5 things you need to know about painful sex

General Wellness
Women's Health
Men's Health
Woman sitting in bed looking unhappy.

Sex is supposed to be enjoyable—but sometimes, it can cause more pain than it does pleasure.

Painful intercourse (called "dyspareunia") can affect both men and women, but it's more common in women. If you have or have ever had dyspareunia, you're not alone—it's been estimated that as many as 3 out of 4 women have experienced painful sex at some point.

"If you have pain during sex, you don't need to just accept that that's how it'll always be, struggle through the pain or feel ashamed," says Anna M. Mesina, MD, an OB/GYN at Riddle OB/GYN Associates.

Here are 5 important things to know about painful sex.

1. There are multiple types of pain with intercourse.

There are two types of sexual pain. Entry pain (also called "superficial pain") is when you have pain at the entrance of the vagina, during the initial penetration.

On the other hand, deep pain is when you have pain that extends beyond the entrance of the vagina during deep penetration or thrusting. The pain can sometimes be felt in the lower pelvis.

While certain pain sources (like vaginal dryness or infections) could lead to either type of pain, entry pain and deep pain often stem from different causes.

Entry pain may be caused by:

Deep pain is often caused by:

  • Vaginismus, a condition where muscles surrounding the opening to the vagina contract involuntarily
  • Vulvodynia, which is chronic pain and irritation around the opening to the vagina
  • Infection, inflammation or a skin disorder, such as a urinary tract infection or eczema
  • Not enough lubrication
  • Changes to the vagina and urinary tract that can happen during menopause
  • An allergic reaction to certain condoms or contraceptive foams and jellies
  • Medical conditions or illnesses, such as endometriosis or irritable bowel syndrome
  • Infections that cause pus to form in the pelvis, like pelvic inflammatory disease
  • Tumors or cysts in the pelvis
  • Scarring from pelvic surgery
  • Certain cancer treatments, like radiation and chemotherapy
  • Anatomical variants, such as a retroverted uterus (where the uterus tips backwards)

When you're deciding whether it's entry or deep pain, it's also important to consider how the pain feels. Ask yourself if it's more of a burning sensation or a deep ache. Burning tends to be linked to conditions like vaginitis and vulvodynia, while deep aching may be a sign of a disease or structural problem, like an imperforate hymen.

2. Your pre-sex routine can play a role in pain.

What you do before having sex could be the difference between experiencing pain and being pain-free.

"Many women find that with some physical and mental preparation, they don't feel as much pain," says Dr. Mesina.

There are several ways to get prepared, such as:

  • Vaginal dryness is the #1 cause of painful sex, and it's often the result of not getting enough lubrication. Try increasing foreplay or using a water- or silicone-based lubricant.
  • Empty your bladder.
  • Enjoy a warm bath.
  • Take over-the-counter pain medications.
  • Get into the right headspace. If you're having a particularly stressful day, give yourself time to relax. Stress can cause your pelvic floor muscles to tighten, which can lead to pain.

3. Changes in your habits and your health might mean changes in pain.

If sex has suddenly become painful—after enjoying pain-free sex in the past—it could be the result of recent changes, like taking a new medication. For example, certain antidepressants and cancer drugs cause vaginal dryness, which we know can lead to pain during sex.

Or, it could be a new sexual partner. Some common sexually transmitted infections (STIs), like chlamydia, can irritate your vagina and cause pain.

"If you have a new partner and don't know their sexual history—and especially if you didn't use a condom—you may want to be screened for an STI," says Dr. Mesina.

Other changes are ones that you cannot control, like going through menopause. During menopause, your body makes less of the hormone estrogen. This can lead to a condition called vaginal atrophy, where the walls of your vagina become thin, dry and inflamed. Vaginal atrophy can also happen right after childbirth or while breastfeeding.

4. You shouldn't ignore pain during sex.

Remember—one of the most important reasons for talking to your provider about painful sex is that the pain could be a sign of a serious medical condition.

Some of these conditions can cause other symptoms in your pelvic region. For instance, gynecological cancers can cause painful sex plus:

  • Abdominal pain or bloating
  • Abnormal vaginal bleeding or discharge
  • Burning or itching of the vulva
  • Difficult or painful urination
  • Menstrual cycle changes, like periods that are heavier or last longer than usual
  • Pelvic pain
  • Sores, rash or discoloration on the vulva

"When you're talking to your provider, be sure to mention any other symptoms you're having in addition to painful sex," says Dr. Mesina.

5. Painful sex isn't always the result of a physical concern.

Painful sex can also be due to psychological factors. Your feelings about sex, your partner and your previous sexual experiences can all impact what you experience physically when you have intercourse.

Think about how you feel about sex in general. If you feel shame, awkwardness or embarrassment, it can be difficult to relax and enjoy. Relationship issues, like not having the same level of sexual desire as your partner, or not being 100% comfortable with intimacy with them yet, can also contribute.

"Another psychological cause can be your sexual history. This can range from having had painful sex before—and anticipating it so much that it happens again—to experiencing the long-term effects of previous sexual trauma," says Dr. Mesina.

Pain that's caused by psychological factors is not "in your head." Any pain you experience is real pain that should be addressed.

Treatment for painful sex

There are many ways to treat painful sex, including pelvic floor therapy, medications, laser treatments and surgery.

While painful sex might be a little difficult to talk about, it's very important that you share this information with your provider.

Even if the pain doesn't signal a serious medical concern, it's still essential to be open with your provider. They can help you pinpoint the source of your pain and may be able to prescribe a treatment plan that will keep the pain at bay.

Next steps:

Make an appointment with Anna M. Mesina, MD
Learn more about our women's health services
You don't have to suffer in silence with pelvic floor disorders