Painful Sex

painful sex


Sex can be painful for both men and women. However, painful sex is significantly more common in women, especially after menopause. In addition to the pain and discomfort, painful sex can negatively affect women emotionally, so it’s important to talk to your partner and doctor openly about the problem.  

Painful sex or Dyspareunia is defined as persistent or recurrent genital pain that occurs right before, during, or after sex. The pain can be felt in the vulva, vagina, perineum, lower back, or deep in the pelvis. Women usually describe the pain as a sharp, aching, or dull pain, it can also present as cramps, discomfort, or a burning sensation.

Pain during intercourse can be divided into: 

Entry pain, which is pain during penetration

Deep pain, which usually occurs with deep penetration


Causes of painful sex can be related to skin conditions, inflammations, muscle pain, or pain in the deeper structures of the pelvis. Psychological factors also play a big role. The main reasons for painful sex are:

  • Lack of vaginal lubrication: Having a dry vagina will make sexual intercourse painful for the woman. This is a common cause of pain during sex and the reasons include: 
  1.  Menopause
  2. Childbirth and breastfeeding
  3. Lack of sexual arousal
  4. Some medications 
  • Infections: Infections caused by bacteria or yeast will affect sex in women. Examples include sexually transmitted Infections such as chlamydia or genital herpes, urinary tract infections, and yeast infections (thrush).
  • Injury or trauma to the genital area: Scars in the area caused by previous injuries, surgeries, female circumcision, or birth injuries can cause painful sex in women.
  • Skin disorders: Many types of skin disorders can affect the intimate area and interfere with sexual activity. Eczema, ulcerations, and sclerosis of the skin are a few examples.  
  • Vulvodynia :  refers to chronic pain in the vulva (the tissue around the entrance to the vagina) for no known reason.
  • Vaginismus : is when the vaginal wall muscles involuntarily spasm because of fear or anxiety, making penetration extremely painful or even impossible.
  • Uterine conditions : including endometriosis, uterine fibroids, uterine prolapse, and ovarian cysts. These conditions cause deep pain during or after sex.
  • Pelvic inflammatory disease (PID) : is an infection of the pelvic organs that can cause deep pain during or after sex.
  • Genital irritation : due to allergies or sensitivities to spermicides, latex condoms, or hygiene products including sanitary pads.
  • Problems with the cervix :including cervical infections and tumors.
  • Ectopic pregnancy :in which a fertilized egg grows somewhere outside the womb. 
  • Treatments for cancer : such as radiation and chemotherapy
  • Anatomical problems: Sometimes, pain is caused by an underdeveloped vagina, a blocked or partially blocked vaginal entrance.  

Painful sex can also be attributed to psychological causes, such as:

  • Stress
  • Fear, guilt, or shame about sex
  • History of sexual trauma or abuse
  • Body image or self-image issues
  • Relationship issues with your sexual partner
  • Depression


Talking about sexual issues with others can be difficult. Remember that your doctor or healthcare provider is trained to deal with these issues and will not judge you or make you feel bad. You can consult with a general practitioner, an OB/GYN, or a specialist in genitourinary medicine. The doctor will diagnose dyspareunia (painful sex) by:

  • Performing a pelvic exam to check the internal and external pelvic area
  • Asking questions to determine the location and severity of the pain
  • Imaging, such as a pelvic ultrasound
  • Lab work including blood draws to test hormone levels, urinalysis, and culture for yeast or bacterial infections.
  • Skin sensitivity tests to evaluate irritations or allergies.


Dealing with painful sex depends on the cause of the problem and ranges from topical creams to sex therapy.  

  • Infections can be effectively treated with antibiotics, and antifungals. Inflammations can also be treated with corticosteroids.
  • Current medications should be checked to determine if they are causing vaginal dryness. In this case, using an alternative medication can solve the problem. 
  • Low estrogen levels in menopausal women can be treated with a topical estrogen cream applied directly to the vagina.
  • Avoiding products that irritate the area is usually advised.
  • Other medical treatments, including surgery, can be used to treat the more serious causes of painful sex.

Things you can do

After physical causes of painful sex are ruled out or treated, you can try these helpful tips: 

  • Using water-soluble lubricants
  • Communicating openly with your sexual partner in a relaxed setting
  • Emptying the bladder before sex
  • Relaxing before sex with a warm bath, a massage, or aromatherapy
  • Taking an over-the-counter pain relief medication before sex
  • Using an ice pack on the vulva after sex to calm any burning pain

Referral to psychological counseling may be recommended if the pain is related to emotional causes or past trauma or abuse. You consult with a general therapist or a sex therapist.


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