Sex is supposed to be a positive experience, both physically and emotionally, but for many women that simply is not the case. Sex can be painful, in a variety of ways, and that can be frustrating and often upsetting to deal with. Painful sex can make a woman feel like she’s letting her partner down, and worst of all, letting herself down. 

But, it’s important that women who experience pain during sex remember that this is not only a common occurrence, but it’s nothing to be ashamed of. There are several causes as to what causes pain during sex, as well as various treatment options. 

Pain During Sex: Defined

If you find yourself asking, “Why is sex painful?” there are definitive answers to that seemingly complicated question. 

The clinical name for pain during sex is dyspareunia and it’s defined as recurring genital and/or pelvic pain during sexual intercourse. The pain is sharp and intense and can occur anytime during sex, whether it’s before intercourse, during, or after. Pain during sex can be the result of a physical issue or can stem from mental and/or emotional causes. 

According to OB-GYN and the author of Healthy Sex Drive, Healthy You, Dr. Diana Hoppe says that painful sex occurs in approximately 75 percent of women at some time in their lives. 

Physical Causes for Pain During Sex

While physical pain during sex is not uncommon, She-ology author and OB/GYN Dr. Sherry A. Ross points out that “it’s not normal to experience persistent painful sex.” 

That’s why, Dr. Ross says, “Paying attention to your body during sex will help you understand the potential cause.” 

12 of the most common reasons for pain during sex

Vaginal Dryness

Vaginal pain during sex can often be linked to vaginal dryness. “The natural lubrications of the vagina can dry up with prolonged sexual contact and penetration causing friction and pain,” Dr. Ross says, adding, “If you haven’t had the right amount of foreplay to become sexually aroused and ‘get wet,’ the vagina will be dry making sex painful when the penis or fingers enter the vagina. 

Vaginal dryness can be caused by a variety of other conditions. Vaginal dryness can be found in postpartum women, Dr. Hoppe explains, which tends to last around six weeks, but often lasts longer in breastfeeding women. “After a woman stops breastfeeding and [her] menstrual cycle resumes, the vaginal tissues become lubricated and pain dissipates.”  

Perimenopause and menopause can also be a culprit when it comes to vaginal dryness Dr. Hoppe says, because “when hormone levels are fluctuating…there is a precipitous drop in estrogen and progesterone.” 

Vaginal Infections

Vaginal infections, and the pain they can cause during intercourse, can stem from a variety of reasons, Dr. Hoppe says. These can include the use of antibiotics, yeast infections, sexually transmitted infections (including gonorrhea and chlamydia), and viral infections (such as herpes). 

“The signs and symptoms of a vaginal infection may include vaginal discharge, odor, or itching, which may be the cause of your vaginal pain and swelling with sex,” Dr. Ross notes. 

Endometriosis

Endometriosis is a painful and oft-misdiagnosed disease that can interfere with sexual intercourse. 

“Endometriosis refers to the growth of the endometrium (the lining of the uterus) inside the pelvis, Dr. Hoppe explains, adding, “This can lead to cysts on the ovaries (endometriomas), hemorrhagic lesions inside the pelvis (endometriotic plaques) and scarring in the pelvis.  All of these can lead to painful intercourse.” 

The pain caused by endometriosis is so unbearable for some women, Dr. Ross says, they will not be able to have sexual penetration, which can be devastating to individuals and couples. 

Skin Disorders

Certain skin disorders can interfere with comfort during sexual intercourse. Dr. Hoppe notes that some of these disorders (such as eczema) can be linked directly to chemical irritants to the labial tissue due to certain soaps and hygiene products. 

“One of the most disruptive and chronic conditions involving the vulva is called Lichen Sclerosis, which represents nearly forty percent of skin disorders,” Dr. Ross notes.  With LS, the skin of the vulva changes color and is accompanied by intense itching, burning, and pain, which can all occur during sex. 

Another skin disorder is Hidradenitis Suppurativa (HS), which Dr. Ross explains is a “condition where the hair follicles of the vagina become blocked, swollen, and tender. Having sex during a bout of HS can be extremely painful, if not impossible.” 

Vulvodynia

Vulvodynia is an extremely painful condition involving the vulva and vagina, the causes of which are unidentifiable,” Dr. Ross says. Some of the symptoms can include burning, stinging, itching, throbbing, and swelling. All of this, Dr. Ross notes, can make for “an agonizing, disruptive recipe in the bedroom.” 

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease, or PID, an infection in the pelvis, can lead to infertility and pelvic pain. If you have PID, Dr. Ross says it’s important to get regular STI checkups when you change sexual partners. 

Vaginismus

Vaginismus, Dr. Ross explains, “is an unusual condition which causes the muscles of the vaginal opening to tighten, making sexual intercourse and pelvic examination painful to the point of impossible.” 

Dr. Hoppe points out that sexual intercourse may not be the only source of pain for those with vaginismus, as “having a speculum placed or trying to insert a tampon can be extremely painful.” 

Vaginal and Ovarian Cysts

Vaginal cysts may affect intercourse due to size and location which can make sex painful, Dr. Hoppe explains. 

Ovarian cysts, Dr. Hoppe notes, “are also painful with certain positions if the penis is hitting the back of the vaginal wall (fornix) and sometimes the cervix.” 

When it comes to a ruptured ovarian cysts, Dr. Ross points out that “if you are having sex during ovulation or mid-cycle, chances are there is an expected large ovarian cyst waiting to ovulate and release the egg.” Aggressive sex can cause this cyst to rupture, releasing its fluid contents along with the egg and causing pain. 

Dr. Ross says that a pelvic ultrasound combined with your menstrual history can help with a proper diagnosis.

Irritable Bowel Syndrome

Irritable Bowel Syndrome, or IBS, is defined as recurrent abdominal pain or discomfort that occurs in association with altered bowel habits (constipation and/or diarrhea) over a period of at least three months.

“Having a sensitive intestinal tract can make the act of sex excruciating if you are having a painful attack of IBS,” says Dr. Ross. 

Emotional Causes for Pain During Sex

Like physical causes, the emotional causes related to painful sex can be a harrowing thing to deal with. Some of the emotional causes for pain during sex can include: 

Stress

“For those suffering from constant and on-going stress, long term physical and mental medical complications can occur,” says Dr. Ross. Chronic stress can lead to depression, anxiety, insomnia, weight loss or weight gain, poor concentration, accidents, high blood pressure, and heartbeat irregularities. “All this can lead to a low sex drive and the potential for painful sex.” 

PTSD or History of Abuse

“Any history of sexual abuse and trauma (emotional or physical) can contribute to an aversion or general dislike of sex,” Dr. Ross says. 

 A devastating experience that leads to post-traumatic stress disorder (PTSD) may only enable you to feel pain with sex. “As in dealing with emotional problems, therapy and an open communication with your partner is key to helping resolve issues linked to abuse and trauma.” 

Self Esteem and Body Issues

“Knowing women’s sexual desire starts above the shoulders many of these conditions cause a lack of intimacy and sexual dysfunction,” Dr. Ross says, adding, “If your brain is not feeling desire or excitement, sexual dysfunction follows.” 

Self-esteem issues related to things like weight and lifestyle habits (smoking, drinking) can also have a major effect on how one feels in the bedroom. 

Diagnosing Pain During Sex

By understanding the various causes for painful sex, you will be able to discuss your issue(s) with your healthcare provider, who can help you through the diagnosis and come up with a treatment plan. During your appointment, your healthcare provider will take a detailed history and pelvic examination to rule out certain conditions.

“Other health care providers including a sex therapist and a pelvic health specialist/physical therapist is often necessary to help treat the underlying condition,” Dr. Ross says. 

What You Can Do About Pain During Sex

Just like you communicate your causes for pain during sex with your healthcare provider, Dr. Ross says communication with your partner is also important. “Understanding why you are experiencing pain with sex is the first step in preventing it from happening. You need to be honest with your partner in order to fix the problem.” 

This can include having adequate lubrication and finding sexual positions that are more comfortable. (“The missionary position tends to be easier for women and their anatomy,” Dr. Ross explains.) 

Once you, your partner, and your healthcare provider have gotten to the root of the issue(s), there are a variety of potential treatments, including self-care options. 

Some treatments to consider include:

  • Antibiotics + antifungal medicines
  • Corticosteroids
  • Therapy 
  • Water soluble lubricants
  • Ice packs
  • Warm baths

Pain during sex is an all-too-common occurence for many, but it doesn’t mean one should have to suffer or avoid intimacy all together. By communicating with your healthcare provider, as well as your partner, you can work towards finding a happy, healthy and pain-free sex life. 

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