Sex shouldn’t be painful. However, it is still extremely common: nearly 3 in 4 women experience painful sex at some point in their lives. But just because it’s common doesn’t mean you have to live with it.
For many, sex is a sensitive topic and experiencing painful sex could add an extra layer of worry or even embarrassment to a conversation. Just know that there is nothing to be ashamed of. You may not feel comfortable talking about painful sex with your family or peers, but your primary care doctor or women’s health specialist is there to help you find a solution. And don’t worry: they are no strangers to these conversations.
Read on to learn more about painful sex, what may be causing it, and how you can reduce or even stop the pain.
What is painful sex?
Painful sexual intercourse, also known as dyspareunia, is a condition in which pain is felt before, during, or after sexual intercourse. Both men and women can experience painful sex, but it is more common in women: most women have painful sex at some point in their lives.
How painful sex can feel
Dyspareunia is divided into two categories: entry pain and deep pain. When it comes to sex and your body, you may focus primarily on your vagina, but if sex is painful and uncomfortable, you may feel it in other areas as well.
Entry pain is felt during initial penetration and the pain you will feel will be “shallow.” It is limited to the area surrounding the opening of the vagina, including:
- Vulva – The external genital area
- Lobby – The area surrounding the opening of the urethra and vagina.
- Perineum – The area between the vagina and anus.
As the name suggests, deep pain is felt during deeper penetration, where you may experience pain in:
- Vagina
- Cervix
- Uterus
- Bladder
- lower back
- pelvic region
When you experience pain in these areas, it could be considered primary or secondary dyspareunia. Primary dyspareunia occurs the first time you have sex, while secondary dyspareunia means that you have started to develop pain after having painless sex.
Painful sexual intercourse can occur for many reasons
Experiencing pain during sexual intercourse can occur at any time in life and there are many reasons why it occurs. Pain during sexual activity could be caused by:
Low vaginal estrogen
Estrogen is a hormone that helps the vagina maintain its lubrication, elasticity, and thickness. Low estrogen levels can cause vaginal atrophy: the thinning, dryness, and inflammation of the vaginal walls. During sex, secretions from the vaginal glands are supposed to keep the vagina lubricated, reducing friction during penetration and making sex smoother. Friction seems harmless, but it can cause discomfort, irritation, and pain during sex.
Vaginal dryness can occur at any time, but it is more common if you are menopausal or postmenopausal. During menopause, your estrogen levels begin to drop.
You may also experience painful sex at other times when your estrogen levels are expected to be low: after childbirth, while breastfeeding, or during cancer treatments. Alternatively, it is possible to experience vaginal dryness without changes in hormone levels. For example, some medications (cold, allergy, and antidepressants) can cause vaginal dryness.
Sexually transmitted diseases (STDs)
Sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) are often used interchangeably, but they are a little different. STIs are infections that are transmitted through sexual contact (oral, vaginal and anal). STIs become a disease once symptoms develop.
There may be a taboo around STDs and STIs, but there is nothing to be ashamed of. Human papillomavirus (HPV) is the most common STI in the US and most sexually active people will get it at some point if they have not received the HPV vaccine. And although HPV usually has no symptoms, other STDs could be the cause of your painful sex.
Chlamydia is the most frequently reported STD in the U.S. In women, the infection most often affects the cervix, but can also affect the mouth, reproductive organs, urethra, and rectum. STDs such as chlamydia and gonorrhea can cause deep pain during sexual intercourse, while genital herpes (an STD in which blisters and sores can appear in the mouth or genitals) can cause entry pain during penetration.
If you are sexually active, regular STI screening and testing can protect you and your sexual partner. Talk to your doctor to learn more about testing and treatment options if you need them.
Gynecological conditions
There are several gynecological conditions related to your reproductive system that could be causing your sexual intercourse to be uncomfortable and painful.
- endometriosis – Endometriosis is a chronic disease in which the uterine lining grows outside the uterus, including the fallopian tubes, ovaries, vagina, pelvis, and cervix. This can cause a buildup of tissue that causes inflammation, cysts, scarring, and painful intercourse.
- uterine fibroids – Uterine fibroids are a condition in which noncancerous growths develop in the uterus that cause painful intercourse if they are close to the cervix.
- ovarian cysts – Ovarian cysts are fluid-filled sacs that form inside or on the ovaries. They can cause pain in the abdomen during sexual activities.
- vaginismus – Vaginismus is the sudden and uncontrollable hardening of the vagina that makes penetration and sexual intercourse difficult and painful.
- Vaginitis – Vaginitis is a condition in which the vagina becomes inflamed and can cause painful intercourse, as well as vaginal itching and irritation.
- vulvodynia – Vulvodynia is a painful disorder in which vulvar pain is experienced for at least three months. It can cause entry pain during penetration.
Other health conditions
Beyond low hormone levels, STIs, and gynecological conditions, there could be other health conditions that cause you pain during sex. They include:
- Vaginal injury – During childbirth, women may have an episiotomy, a surgical cut made in the perineum to widen the vaginal opening, or experience tears in the perineum that can cause penetration and painful intercourse for months after childbirth.
- Skin disorders – Some skin disorders or dermatological conditions, such as contact dermatitis, can affect the skin of the vulva, causing ulcers and cracks that can cause burning and pain during sexual intercourse.
- Irritable bowel syndrome (IBS) – A condition that can cause bloating, constipation and stomach cramps. It can also cause you to feel deep pain in your pelvis during sex.
Conditions like pelvic inflammatory disease (PID) and chronic back pain can also make sex more painful and uncomfortable.
Sexual response problems
Sex is as much an activity for your mind as it is for your body. Lack of desire or arousal can make sex painful and there are a few reasons why this could happen.
Your mental state and your relationship with your partner could make you feel anxious, embarrassed, or uncomfortable having sex. These feelings make it difficult to feel aroused, and if your body is not aroused, it will be harder for your vagina to produce the natural lubrication it needs to facilitate penetration.
Certain medical conditions and medications can also decrease your desire and arousal. Arthritis, diabetes, cancer, and thyroid conditions, as well as some medications, can lower libido and affect sexual response.
When to see a doctor for painful sex
Experiencing painful sex once or twice may not be a cause for concern, but if you have frequent or severe pain, make an appointment with your doctor.
During your appointment, your doctor may:
- Review your medical history. Your doctor will review any signs or symptoms you are experiencing. They will also cover your medical and sexual history, including medications, medical conditions, and your past sexual experiences.
- Perform a pelvic exam or ultrasound. These tests may be necessary to determine the cause behind painful sexual intercourse.
- Refer you to another care provider. Depending on the cause of your painful intercourse, your doctor may refer you to other specialists, such as gynecologists, physical therapists, or gastroenterologists, to help treat or manage your symptoms.
Treatment Options for Painful Sexual Intercourse
There is no single standard way to treat painful sex, and your doctor can’t offer treatment until you know what’s causing it. Once they do, treatment options may include:
- antibiotics – Antibiotics are used to treat STIs and, in turn, can treat any STD-related dyspareunia. Medications such as azithromycin can treat sexually transmitted diseases such as chlamydia and help treat gonorrhea.
- Topical estrogens – When low hormone levels cause vaginal atrophy or dryness, doctors may prescribe topical estrogens to balance low estrogen levels. This will help your vagina maintain its lubrication and elasticity.
If painful intercourse is caused by other gynecological conditions, a women’s health specialist can help relieve your symptoms by treating conditions such as uterine fibroids, endometriosis, and ovarian cysts.
How can I reduce pain during sexual intercourse?
The best way to reduce painful sex is to see your doctor, but you can be proactive and make certain adjustments before, during, and after sex to increase symptom relief:
- Take an over-the-counter pain reliever before having sex.
- Use a water-soluble or silicone-based lubricant to make penetration smoother and less irritating to the vagina.
- Apply a cold gel pack to your vulva to relieve burning or tenderness after intercourse.
- Try non-penetrative sex or masturbation.
Improve your sex life
Talking about painful sex can be an uncomfortable conversation, but you’re not the only one who experiences it. Hopefully, knowing that can give you the courage to feel comfortable talking about it with your peers and, more importantly, your doctor.
If your symptoms are frequent and severe, make an appointment with your primary care doctor or OB-GYN. Not only can they help you discover what is causing you to have painful sex, but they can also guide you through a treatment plan that will give you relief and improve your sexual experiences.
