Highlights from this article:
- Painful sex (dyspareunia) can be caused by vaginal dryness, STIs, vaginal infections, or chronic gynecological conditions.
- Pain during sex is common, but it’s never normal. Sex is supposed to be pleasurable!
- Treatment for dyspareunia depends on the cause, and in some cases, there’s no clear treatment option.
Pain during sex, AKA dyspareunia, can be caused by several reasons — from STIs and vaginal infections to lack of arousal, and even some gynecological conditions like vaginismus.
Sex is supposed to be a pleasurable and fun experience, so experiencing pain during intercourse can be alarming (and overall feel like a massive bummer).
Let’s have a look at the reasons why sex can be painful, and how to treat dyspareunia.
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 pain in the deeper parts of the vagina or lower pelvis 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:
Dyspareunia can also be classified as primary or secondary. Primary dyspareunia is categorized as 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. Is painful sex normal?
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 an emphatic “no”. Pain during sex 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 pain during sex?
So why can sex be painful? Here are 10 common causes of dyspareunia.
1. Vaginal dryness
Not being “wet” enough is one of the most common reasons why people with vaginas feel 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)
- Being on antidepressants
- Breastfeeding and being in a postpartum state
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.
Vaginal dryness can make penetration uncomfortable and can cause chafing or tearing. Luckily, if vaginal dryness is 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.
Endometriosis is a condition where tissue similar to the uterine lining starts to grow 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 pain with sex. Intercourse can make endometriosis pain flare-up because penetration 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.
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 sexual trauma or 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.
- 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~, some sex 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 sexual 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.
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 vaginal infections can look the same, it is important to get routine STI checks.
7. Vaginal infections
Painful intercourse is sometimes caused by a vaginal infection, including:
Vaginal infections also can present with vaginal itching, unusual discharge, or a burning sensation, as well as swelling, inflammation, and more. This can make any sort of friction or penetration painful. (FYI testing with Evvy can help to decode the full microbiome in order to determine if the microbes responsible for these infections are present).
Recurrent symptoms? Meet Evvy's at-home vaginal microbiome test, approved by leading OB-GYNs.
Vulvodynia is a condition that causes chronic, unexplained 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 vaginal opening (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 vaginal opening. 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. Lichen sclerosus
Lichen sclerosus is a skin condition that causes itchy white patches on the vulva and vaginal opening. It makes the skin around your vulva and anus dry and uncomfortable, which can lead to tearing during sex.
Treatment for dyspareunia
Treatment for painful sex depends on the cause of dyspareunia. If the pain is caused by an infection, it should be easily treated with medication 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 hormone treatment for menopause.
That being said, some conditions that cause dyspareunia are notoriously hard to diagnose — like endometriosis, vaginismus, and vulvodynia.
It may take time to diagnose what’s causing pain during intercourse, 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 physical 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 doctor.
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.