There are some home treatments for painful sex, but it may also be appropriate to see a healthcare professional. If you’re nervous or shy about discussing intimate details with your doctor or nurse, see this dedicated page for help. Medical professionals call painful sex dyspareunia (say diss-parren-yoo-ear).
What are the symptoms of painful sex?
Sex can be painful at different stages, so try to define when it hurts.
- Is it at entry – during penetration?
- Does it happen even if you use a tampon?
- Is it deep pain during thrusting?
- Is it a burning pain?
- Is it an ache?
- Is it a throbbing pain that lasts for some time after sex?
Each of these can indicate a different cause.
What causes sex to be painful?
There are a number of causes. These include:
Vaginismus. A condition where the vaginal muscles spasm and this makes penetration difficult or impossible. This commonly has an emotional cause and therapy may be very useful.
Lack of lubrication. If a woman isn’t sufficiently turned on during foreplay, she often doesn’t produce enough of her own lubricating fluid (‘love juice’). But this can also happen as part of the menopause, after childbirth or when breastfeeding, when changes in oestrogen levels cause this lack of lubrication. Patience, water-based lubricants, even saliva, can all be useful in reducing pain during penetration. Have a look at these foreplay tips.
Injury, skin irritation. Rough sex can cause injury to the vaginal area and surrounding skin. So also, can skin conditions such as eczema, lichen sclerosis or psoriasis.
Infection can cause the skin the break/crack/have a rash, all of which are painful. Infections include urinary infections, thrush or sexually transmitted infections (STIs). These conditions also cause pain during penetration.
A congenital abnormality, where the vagina isn’t fully or properly formed, or a there is a thickened hymen membrane can also make sex painful and difficult at penetration.
Pain during the thrusting movements of sex, often felt deeper in the vagina or abdomen, can be caused by other conditions. If you have endometriosis, a prolapsed uterus, pelvic inflammatory disease (PID), ovarian cysts or irritable bowel syndrome (IBS), this can cause pain during sex.
In addition, if you’ve had some pelvic surgery that has caused internal scarring (eg a hysterectomy or some bowel ops), or radiation treatment/chemotherapy, this can also make sex painful during thrusting.
The non-physical causes of painful sex are mainly emotional. Because sexual intimacy and our emotions are so closely linked, they may be deep-rooted or just temporary.
Life stress and anxiety can dull the libido and make you feel less like having sex, but they can also make the pelvic floor muscles tighten. The muscles of the pelvic floor run front-to-back from the pubic bone to the tail bone. The bowel, vagina and urethra run down through these muscles and if they are tight because of stress, both penetration and thrusting can be painful.
Insecurities over appearance, your relationship, the circumstances that lead to sex, fear of intimacy, in fact just about anything can mean that you’re unable to relax, can mean sex is uncomfortable.
Having a history of sexual abuse is also a major emotional factor for dyspareunia.
Often there is an emotional component to a physical problem, but not always. If your doctor can reassure you that all is well physically, ask if you can be referred to a registered sex and relationships counsellor. You may want to attend with or without your partner.
What tests will the doctor do for painful sex?
He or she will ask you about the history of the problem – how long it’s been happening, what might have brought it on etc. You might also be asked about the emotional impact this has on you and your partner.
You may have an internal exam and you may be referred for an ultrasound of your lower abdomen.
You may also be asked for a urine test and vaginal swabs may be taken, both to investigate infection.
What is the treatment for painful sex?
Depending on the cause, treatment ranges from antibiotics (if the cause is thought to be from a bacterial infection), to counselling or cognitive behavioural therapy (CBT) if it might have an emotional cause. Your doctor will guide you.
Communicate with your partner about the problem so that you can work through it together. Take your time and be patient. Prolong foreplay and use water-based lubricants if that’s necessary.
Avoid positions that give deep penetration, for example woman-on-top, which can make sex more painful.
Prescription meds might be needed and a drug called ospemifine (trade name varies in different countries) is approved for women with vaginal lubrication problems. It has oestrogen-like effects on the vagina, but without giving the problems oestrogen has for some women.
There is more information about painful sex in this article from WebMD.
And for painful sex in men and women, see this article from the UK’s NHS Choices website.
If you’re worried about your symptoms or medical problem but don’t want to seek professional help because you feel embarrassed, silly or that it’s your fault in some way, read this page now: How to talk to a doctor about an embarrassing problem.