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Painful sex, also known as dyspareunia, can be caused by various factors such as sexually transmitted infections (STIs), a yeast infection, and or an underlying medical cause like vaginismus.
Although pain during sex is common, it's important to understand that it's not normal and shouldn't be ignored. Sex should be a pleasurable and enjoyable experience, so experiencing pain can be both alarming and disheartening.
The treatment for dyspareunia depends on its underlying cause, and in some cases, finding a clear treatment option can be challenging. Below, we explore the different causes of painful intercourse and discuss what you can do about it.
What is dyspareunia (aka painful intercourse)?
Dyspareunia is the medical (and frustratingly vague) definition of painful intercourse.
Pain in your vulva and vaginal opening is called superficial dyspareunia, while deep intercourse pain is called deep dyspareunia. Sometimes the pain can also be felt in the lower back, uterus, and bladder.
Pain during sex can range from a mild irritating sensation to debilitating pain. It can feel like:
- Burning
- Aching
- Throbbing
- Tearing
- Chafing
Dyspareunia can also be classified as primary or secondary. Primary dyspareunia is categorized as sexual pain with vaginal insertion that has been there since the first onset of sex, while secondary dyspareunia is defined as pain with sex that occurs after a period of pain-free sexual activity.
Dyspareunia can affect everyone differently and can be both short-term or chronic. Regardless of the severity, painful sex is an indication that something’s not quite right and needs to be addressed.
Is painful sex normal?
The answer to that question is a loud but emphatic “no”. Sexual pain may be common, but that doesn’t mean it is normal. BTW, dyspareunia is very different from consensual pain during sex. Having a pain kink or engaging in BDSM play is a-ok, but sex should only be painful if you want it to be.
Unfortunately, painful sex is as common as it is neglected. Many women and people with vaginas think it’s normal to experience discomfort while having sex and suffer in silence.
What causes painful sex?
So why can sex be painful? Here are 10 common causes of dyspareunia.
1. Vaginal dryness
Not having sufficient vaginal lubrication enough is one of the most common reasons why people with vaginas experience pain during sex.
Most of the time your vagina will produce arousal fluid as part of the sexual response cycle (think of it as your body’s very own lube). This makes penetration easier and more pleasurable. But there are loads of factors that can affect how wet you get, including (but not limited to):
- Lack of arousal (not being turned on enough)
- Hormonal changes caused by menopause, breastfeeding, or being postpartum
- Being on antidepressants.
And sometimes, your vagina’s response to being turned on simply doesn’t match up with how turned on you are, a phenomenon called arousal non-concordance.
Being too dry can make penetration uncomfortable and can cause chafing or tearing of the vaginal lining. Luckily, if that's the cause of painful sex, the solution is simple: lube! There is nothing wrong with you (or your body) if you need to use lube during sex. Remember, when it comes to mitigating pain during sex, the wetter the better.
2. Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus grows in other places, like the ovaries, fallopian tubes, and even the vaginal wall.
While heavy, painful periods are the most common symptom of endometriosis, another key symptom is painful intercourse. Deep penetration can make endometriosis pain flare-up because it can stretch and pull endometriosis lesions near the vagina.
Adenomyosis is another condition that can cause dyspareunia. Similar to endometriosis, adenomyosis happens when tissue similar to the uterine lining grows into the muscle wall of the uterus (the myometrium).
If you think you may have endometriosis, discuss this with your doctor the next time you go to the OBGYN.
3. Vaginismus
Vaginismus is a psychosexual condition where the vagina involuntarily contracts and tightens, making penetration painful or downright impossible.
Vaginismus pain can vary from slight discomfort to a stabbing or excruciating pain in the vulva and vagina.
Doctors don’t always know why vaginismus happens, but some common causes include:
- Past trauma from sexual abuse
- Acute vaginal infections
- Trauma or injury from childbirth
- Mental health issues like PTSD, anxiety, or depression.
4. Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs, including the uterus, fallopian tubes, and ovaries.
PID is often caused by an untreated STI, like chlamydia or gonorrhea. When bacteria enter the vagina, they can travel up the cervix and into the upper reproductive tract.
Symptoms of PID include:
- Pain in the lower abdomen
- Abnormal vaginal discharge that has a strong odor
- A high temperature
- Nausea and vomiting
- Pain during sex
- Bleeding between periods and after sex
- A burning sensation when you pee.
PID is no joke. If you experience these symptoms, contact your doctor immediately.
5. Sex positions
Deeper penetration can feel awesome, but if your partner (or sex toy) is particularly ~well-endowed~, certain sexual positions can be uncomfortable. Over-zealous thrusting can also cause pain — hardly anyone enjoys being stabbed in the cervix with a phallus.
Anatomy may also play a role. For example, women with a retroverted uterus may experience more pain during posterior penetration (i.e. doggy style). Working with your anatomy, rather than against it, can help to find sex positions that feel best.
If you’re not feeling a certain position, try switching it up and opting for a move that allows you to have control over depth and speed, like being on top.
6. Sexually transmitted infections
A common symptom of many STIs is often painful sex. STIs that cause pain and discomfort during sex include:
If you experience painful intercourse along with vaginal itching, unusual discharge, or a burning sensation when you pee, it could be a sign of an STI. Since so many infections can look the same, it is important to get routine STI checks.
7. Vaginal infections
Painful intercourse is sometimes due to vaginal irritation caused by the following conditions:
Get care with Evvy
Understanding why you're having pain with sex can be as confusing as it is debilitating.
That's why, alongside leading OBGYNs, we designed Evvy to be the first-ever platform for vaginal healthcare that combines state-of-the-art testing, prescription treatment, and 1:1 coaching to create personalized care as unique as your vaginal microbiome.
Testing your vaginal microbiome will help you understand if disruptive microbes are contributing to your discomfort.
And, for eligible testers, we offer first-of-its-kind clinical care, including an Rx treatment program developed by a provider, supportive coaching, and much more based on your results.
8. Vulvodynia
Vulvodynia is a condition that causes unexplained chronic pain in the vulva. Vulvodynia can feel like burning, stinging, or irritation that can affect the entire vulva (called generalized vulvodynia) or only a certain part of the vulva, like the clitoris or opening of the vagina (called localized vulvodynia).
Vulvodynia can also be provoked or unprovoked, which means the pain flares up with certain activities (like penetration during intercourse) or just shows up out of nowhere.
9. Bartholin cysts
The Bartholin glands are two small glands found at the entrance of the vagina. They secrete fluid into the vagina (especially when you’re aroused) via small tubes called “ducts”.
Sometimes the ducts can become inflamed and form a cyst, known as Bartholinitis or Bartholin cysts. Bartholin cysts aren’t necessarily a cause for concern and often go away on their own, but depending on their size they can cause pain during intercourse.
10. Skin disorders
Vulvar lichen sclerosus is a chronic skin condition that affects the vulva. It causes thin, white, and delicate patches of skin that can be itchy and sore. This condition can make sexual intercourse uncomfortable because it makes the skin around your vulva and anus dry and uncomfortable, which can lead to tearing during sex. The inflammation and scarring can also cause the opening of the vagina to narrow, adding to the discomfort.
Similarly, vulvar lichen planus is another chronic condition that can make the skin of the vulva itchy, painful, and sometimes raw. This can lead to a lot of discomfort, including burning sensations and soreness, which can make sex painful. Additionally, it can cause scarring that can lead to narrowing of the vaginal opening, further making sexual activities uncomfortable.
Treatment for dyspareunia
Treatment for painful sex depends on the cause of dyspareunia, as well as your sexual history. If the pain is caused by an infection, it should be easily treated with prescription medications like antibiotics. If the cause is vaginal dryness, you can easily make sex more comfortable with the help of lube, or your doctor may prescribe a vaginal estrogen creams for menopause.
That being said, some conditions that cause dyspareunia are notoriously hard to diagnose — like endometriosis, vaginismus, and vulvodynia.
It can take a long time to get dyspareunia diagnosed, and in many cases, there’s no clear-cut treatment. Depending on your condition and the severity of your symptoms, treatment can include a mix of medication, pelvic floor therapy, and in the case of vaginismus, vaginal dilators.
You have a right to safe and pleasurable sex, so if you’re experiencing any type of pain or discomfort when having sex, please bring it up with your healthcare provider.
And remember: penetration isn’t the only way to have sex! If intercourse is difficult for you, you can still have a fun and fulfilling sex life without it.
FAQ
Why do I feel pain during sex?
Experiencing pain during sex, known as dyspareunia, can be caused by various physical, psychological, and emotional factors. These include issues like inadequate lubrication, infections, medical conditions, as well as trauma past sexual abuse. To address this, it's important to openly communicate with your partner, use a water-based lubricant, ensure plenty of foreplay, and try relaxation techniques. Speaking with a healthcare provider is important to identify and treat any underlying medical conditions, and pelvic floor therapy may offer exercises and treatments to help.
How to fix painful sex?
If experience painful sex, it's important to talk openly with your partner about what you're experiencing. Using a water-based lubricant can make things more comfortable, and don't ski the foreplay — it can really help with arousal and natural lubrication. Try some relaxation techniques like mindfulness to ease anxiety and muscle tension. If the pain persists, it's essential to see a healthcare provider to rule out any underlying medical issues. Pelvic floor physical therapy could also be an option to explore, along with seeking support from a certified sex counselor. Remember, reaching out for medical advice is crucial to get to the bottom of this and find the right treatment.
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