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    What to do about painful sex

    Updated 21 March 2024 |
    Published 04 October 2018
    Fact Checked
    Medically reviewed by Dr. Brandye Wilson-Manigat, Obstetrician and gynecologist, CEO of Brio Virtual Gynecology, California, US
    Written by Kate Hollowood
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    Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles.

    Pain during sex is pretty common but may put you off being intimate with a partner. It’s not something you have to deal with alone. Here’s the lowdown on painful intercourse with advice from a Flo expert.

    Sex is supposed to be fun, right? You should enter every sexual experience with pleasure at the forefront of your mind. This might be difficult if you feel pain, though. Frustratingly, it’s fairly common to experience some pain during sex. In fact, around 3 in 4 women experience it at some point during their lives. But that doesn’t mean you need to just put up with it. 

    Aches and twinges during sex can be attributed to a number of things, from trying a new position to underlying emotional or physical reasons. For many people, the pain is only temporary. However, it might make you feel apprehensive or anxious about sex, so it can be useful to understand what’s causing it for you.

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    Key takeaways

    What does painful sex feel like?

    Painful sex (also known as dyspareunia) can be annoying and uncomfortable at best, and at worst, impossible to bear. It can feel different depending on what’s causing it. You might feel anything from a short, sharp pain to more persistent cramping, explains Flo expert Dr. Sameena Rahman, obstetrician, gynecologist, and clinical assistant professor, Northwestern Feinberg School of Medicine, Illinois, US. 

    “Painful sex can feel like pain on initial or deep penetration,” says Dr. Rahman. “It can feel like a burning sensation at the opening, a sharp shooting pain, or a knife-like sensation. Or it can be a sharp pain with deep thrusting or cramping like menstrual cramps. Some people describe it as cutting or stabbing, or feeling like sandpaper.” 

    If sex hurts, then it might make you feel anxious and put you off getting intimate with a partner. It can feel like a personal and vulnerable issue, but know that you’re not alone. Just because most of us will experience some sort of pain during sex at some point in our lives doesn’t mean that we have to simply put up with it. With the help of your doctor, you can learn what’s making sex painful for you and get the treatment you need as soon as possible. 

    What causes painful sex?

    Working with your doctor to figure out the underlying cause of painful intercourse is the first step to getting it resolved. Here are some common causes of dyspareunia to help you get started. 

    Vaginal dryness

    Sometimes sex can hurt because there isn’t enough natural lubrication coating your vaginal walls to ease friction from penetration. This lubrication is sometimes known as “getting wet.” When you’re feeling turned on, there’s an increase of blood flow to your vagina. The resulting pressure in your blood vessels pushes fluid through the cells of your vaginal wall. You may notice that you feel “wetter” the more foreplay you do or the more you and your partner play before penetrative sex. 

    Your body’s natural fluids can help to keep the lining of your vagina thick and elastic while also easing friction during sex. If you experience vaginal dryness before or during sex, it doesn’t necessarily mean you’re not attracted to your partner. It may just mean that you’d like to try more foreplay before penetrative sex, or it may be linked to your hormones.

    You might be curious how your hormones can be linked to how wet you feel. It’s actually quite straightforward. Estrogen plays an important role in keeping your vaginal lining thick, soft, and pliable. If you have low estrogen levels, your vaginal tissue can become thin and dry. This can lead to discomfort and pain during sex.

    This is common among those who are breastfeeding, experiencing perimenopause, or postmenopausal. Vaginal dryness at this time is pretty easily explained. As your estrogen levels naturally decline, you may feel drier. 

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    However, perimenopause isn’t the only cause of vaginal dryness. Around 17% of women aged 18 to 50 experience problems with vaginal dryness during sex, even before menopause and estrogen decline start. So if you haven’t started perimenopause and you’re experiencing vaginal dryness, know that it’s definitely not just you. 

    Some medications including antihistamines, hormonal birth control, and certain antidepressants can leave you feeling drier than normal. So it’s worth investigating whether this is a listed side effect of any medications you’re taking. 

    Emotional factors

    Sex might be a physical act, but the way you’re feeling can understandably have a big impact on how you react in intimate situations. Conditions like anxiety and depression can impact your arousal levels. Emotions like fear, shame, or anxiety can also make it hard to relax during sex. 

    This is why having a history of sexual abuse or trauma can make sex physically — as well as emotionally — painful. If you identify with this, then know that it’s not your fault. Often, we don’t have any way of controlling our emotional responses. It’s simply your body’s way of protecting you. 

    If you’re experiencing difficult emotions around sex or think that a past trauma might be impacting your sex life, it’s important to know that you’re not alone. Help is out there. If speaking to your partner about it feels too scary, try chatting to someone else you can trust first, whether that’s a close friend, family member, or therapist. 

    Past trauma isn’t the only reason your emotions may impact your sex life. High levels of stress can make sex hurt, as it can cause your pelvic floor muscles to tighten and lead to lower levels of arousal. If sex has hurt in the past, then it’s totally understandable if you feel stressed by the idea of penetration. 

    “Your brain is a sexual organ,” says Dr. Rahman. “Some people have an automatic reaction to the act of penetrative sex, causing the pelvic floor to contract. This is called primary vaginismus and is related to fear or anxiety around penetration. You can also develop this if you have a fear of anticipated penetration due to pain at the opening of the vagina too.”

    So painful sex can become a vicious cycle when it leads to further fear, stress, and worry. Crucially, it’s a cycle you can break, but more on that later. 

    Health conditions

    Painful sex can sometimes be caused by an underlying health condition. This isn’t an exhaustive list, but if you’re experiencing pain during sex and think it might be a sign of an underlying health condition, then don’t hesitate to reach out to your doctor. 

    • Endometriosis: This is a condition where tissue similar to the lining of your uterus grows in other parts of your body. Some signs of endometriosis include chronic pain, pain before and during your period, pain when you pee or poop, and difficulty getting pregnant. 
    • Dermatitis: Vulvar dermatitis is a common skin condition that causes your vulva to become dry, itchy, and inflamed. It can also lead to painful sex, and it may also hurt when you put in a tampon. 
    • Vulvodynia: Vulvodynia is a type of long-term vulva pain that makes even sitting for a long time uncomfortable, let alone sex. It lasts for at least three months and can go on for years.
    • Vaginismus: As Dr. Rahman touched on earlier, vaginismus is when your vagina involuntarily contracts and can lead to painful intercourse. As well as during sex, it can happen when inserting a tampon or having a pelvic exam.
    • Injury or trauma: Injuries to your genitals after an accident, surgery, childbirth, or assault can result in painful sex. 
    • Pelvic floor dysfunction: This is a common condition where you can’t fully relax or coordinate your pelvic floor muscles (the muscles around your bladder, bottom, and vagina). Along with painful sex, signs can be straining to poop and needing to pee more frequently. 

    Infections 

    Infections are another common cause of painful sex. If you think you might have any of the symptoms mentioned below, try not to panic. Your health care provider will be able to help you figure out what’s going on and get you the right treatment. 
    Yeast infections: Vaginal yeast infections can cause dyspareunia along with irritation, discharge, tenderness, and itching. They can also be the cause of swollen labia after sex

    • Urinary tract infections (UTIs): UTIs can cause pain during sex as well as painful urination, needing to pee more often, and cloudy-looking pee with a foul or strong smell. They’re caused by bacteria getting into your urinary system and are very common. Around half of women will have a UTI at some point during their lives.
    • Sexually transmitted infections (STIs): Common STIs, like gonorrhea and chlamydia, can cause vaginal irritation, which can then lead to painful sex. These STIs can also cause painful urination and unusual vaginal discharge, among other symptoms. Meanwhile, genital herpes (that's different to genital warts, FYI) can also make sex painful by causing blisters or sores around the genitals. If you think you might have an STI, it can be distressing, but know that most STIs can be cured with the right treatment. STIs are also incredibly common and nothing to be ashamed of. 
    • Bacterial vaginosis: Although up to 84% of people with bacterial vaginosis don’t have symptoms, it can cause painful sex, unusual or foul-smelling discharge, itchiness, and abdominal cramps. 
    • Pelvic inflammatory disease: Pelvic inflammatory disease (PID) can cause pain deep inside the pelvis during sex. It’s often caused by untreated STIs, like chlamydia or gonorrhea.

    What should you do if sex hurts? 

    Pain during sex can feel deeply personal, but there are things you can try to alleviate it. Speaking to your partner may help you feel less alone, and knowing the cause of the pain could help you in the long run. 

    Communicate with your partner

    Talking about sex can feel daunting, even with the person that you’re doing it with. However, if you aren’t enjoying sex or feel pain, it’s important that you let your partner know. 

    It can be easy to feel like you’re ruining things when you’re the one experiencing pain. But as Dr. Rahman points out, your partner is also responsible for ensuring you have the best possible time. Working through any issue together can be a bonding experience and make your sex life even better in the long run. 

    Try different sex positions 

    Once you’ve opened up the conversation with your partner, try experimenting with different positions to see if any suit you better than others. “Sometimes being on top, for instance, can avoid the thrusting or hitting the back wall of the vagina that causes pain,” says Dr. Rahman. “You can also control the penetration depth with certain positions and devices.”

    Use lubricant

    If you think vaginal dryness might be the cause of your pain, don’t hesitate to reach for lube. Vaginal lubricants and moisturizers can add moisture to your vaginal tissue, helping to ease pain during sex. 

    “Lots of people need additional lubricant to ensure less pain from friction and a gentler or easier time with penetration,” says Dr. Rahman. While it can help with many of the factors mentioned above, you may also “just want to have a good time and last longer,” says Dr. Rahman. “There is no shame in using lubricants!” 

    Speak to your doctor 

    With so many different causes of painful sex, ranging from the everyday to those needing more serious attention, it’s important not to self-diagnose. Your health care provider will be able to help you figure out what’s going on or refer you to a specialist. 

    If you feel awkward or embarrassed discussing such an intimate topic, that’s totally understandable. It can help to remember that your doctor has had similar conversations with countless other patients before. There’s likely to be very little that could phase them. 

    More FAQs

    What could cause pain in the lower abdomen during sex?

    There are multiple causes of lower abdomen or deep pain during sex, ranging from conditions like endometriosis, PID, UTIs, and pelvic floor dysfunction to emotional factors. We explore these in more detail above.

    What’s the best lube for vaginal dryness?

    Make sure you choose a lube that has been developed specially for the vagina. You shouldn’t use your regular face or body creams. Vaginal moisturizers can be applied every day, while lubricants are for use just before sex. You can buy them at your local drugstore.

    What could vaginismus feel like?

    Vaginismus can feel like tightness and pain in your vagina when you try to insert something into it. Here’s how Flo expert, clinical health psychologist, and certified sex therapist Jordan Rullo, PhD, Utah, US, describes vaginismus: “When I see people with vaginismus who have male sexual partners, they’ll say that when they first tried vaginal penetration, it was like the penis was hitting a wall.”

    References

    Bachmann, Gloria, and JoAnn Pinkerton. “Patient Education: Vaginal Dryness (Beyond the Basics).” UpToDate, 9 June 2022, www.uptodate.com/contents/vaginal-dryness-beyond-the-basics/print.

    Bilardi, Jade E., et al. “The Burden of Bacterial Vaginosis: Women’s Experience of the Physical, Emotional, Sexual and Social Impact of Living with Recurrent Bacterial Vaginosis.” PLOS ONE, vol. 8, no. 9, Sep. 2013, https://doi.org/10.1371/journal.pone.0074378. 

    “Dyspareunia (Painful Intercourse).” Cleveland Clinic, my.clevelandclinic.org/health/diseases/12325-dyspareunia-painful-intercourse. Accessed 20 Mar. 2024.

    “Endometriosis.” The American College of Obstetricians and Gynecologists, Feb. 2021, www.acog.org/womens-health/faqs/endometriosis

    “Endometriosis and Sex: What You Need to Know for a Healthy Sex Life.” Mayo Clinic, 28 Aug. 2023, mcpress.mayoclinic.org/women-health/endometriosis-and-healthy-sex-life/

    “Vulvodynia.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/17878-vulvodynia. Accessed 20 Mar. 2024.

    Hamilton, Lisa Dawn, and Cindy M. Meston. “Chronic Stress and Sexual Function in Women.” The Journal of Sexual Medicine, vol. 10, no. 10, Oct. 2013, pp. 2443–54, https://doi.org/10.1111/jsm.12249.

    “Painful Intercourse (Dyspareunia).” Mayo Clinic, 16 Feb. 2024, www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967

    “Pelvic Floor Dysfunction.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction. Accessed 20 Mar. 2024.

    “Pelvic Inflammatory Disease.” NHS, www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/. Accessed 20 Mar. 2024.

    “Pelvic Inflammatory Disease (PID).” Mayo Clinic, 30 Apr. 2022, www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594

    “Bacterial Vaginosis.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/3963-bacterial-vaginosis. Accessed 20 Mar. 2024.

    “Sexually Transmitted Disease (STD) Symptoms.” Mayo Clinic, 12 Mar. 2024, www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/in-depth/std-symptoms/art-20047081

    “Sexually Transmitted Infections.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/9138-sexually-transmitted-diseases--infections-stds--stis. Accessed 20 Mar. 2024.

    Sommers, Marilyn Sawyer. “Defining Patterns of Genital Injury from Sexual Assault: A Review.” Trauma, Violence and Abuse, vol. 8, no. 3, July 2007, pp. 270–80, https://doi.org/10.1177/1524838007303194.

    “Urinary Tract Infection (UTI).” Mayo Clinic, 14 Sep. 2022, www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447

    “Vaginismus.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/15723-vaginismus. Accessed 20 Mar. 2024.

    “Vulvar Dermatitis.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/24336-vulvar-dermatitis. Accessed 20 Mar. 2024.

    “What Causes Painful Sex?” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/wellness-and-prevention/what-causes-painful-sex. Accessed 21 Mar. 2024.

    “When Sex Is Painful.” The American College of Obstetricians and Gynecologists, Sep. 2017, www.acog.org/womens-health/faqs/when-sex-is-painful

    “Vaginal Dryness.” Cleveland Clinic, my.clevelandclinic.org/health/symptoms/21027-vaginal-dryness. Accessed 20 Mar. 2024.

    “Yeast Infection (Vaginal).” Mayo Clinic, 11 Jan. 2023, www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999.

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