet with your legs open to the sides, to help encourage pelvic floor muscle relaxation which will only improve your comfort with tampon use. Be sure to use a lubricant to prevent any potential for dryness which can cause chafing or discomfort during insertion, separate the external genital folds so you can make sure you are inserting the tampon at the vaginal opening, and then angle the tampon at a 45-degree angle as though you are directing it towards your lower back or tailbone instead of straight up towards your pubic bone or bladder. Using a 45-degree angle will help to follow the natural curve of the vaginal canal which should make things more comfortable for you.
If the tampon is placed correctly, once it is fully inserted you shouldn’t even be able to tell that you have a tampon in the vaginal canal!
Having a vaginal infection or another type of medical condition (like vulvodynia, endometriosis, or vaginismus that can cause pain with insertion and contact at the vulvar and vaginal tissues)
With vaginal infections, like yeast or bacterial vaginosis, there is an increase in inflammation of the vaginal tissues which can cause swelling creating irritation and discomfort with tampon insertion. Using a tampon while you have an active infection that is not currently being medically treated can also potentially make your infection worse and further flare up discomfort with tampon use.
With different medical conditions such as endometriosis, vulvodynia, and vaginismus, there is increased inflammation in the pelvic region, increased tension or activity of the pelvic floor muscles, and there can be nodules, lesions, or scar tissue that can be twisted, pressed against, or stretched, which can cause pressure and discomfort with tampon insertion.
Pelvic floor muscle tension or tightness
The pelvic floor muscles wrap around the pelvic openings (your urethra, vagina, and anus) and also have a deeper layer inside the pelvis that helps to support your pelvic organs. When these muscles get tight, tense, and/or tender to the touch, they can cause pelvic pain during tampon insertion and even sometimes with tampon removal.
Using the incorrect tampon size or absorbency for you and your flow
You want to make sure that you choose the appropriate level of absorbency for your tampon based on the level of your flow which tends to vary throughout a period. Typically lighter flow days, which occur at the beginning and end of your cycle, should usually only need using a “light” or “regular” flow tampon. You may even choose to opt to use a menstrual pantyliner or menstrual underwear for lighter days since these days can mean more friction to the vaginal tissues during tampon insertion and removal.
Usually, you will want to use a “regular” or “super” sized tampon during the days when your flow is heavier.
For those who have never used a tampon before (or have never been sexually active or had something inserted into the vaginal canal), usually it is recommended to start with a smaller-sized tampon, like a “light” tampon, that has a plastic applicator with lots of water-based lubricant. This will help to improve the ease of insertion and to help first-time users begin to get acclimated to having something inserted and removed from the vagina.
Emotional factors like fear or anxiety surrounding using tampons (especially if it’s your first time or if you have had a previous painful experience)
Stress and anxiety usually cause an upregulation of the sympathetic nervous system, which is a big player in the functioning of the pelvic floor muscles. When this part of the body is active it can cause increased tension and tightening of the pelvic floor muscles, which can cause pain during tampon insertion.

is it normal to have pain when putting in a tampon?

Although pelvic pain during tampon insertion is incredibly common, it is not normal or something that you have to deal with. There are treatment options available to help improve your discomfort and to help you get to the point of using menstrual products pain-free if that is a goal for you.

when to seek help for pain with tampon use and insertion

If your pelvic pain during tampon insertion is not a one-off experience and is something you are starting to notice more frequently, has been going on for a while, or is starting to worsen or impact being able to live your life and participate in activities that you enjoy, you should see a specialist.

Gynecologists, urogynecologists, and urologists can help to rule out underlying causes of pelvic pain during tampon use like vaginal infections and other medical conditions that could be causing pelvic pain like endometriosis.

Typically, working with a certified and skilled pelvic floor physical therapist can be incredibly helpful when it comes to addressing pelvic pain with tampon insertion and use that is caused by tension, tightness, and pain in the pelvic floor muscles (think medical conditions like vulvodynia, vaginismus, vestibulodynia, and pelvic floor dysfunction). We have a specific skill set to assess your pelvic floor muscles and come up with a treatment plan to help resolve the pelvic pain that you are experiencing when it is due to issues from the musculoskeletal system.

treatment options for pelvic pain during tampon insertion and use

As a Board-Certified Pelvic Floor Physical Therapist, there are SO many things that we can do during pelvic floor physical therapy to help improve symptoms of pelvic pain during tampon insertion. Here are some general recommendations for some symptom relief for pelvic pain with tampon or menstrual product use:

Lubrication and moisture are incredibly important
Typically, with dryness, using a high-quality lubricant can be incredibly helpful when it comes to managing dryness that is present during tampon insertion which can result in micro-tearing of the vulvar and vaginal tissues. I typically recommend that clients use a water-based lubricant, like Slippery Stuff, during tampon insertion since it is the closest to normal vaginal secretions and closely mimics the pH of the vagina. You want to avoid using anything like petroleum jelly in the vaginal area since it can be occlusive and increase your risk of developing a vaginal infection. as well as following to help prevent chafing and the potential of micro tears forming in the pelvic tissue.
Hormones make a big difference
If you are perimenopausal, on hormonal birth control, postpartum, or chestfeeding, you may be experiencing vulvar and vaginal or pelvic dryness because of hormonal changes, which can also cause issues with pelvic pain during tampon insertion. If this sounds like you, it is so important to have a conversation with your healthcare provider about potentially getting onto hormone replacement therapy (like topical estrogen, DHEA, or testosterone) to help improve some of your symptoms.

Deep breathing can go a long way
I usually recommend that clients who are experiencing discomfort with tampon insertion make sure they are practicing “diaphragmatic breathing” when putting a tampon in as well as when taking a tampon out. This means breathing in through your nose, carrying your breath from your upper chest down into your abdomen to help stimulate the diaphragm (which separates your upper chest from your belly) and then breathing out through your mouth. You want your breath out to be twice as long as your breath in and you can even pause at the top of the inhale to get a little more benefit. This breathing technique helps to stimulate the vagus nerve which has a calming effect on the nervous system and can help to improve pelvic floor muscle tension and discomfort.
Work with a mental health provider if you are struggling with a history of stress or anxiety when it comes to tampon use
I am a HUGE advocate of mental health as a pelvic floor provider and personally work with a mental health provider myself. Y’all, mental health is part of whole body health. You are a whole person and can’t disassociate your brain from your pelvic region and how those tissues respond to stress.
The pelvic floor muscles go hand in hand with stress and anxiety, so there is a ton of overlap when it comes to pelvic floor dysfunction and mental health diagnoses. I frequently recommend that clients who I am working with also work in conjunction with a mental health provider as we are helping to treat pelvic floor issues since the two complement each other so well.

Dilator therapy is important
Because pelvic floor muscle tension can be a huge factor when it comes to pelvic pain with tampon use, most clients who I work with who are struggling with or have struggled with pelvic pain with tampon insertion see big improvements when using dilators to address their symptoms. The research proves that dilator therapy (in conjunction with working with a pelvic floor physical therapist) is one of the most effective ways to address pelvic pain with tampon use.
Think of dilators as a form of graded exposure where they gradually increase in size and length (starting as small as your pinky finger and gradually increasing up to the size of a large dildo). These tools help to desensitize, stretch, and lengthen your pelvic floor muscles to help improve the discomfort that you feel during tampon or menstrual product use.
Some of my go-to dilators that I recommend to clients are from the following companies:
- Intimate Rose Vaginal Dilators and Rectal Dilators
- NewFlora

See a pelvic floor physical therapist!
If you are struggling with pelvic pain with the use of tampons, just know that it’s common but not normal and not something that you have to deal with. Working with a skilled pelvic floor physical therapist can help to identify the underlying cause of your issues and come up with a treatment plan tailor-made to you to help improve your symptoms.

So, if this sounds like you and you are located in Durham, NC, I would love to hear from you. Please don’t hesitate to reach out using the link below!

Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you are looking for treatment for pelvic pain during tampon insertion and you’re located in Durham, North Carolina I would love to work with you! Reach out to me using the link below to tell me a little more about what is going on so we can chat more and get the process started.

Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor physical therapy treatment.

request an appointment

Struggling with pelvic pain during tampon insertion or other pelvic floor conditions and having a hard time finding a knowledgeable pelvic floor physical therapist?

Check out my website here to see what other conditions I treat as a pelvic floor physical therapist.

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