Painful Intercourse

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Painful intercourse (dyspareunia) can be challenging. Studies show pain with sex may affect as many as 22% of sexually active women.

The cause of this condition can vary widely and may include infection, disease, certain medications, age-related changes, or psychological stressors. Speak with your healthcare provider if you experience regular painful intercourse so you can understand what might be causing your symptoms.

This article discusses the common symptoms and causes of painful intercourse.

Couple laying in bed talking about sex

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Symptoms of Painful Intercourse

Pain with sex can occur before, during, or after penetrative sex. Pain can also vary based on the cause.

To better understand the cause of pain, healthcare providers may ask questions like:

  • Do you experience pain throughout sexual intercourse or only during penetration?
  • Do you feel pain only at the start of penetration?
  • Do you experience pain outside of intercourse, such as putting in a tampon?
  • Do you feel pain after intercourse or only during sexual activity?
  • Is the pain throbbing, aching, burning, or something else?

Write down your symptoms or keep a log of when the pain is triggered to help your healthcare provider better understand your symptoms.

Causes of Painful Intercourse

Some causes of painful sex can be easily treated, while others require more support.

Possible causes of painful sex include:

  • Low estrogen levels: Menopause, childbirth, or breastfeeding may all affect estrogen levels, resulting in less lubrication.
  • Sexually transmitted infections (STIs): Some STIs, like gonorrhea and chlamydia, can cause vaginal irritation that results in pain with intercourse. If not treated, these infections can lead to pelvic inflammatory disease, another cause of painful sex.
  • Genital herpes: Herpes causes blisters and sores that can lead to painful sex.
  • Vaginitis: Bacteria or yeast infections in the vagina can cause inflammation, irritation, itching, or discharge, making sex uncomfortable.
  • Vaginismus: Painful sex may result from involuntary muscle spasms of the vaginal wall.
  • Pelvic diseases: Endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) can cause various symptoms, including painful sex. Vulvodynia is another condition that may make sex painful.
  • Injury or trauma: Childbirth may cause injury or trauma to the genital area, including vaginal tears or episiotomies, which can result in painful sex. Prior accidents or pelvic surgery also play a role.
  • Previous sexual trauma or abuse: Prior sexual trauma can negatively affect sex, making it difficult to relax during intercourse.

Victims of Sexual Abuse

If you are a survivor of sexual assault, you can contact the RAINN National Sexual Assault Hotline at 800-656-4673 to receive confidential support from a trained staff member at a local RAINN affiliate. For more mental health resources, see our National Helpline Database.

What Medications Can Cause Painful Intercourse?

Certain medications affect arousal, desire, and vaginal lubrication. These include:

  • Birth control medications including oral birth control pills or injectable birth control methods.
  • Sedatives
  • Cold and allergy medications that lower moisture levels and reduce mucus, including both prescription and over-the-counter medications
  • Estrogen modulators used in cancer treatment, as well as other chemotherapy agents

Treatment for Painful Intercourse

Treatment for painful intercourse will depend on the cause of your pain.

Medications

Sexually transmitted infections may require antibiotics. Conditions like endometriosis and PCOS may require a multifaceted approach that includes medications and lifestyle changes. In some cases, surgery is required.

Low estrogen related to menopause, childbirth, or breastfeeding can be treated using various methods.

Vaginal Lubricants

Vaginal lubricants can reduce pain associated with vaginal dryness. Others find that increasing time spent in foreplay helps build desire and increase natural lubrication. Estrogen therapy may be suitable for some individuals, particularly postmenopausal.

It may help some individuals to know that changes in sexual function are normal, especially with pregnancy, childbirth, and breastfeeding. Most couples do not return to pre-pregnancy levels of sexual intercourse until 12 months after delivery due to various factors, including pain related to the trauma of childbirth.

Training Tools and Therapy

If your painful intercourse is related to issues like injury, stress, or tension, you may need additional help from a trained pelvic floor specialist. They can help you work through physical barriers to sex using tools like vaginal dilators or pelvic floor therapy.

Pelvic physiotherapists use tools like myofascial release, intra-vaginal massage, and transcutaneous electrical neural stimulation (TENS) to help relieve pain and improve sexual function.

Mental health providers can also help individuals who suffer from previous abuse or trauma and those suffering from sexual dysfunction. Because many individuals who suffer from pain with sex also experience problems with anxiety and depression, it's important to seek help from a mental health provider when needed.

Other Treatment Options

Other ways to address painful intercourse related to vaginal dryness and irritation include:

  • Avoid douching.
  • Use the right tampon absorbency for your needs.
  • Avoid smoking and nicotine products.
  • Avoid scented soaps and bubble baths, which may cause irritation.

If penetrative sex is too painful, there are other ways to enjoy physical closeness with your partner, including outercourse and oral sex.

When to See a Healthcare Provider

If you experience pain with sex, it's important to speak to your healthcare provider. Pain with sex is not normal. Sometimes, relatively simple treatment options can reduce or even eliminate the source of pain.

See your healthcare provider if you experience other symptoms, like discharge, burning, fever, itching, or unexplained bleeding. This may indicate an infection or other problem that requires more immediate medical attention.

It's important to be properly evaluated for painful sex because symptoms may be related to more serious conditions or infections. Untreated painful intercourse is also associated with mental health issues like depression and anxiety.

Summary

Painful intercourse may occur for many different reasons. In some cases, treatment can be simple: more foreplay, over-the-counter lubricants, and antibiotics can clear up many routine problems. In other cases, treatment can be more involved. Conditions like endometriosis, PCOS, menopause-related changes, or past sexual trauma may require more support from healthcare providers specializing in sexual health.

A Word From Verywell

Painful sex isn't normal, and you don't have to suffer. If you experience pain with intercourse, speak to your healthcare provider about your symptoms. Though this topic can be embarrassing or distressing for some, it's important to know that healthcare providers are trained to protect your privacy and treat all questions professionally.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Elizabeth Morrill, RN
Elizabeth Morrill is a former ER nurse and current nurse writer specializing in health content for businesses, patients, and healthcare providers. Her career has spanned the globe, from Bosnia-Herzegovina to Colombia to Guatemala. You can find her online at www.emfreelancing.com.