Sex isn’t supposed to be something you have to grit your teeth and get through.
Yet pain during sex is common among women, and many put up with it for months, or even years, before asking for help.
Maybe penetration burns. Maybe you feel tightness at the vaginal opening. Maybe the pain is deeper in your pelvis. Or maybe sex suddenly started hurting when it never did before.
These details matter because painful sex, medically known as dyspareunia, isn’t one condition with one cause.
Here are seven possible reasons sex may hurt, and why figuring out the cause is the first step toward feeling better.
1. Vaginal Dryness
Sometimes the simplest explanation is that there isn’t enough lubrication.
Vaginal dryness can cause friction, burning and discomfort during penetration. It may occur when you’re not sufficiently aroused, but hormonal changes can also play a role.
Lower estrogen levels, particularly during and after menopause, can cause vaginal tissues to become thinner, drier and less elastic, a group of changes known as genitourinary syndrome of menopause (GSM).
Lubricants and vaginal moisturizers may help some women, while hormonal or other treatments may be appropriate depending on the cause.
2. Your Pelvic Floor Muscles Are Too Tight
Your pelvic floor muscles need to be able to both contract and relax.
When those muscles remain overly tight or don’t relax appropriately, penetration can become uncomfortable or painful.
Pelvic floor dysfunction may cause vaginal or pelvic pain, pressure, difficulty with penetration and other bowel, bladder or sexual symptoms.
This is also why telling someone experiencing painful sex to simply “relax” isn’t particularly useful. Pelvic floor muscle dysfunction can require proper evaluation and treatment.
3. Vaginismus
If penetration feels impossible, or your vaginal muscles seem to tighten automatically when penetration is attempted, vaginismus may be involved.
The muscle tightening isn’t something a woman simply chooses to do.
Vaginismus can make intercourse, tampon insertion and even pelvic examinations painful or difficult. Treatment varies depending on the individual and may involve pelvic floor therapy, gradual vaginal dilation, counseling or other approaches.
At Maze Women’s Health, treatment for vaginismus is individualized based on the woman’s symptoms, history and severity.
4. An Infection or Irritation
Sometimes burning or pain during sex is related to an infection or inflammation.
Yeast infections, bacterial vaginosis, sexually transmitted infections and urinary tract infections can all cause symptoms that make sex uncomfortable.
Skin conditions and reactions to products, including soaps, fragrances or other irritants, can also contribute to vulvar or vaginal discomfort.
If pain is accompanied by unusual discharge, odor, itching, sores, bleeding or urinary symptoms, it’s worth getting evaluated rather than assuming you just need more lubricant.
5. Vulvodynia
Sometimes the pain is concentrated around the vulva or vaginal opening.
Vulvodynia refers to chronic vulvar pain lasting at least three months without a clearly identifiable cause. Pain may feel like burning, stinging, irritation or rawness and can occur spontaneously or be triggered by touch or penetration.
Because vulvar pain can have multiple possible causes, getting the right diagnosis is especially important.
6. Endometriosis or Another Pelvic Condition
Not all painful sex happens at the vaginal opening.
Deep pain during intercourse can sometimes be associated with conditions affecting the pelvis, including endometriosis. Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus and can cause pelvic pain, painful periods and pain during or after sex.
Other pelvic conditions may cause similar symptoms, which is why the location and timing of the pain can provide important clues.
7. Your Brain and Body May Both Be Involved
Sexual pain isn’t always purely physical or purely psychological.
If you’ve experienced pain during sex repeatedly, it’s natural for your body to start anticipating that pain. Anxiety about penetration can increase muscle tension, which may make the next attempt even more uncomfortable.
Stress, previous sexual experiences, relationship concerns and fear of pain can all interact with physical symptoms.
That doesn’t mean the pain is “all in your head.”
It means sexual function involves both the body and the brain, and effective treatment sometimes needs to address both.
Painful Sex Isn’t Something You Have to Push Through
One of the biggest problems with painful sex is that women often normalize it.
Maybe you’ve been told you’re too tense.
Maybe you’ve assumed you need more lubricant.
Or maybe you’ve simply stopped having sex because avoiding it feels easier than dealing with the pain.
But persistent pain during intercourse deserves an evaluation.
At Maze Women’s Health, sexual health specialists look at the whole picture, including hormonal changes, pelvic floor function, vaginal and vulvar health, medical conditions and the emotional components of sexual pain, to help determine what’s actually causing your symptoms.
Because the goal isn’t simply to make sex tolerable.
It should be comfortable, and ideally, enjoyable.
Schedule a Consultation with Maze Women’s Health Today!