Pain During Sex: What Causes It and What Helps?

Pain during sex is a common problem for women.

As many as 75% of women will experience pain during sex—also known as dyspareunia—at some point, according to the American College of Obstetricians and Gynecologists. For some women, the pain is rare or happens only once, but for others it’s persistent.

Cedars-Sinai urogynecologists Karyn Eilber, MD, and Alexandra Dubinskaya, MD, treat women with sexual dysfunction and study its causes. Here’s what they think women should know about painful sex.

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Is Pain During Sex Normal? Here’s When to Pay Attention

Just because painful sex is very common doesn’t mean you have to accept it as “normal.” Occasional minor soreness is likely nothing to worry about, but intense or frequent pain might be a symptom of an underlying medical condition that needs to be addressed.

“Some women may have experienced sexual joy, but then at some point in their life, sex becomes painful,” said Eilber. “They may stop having sex with their partners. Whether your pain is mild or severe, if it bothers you and it’s keeping you from having sex, you should definitely talk to your doctor and your partner."

Sex should be a pleasurable experience, and if it’s not, don’t hesitate to speak up.

How to Talk to Your Doctor About Painful Sex

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Many women are hesitant to bring up sexual problems with their doctor, Eilber said.

“It can feel embarrassing,” she said. “It’s difficult enough to share with our partners and friends, so telling a doctor—a stranger—can feel intimidating.”

Whether your pain is mild or severe, if it bothers you and it’s keeping you from having sex, you should definitely talk to your doctor and your partner.

Shame and fear of judgment are obstacles to addressing pain during sex—or even talking about it.

“Like mental health, sexual health can carry a stigma,” she said. “Mental health is slowly losing that stigma, and sexual health needs to follow that trend. We can look at these things as health conditions and normalize having these conversations as part of our regular healthcare.”

Vaginal Dryness Is a Leading Cause of Painful Sex: What Can Help

Dryness is one of the most common causes of painful sex, and it can occur in any woman at any age. While it is more common in perimenopausal and postmenopausal women, younger women can experience it, as well.

In addition to making sex painful, vaginal dryness can throw off the vagina’s balance of good bacteria, which can result in infections that contribute to painful sex. Dryness can happen for many reasons, including birth control use, breastfeeding and menopause.

“It’s normal to use a personal lubricant,” Dubinskaya said. “There are studies that show women who use personal lubricant while having intercourse experience more pleasure. I think it’s important for people and their partners to recognize that just because a woman isn’t lubricating does not mean she isn’t aroused.”

Eilber and Dubinskaya suggest approaching lubricants in the same way many women consider skin care products: Pay attention to the ingredients, and test it on a small patch of skin first to make sure it doesn’t cause irritation.

Medical Conditions That Can Cause Pain During Sex

Vaginal dryness is a frequent contributor, but there are many other reasons sex might become painful. Some conditions that can be at the root of the problem:

• ‍Endometriosis: In people with endometriosis, the tissue that normally lines the uterus grows in other areas of the pelvis, such as the ovaries, fallopian tubes or intestines. The condition can be painful, including causing pain during sex.‍
• Fibroids: These noncancerous growths on the uterus can cause heavy menstrual bleeding, pelvic pressure, pain and painful intercourse.‍
• Genitourinary syndrome of menopause: When estrogen levels decrease during menopause, the vaginal and urinary tissues become thinner, drier and more fragile. Known as genitourinary syndrome of menopause, this can cause symptoms such as vaginal discomfort, painful sex, decreased arousal, urinary urgency and frequent urinary tract infections.‍
• Infections: Bacterial, yeast or sexually transmitted infections can cause pain during sex and usually have other symptoms, such as discharge.‍
• Interstitial cystitis: Also known as painful bladder syndrome, this condition is often mistaken for a urinary tract infection because it shares many of the same symptoms, such as bladder and pelvic pain, pressure, and a frequent urge to urinate. However, the condition is not an infection.‍
• Ovarian cysts: These fluid-filled sacs on the ovaries often have no symptoms. When they rupture, they can cause pain and bleeding.‍
• Pelvic floor dysfunction: The pelvic floor muscles—the ones you tighten when you want to stop passing urine quickly—can become painfully tight. It can cause an achy pelvis and pain with penetration.‍
• Pelvic floor injury: An injury to the pelvic floor—which can have many causes, from vaginal childbirth to improperly fitted bicycle seats—can cause pain during sex. ‍
• Vaginismus: Vaginismus is a condition where the muscles at the opening of the vagina become tightly contracted, which can cause pain with penetration or even make penetration impossible.‍
• Vulvodynia: Patients with vulvodynia experience chronic pain at the opening of the vagina, including burning, stinging, soreness, itching, rawness and pain during sex.

Don’t Suffer in Silence: When to See a Doctor

Painful sex usually has a cause, and once it’s identified, it’s likely treatable. If you’re avoiding sex, it’s time to see your doctor. Your gynecologist is often the best place to start, as it’s likely they will be able to accurately diagnose the cause of the pain.

“Sometimes we refer people to pelvic floor physical therapy to help decrease pain during sex. Other times, there can be issues related to the vulva that could be contributing to your pain, so medications might be helpful. It could be a positional issue that can be easily solved. Either way, sex doesn’t have to be painful, and there are ways to address this issue,” said Diamond Goodwin, MD, a minimally invasive gynecological surgeon at Cedars-Sinai.

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Many women are reluctant to talk about any issues they’re having in the pelvic region, whether it’s a prolapse, incontinence or painful sex. Many may not even feel comfortable opening up to friends or loved ones about these issues.

“I think as women, we often tend to blame ourselves,” Eilber said. “That can definitely contribute to the pain and to sexual dysfunction. I think the more resources we can make available and the more we’re able to talk openly about these issues, the more beneficial it will be.”