Painful Sex: Symptoms, Causes, and Treatment

What is painful intercourse?

Dyspareunia is the medical term used to refer to genital pain that occurs before, during, or after sex. It’s very common and affects 75 percent of the female population at some point in their lives.

Painful sex can affect body image, relationships, and even plans to conceive. In some cases, dyspareunia can make a person avoid sex entirely. 

While it’s usually possible to determine what causes sex to be painful, some people are reluctant to talk about it with their health care providers.

Symptoms of painful intercourse

Symptoms of painful intercourse can include:

• Sharp, shooting pain
• A burning sensation
• Cramping pain
• Difficulty achieving orgasm due to the pain
• Low libido
• Some conditions can have other symptoms such as genital itching or pain during urination

Where is the pain felt?

Painful sex can be different for each person. Some people feel vaginal pain after penetration, while others feel discomfort upon any genital contact. Some people experience painful sex only after menopause.  

Pain can occur:

• Inside the vagina
• In the vestibule or opening of the vagina
• In and around the vulva
• In the perineum, which is the area that stretches from the genitals to the anus
• In the lower back
• In the pelvic area
• Inside the uterus

Some people have painless sex but then experience pain afterward. Others feel pain during sex, daily activities, and/or while urinating.

Causes of painful sex

Some of the most common causes of painful sex include:

• Vaginal dryness — This is common after menopause because of the hormonal changes that can decrease the vagina’s ability to produce lubrication. Other causes of vaginal dryness include oral contraceptives, breastfeeding, insufficient foreplay, and stress.
• Infections — Different infections can cause pain during sex. For example:

1. Yeast infections are characterized by an itchy, cottage cheese-like vaginal discharge. Yeast infections are not a sexually transmitted infection because yeast is part of the normal microbiome and isn’t usually contagious. Candidiasis can be associated with oral contraceptives or recent antibiotic use, and some people are more prone to it than others.
2. Urinary tract infections cause a burning sensation while urinating.
3. Gonorrhea
4. Urethritis
5. Bacterial vaginosis causes foul-smelling, gray, green, or white discharge.
6. Pelvic inflammatory disease
7. Chlamydia

• Endometriosis — This condition occurs when endometrial tissue, which is usually only inside of the uterus, spreads to other parts of the body.
• Dermatitis — The skin on the genitals can become irritated by perfumed hygiene products, new soaps or detergent, or products that contain ingredients that cause an allergic reaction. This condition causes itchy, dry, red skin.
• Vulvodynia — This term refers to pain in the vulva that isn’t associated with another medical condition. Vulvodynia can also cause pain after sitting for too long or while inserting a tampon.
• Vaginismus — This condition causes the muscles at the entrance of the vagina to painfully and involuntarily tighten, which causes pain when penetration is attempted. It can be caused by emotional and physical conditions.
• Hymen lacerations — All hymens are different. Some are very small and never cause issues; however, a large or thick hymen can sometimes cause pain during sex. Some people experience pain after their first sexual encounter due to a hymen that hasn’t been completely perforated. 

Other causes of pain when having sex include:

• Hemorrhoids
• Postmenopausal atrophic vaginitis
• Cervicitis
• Ovarian cysts
• Uterine prolapse
• Bartholin’s abscess
• Depression or anxiety
• Past sexual or emotional trauma

How to stop the pain

Treatment for painful sex will depend entirely on its cause. After the cause of the discomfort is discovered, a health care provider should be able to recommend appropriate treatment to make sex pleasurable again.

Communication

Communication is an important factor in every relationship, and it can be helpful to talk to your partner about any discomfort you’re experiencing. Repeatedly trying to have sex while in pain can lead to emotional repercussions and negative associations in the future. Discussing what you’re feeling with your partner can take a big weight off your shoulders.

Medications

Depending on what is causing sex to be painful, a health care provider may prescribe different medications. The medications commonly used to relieve painful sex include:

• Antibiotics for bacterial infections such as urinary tract infections or pelvic inflammatory disease
• Antifungals for mycotic infections like candidiasis. Keep in mind that these products are the best way to treat yeast infections. 
• Non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen; these can be used to relieve symptoms.
• Estrogen creams can be prescribed after menopause to relieve vaginal dryness.
• Oral contraceptives are used to control some causes of painful intercourse, such as endometriosis and ovarian cysts.

Home remedies for painful sex

If discomfort is caused by insufficient lubrication, it can be helpful to spend more time on foreplay and use lubricant. This is often enough to make intercourse stop hurting.

Keep in mind that oil-based lubricants can damage condoms and make them ineffective. It’s best to use water-based lubricants with condoms.

People who are experiencing allergic dermatitis can switch to unscented products and wear cotton underwear to help the skin heal.

If painful sex is only an occasional experience without any other symptoms, certain sexual positions or deep penetration may be the cause of the issue. Gentler intercourse and a change of positions can be helpful.

When to see a health care provider

You shouldn’t try to diagnose the cause of your dyspareunia yourself or self-medicate. Douching can also irritate the vagina and lead to infections.

Gynecological check-ups are recommended for women who are over 21 years old or sexually active, whether or not they’re experiencing dyspareunia.

How a health care provider can help reduce pain during sex

A health care provider can help diagnose the cause behind pain during sex, order diagnostic procedures, and prescribe treatment.

Some conditions, such as severe endometriosis or ovarian cysts, can require surgical procedures. Pelvic floor physical therapy can also be recommended in certain cases.

If dyspareunia is caused by past traumatic experiences or other emotional circumstances, a health care provider can offer a referral to a certified sex therapist. Different types of approaches, especially cognitive behavioral therapy, can be helpful in managing pain during sex.

While treating painful sex can require dedication and time, it is possible to overcome it and enjoy pleasurable sex again.