Pain During Sex

Pain during sex at a glance

• Women may experience pain during sex (dyspareunia) when penetration is attempted, or during and/or after sexual intercourse.
• Pain during intercourse may be caused by a variety of issues, both physical and emotional.
• Symptoms may include sharp pain on entry, muscle spasms, or deep pain during thrusting.
• Treatment for painful intercourse depends on the source of the pain, and may include using lubricants, therapeutic relaxation exercises, counseling, or addressing any infections or underlying medical conditions that may be present.

Symptoms of painful sex

Pain during intercourse affects many women at some point during their lives. For some women, however, it is a recurring problem that can affect their self-esteem, relationships, and sex lives. If you experience pain during sex, it is important to talk openly with your doctor about your symptoms.

Common symptoms include:

• Sharp pain during penetration
• Pain with all types of penetration, including tampon insertion
• Pain deep inside the vagina during thrusting
• Burning or aching pain

A woman may have experienced pain during intercourse throughout her life, or she may have had pain-free intercourse previously. She may only feel it in certain positions or with certain partners.

Causes of pain during sex

Pain during sex may be caused by a variety of physical and emotional issues.

Physical causes of pain during intercourse

Some common physical causes include:

• Insufficient lubrication: This can be due to childbirth or breastfeeding, lack of foreplay, lowered estrogen levels after menopause, or because of medications that affect sexual desire such as antidepressants, some birth control pills, or antihistamines.
• Vaginismus: Involuntary muscles spasms in the vaginal wall
• Skin disorders or infections: Due to eczema, irritation from soaps or perfumes, or infections in the genitals such as vaginitis
• Injury or trauma to the vulva, perineum, or vagina: Including episiotomy, accidents, or pelvic surgery
• Vulvodynia or Vulvar Vestibulitis Syndrome (VVS): This pain disorder affects the vulva and/or the entrance to the vagina, known as the vestibule
• Illnesses or other medical conditions: Including endometriosis, pelvic organ prolapse, cystitis, ovarian cysts, or uterine fibroids.

Emotional causes of pain during intercourse

Stress, anxiety, and depression can lead to changes in a woman’s sexual response. In addition, if previous sexual experiences have been painful, the body may become tense in anticipation of another painful experience, which can ultimately cause pain during sex to occur again.

Feelings of fear, guilt, or shame can make it difficult for women to become aroused, which can make sex painful. For some women, emotional issues from previous sexual trauma or abuse can contribute to pain during sex.

Treatment for pain during sex

Home treatments for pain during sex include:

• Using lubricants
• Trying more foreplay before penetration is attempted
• Changing sexual positions (such as the woman on top) that allow the woman more control over penetration depth
• Trying sexual activities that do not cause pain

Because there are so many potential causes of pain during intercourse, it is important to consult a health care provider about the appropriate course of treatment for you.

Related resource: ACOG’s “When Sex is Painful” handout