The most common causes of painful sex

Painful intercourse is known medically as dyspareunia. It is a term used to describe recurrent pain anywhere in the genitals. It may feel like a sharp, sore or stinging sensation in and around the genital area or deep in your stomach.

Below, we summarise the most common causes of sexual pain in women.

Lack of sexual arousal

The simplest and most common reason is that you’re not aroused enough. Your vagina naturally lubricates itself when you’re aroused. However, if you’re not in the mood, your vagina doesn’t produce any lubrication. This can cause discomfort and vaginal dryness when you try to have sex.

Pregnancy and childbirth

Another common cause in women is childbirth. Being pregnant and giving birth change the body in multiple ways. How does this affect sex?

• Pelvic floor muscles and bones stretch to allow for the baby to grow, which can cause pelvic pain during sex.
• Changing hormones increase blood flow which can cause oversensitivity in and around the vagina.
• General discomfort from weight changes.
• Vaginal tearing after delivery and the surgery to repair it (episiotomy) can cause discomfort for a few weeks after giving birth.

For most women, it’s safe to have sex during pregnancy. Finding what feels good for you may require some trial and error.

Menopause

Menopause happens when a woman’s hormone levels naturally drop and tour ovaries stop releasing eggs each month (ovulation). It can be a difficult time for women physically and emotionally, especially when it comes to sex.

The main cause of pain during sexual intercourse is vaginal dryness, known medically as vaginal atrophy. Oestrogen is responsible for many functions in the body, particularly vaginal lubrication and elasticity. So as oestrogen levels drop, so does your vagina's natural lubrication.

Menopause can also take a huge emotional toll. Many postmenopausal women grieve the loss of their fertility and struggle with anxiety from all the symptoms of menopause. This can worsen the symptoms of vaginal dryness, and make sex more difficult.

Infections

Another common cause is an infection. The bacteria or fungus can cause inflammation and discomfort in and around the vagina depending on where your symptoms are.

For example, infections that cause visible sores (e.g. genital herpes) may cause pain in the entrance of the vagina. More serious infections, on the other hand, may cause deep pain in the pelvis.

Infections that may cause painful sex include:

• sexually transmitted infections (STIs) like chlamydia or gonorrhoea
• sexually transmitted diseases (STDs)
• pelvic inflammatory disease (PID)
• urinary tract infections (UTIs) like cystitis
• yeast infection (thrush)

You may also experience other symptoms such as a fever or nausea. If you think you have an infection, consult your healthcare provider or a sexual health clinic before having sex again.

PCOS

Polycystic ovary syndrome (PCOS) is a common condition. It is caused by an imbalance in hormones, which results in small ovarian cysts.

It causes symptoms such as acne, weight gain, excess hair growth and irregular periods. Many women also report pain during sexual intercourse. The association is not clear, but it could be due to several aspects of the condition.

The main factor is your hormone levels. Women with PCOS tend to have lower levels of oestrogen, which can cause vaginal dryness and discomfort. Many women with PCOS also struggle with self-esteem issues and other negative emotions. This can affect sexual desire and arousal.

Endometriosis

Endometriosis is a condition that causes chronic pain. It is caused by womb tissue growing in other places, such as your fallopian tubes. The main symptom is constant pelvic pain which feels worse during your period or sex.

Painful sex is one of the most common symptoms of endometriosis. This is because sex can pull or stretch irritated tissue. The pain will likely be behind your vagina and in the lower part of your womb.

Vaginismus

Vaginismus is where the vaginal muscles squeeze shut when you try to insert something into it. It’s a movement you can't control and can occur even if you feel aroused or you have enjoyed other forms of sexual activity. The cause isn’t clear, but it is generally believed to be caused by a psychological issue such as trauma from sexual abuse.

Vulvodynia

The vulva refers to the external part of the genital area, including the labia (lips) and clitoris. Some women experience unexplained but persistent pain in these areas, a condition known as vulvodynia.

The pain usually feels like a burning, stinging or throbbing sensation. It can be triggered by touch or by sitting down. Some women experience pain constantly.

It usually gets better on its own but may require prescription treatment.

Uterine fibroids

Fibroids are noncancerous growths that can occur in the womb. They often cause no symptoms and are usually discovered during a routine check-up.

Symptoms are usually present when there are many or large fibroids. One such symptom is pelvic pain, which may be worse during sex.

Tilted uterus

Usually, the uterus (womb) faces towards the front of your body. But in some women, the uterus faces the other way. It doesn’t cause any symptoms or serious problems. Your nurse or gynaecologist may spot it when you have a pelvic exam.

The only issue that these women may face is during sex. This is because your partner is more likely to bump your uterus during sex, especially in positions where the woman is on top.

Digestive problems

Another common cause of pain during sex is digestive issues, such as constipation or diarrhoea. These conditions can cause bloating and stomach pain, which sex can worsen.

Many women also struggle with inflammatory bowel disease (IBD). These conditions are chronic and cause persistent discomfort. On top of that, they can cause mental health and body image issues.

All of these factors can interfere with sex.

Bleeding during or after sex is usually nothing to worry about. The most common causes in women include:

• vaginal dryness or damage (e.g. from childbirth)
• an infection
• polyps (small benign growths)
• cervical erosion

However, bleeding after sex can sometimes indicate something more serious like cancer. If you have any other symptoms, then see your doctor as soon as possible.

While painful sex in women can usually be fixed with lube or changing position, this is not the case for men. Painful sex in men is more uncommon and more likely to have an underlying cause.

• an infection such as an STI or thrush
• a tight foreskin
• tears in the foreskin
• inflammation of the head of the penis
• inflammation of the prostate (prostatitis)
• testicular pain and swelling
• a prolonged erection (priapism)

Any pain or bleeding should be seen by a doctor as soon as possible. It may require treatment.

Depending on the cause, there are ways to combat dyspareunia.

Foreplay

The first-line solution for any sexual pain is foreplay. Don’t jump straight into sex if you don’t feel ready or aroused enough as this will make your discomfort worse. Ensure you dedicate enough time to getting in the mood so sex is as enjoyable and comfortable as possible.

Lube

Another simple solution is lubrication. There are oil-based and water-based lubricants. If you use a condom, you should only use water-based lube as oil-based types can break the condom.

Switch positions

Not every position will feel amazing, even if your partner enjoys it. Try out different sex positions, relax and see what feels good. Don’t be afraid to communicate with your partner.

Good hygiene

You should also avoid excess irritation to your genital area.

Some good tips include:

• avoiding harsh or overly scented products
• wear loose breathable underwear
• wipe front to back
• wash with water and an unscented soap

Not only will this prevent irritation, but it will also significantly reduce your risk of developing an infection.

Prescription treatment

If you have an infection, it will not go away on its own. Most will need a course of antibiotics or antifungals to clear the symptoms.

Vaginal dryness post-menopause can also be treated using hormone replacement therapy (HRT). You can use a general HRT, such as Evorel or use a vaginal-specific treatment such as an estrogen cream.

Those with hormonal disorders like PCOS may also benefit from using a hormonal contraceptive such as “the pill”. It helps by balancing out your hormones which could reduce some discomfort.

Therapy

For those with chronic conditions or mental health issues, talking therapies or sex therapy can be very beneficial. Your therapist can help you change your perspective on your body and sex as well as give you solutions to improving your sex life.