Is Pain During Sex Normal?
Pain during intercourse is common — nearly 75% of women report having had painful sex at some point. However, frequent and lasting pain during sex should not be considered normal. Long-term pain with sex could indicate a gynecological problem, problems with your body's sexual response, or disinterest in sex.
Medical professionals refer to painful sex as dyspareunia. Dyspareunia can be felt inside or outside your reproductive tract before, during, or after sex. If your sexual pain is severe or persists, it's important to tell your partner and see a doctor.
What Causes Painful Vaginal Intercourse?
Vaginal atrophy
This happens when the lining of your vagina gets thinner and drier. The condition is common during perimenopause and menopause when estrogen levels drop, but younger people may experience it after cancer treatment or removal of their ovaries.
Urethritis and urethral syndrome
Urethritis is an inflammation of the urethra, the tube that carries urine from your bladder. The causes of urethral syndrome, irritation of the urethra, are unknown, but hormonal changes, injury, and sexually transmitted diseases (STDs) are suspected culprits. Anyone can get urethral syndrome, but it is more common in women and people assigned female at birth (AFAB). Both conditions cause a range of symptoms including painful intercourse.
Inadequate lubrication
If you have pain when your partner penetrates you, it may be due to insufficient lubrication. You may need more stimulation at the start of sex, or your pain may be the result of lower estrogen levels after giving birth, during breastfeeding, or in menopause. Some medications, such as antihistamines, birth control pills, high blood pressure drugs, and antidepressants can decrease lubrication as well.
Vaginismus
Vaginismus occurs when the muscles in your vagina involuntarily contract upon penetration. These muscle spasms can range from mild to severely painful. Vaginismus pain can be made worse by a bladder, yeast, or urinary tract infection.
Vaginal stricture
Vaginal stricture, also called vaginal stenosis, is the result of scar tissue in the vagina, usually caused by surgery, radiation therapy in the pelvic area, or childbirth. Scar tissue, which is stiffer than normal tissue and has less "give," shortens and narrows the vaginal canal, making intercourse painful.
Interstitial cystitis
Interstitial cystitis is inflammation and irritation of the wall of the bladder. The cause is unknown, but certain acidic, spicy, or potassium-rich foods along with caffeinated and carbonated beverages and alcohol can worsen symptoms such as dyspareunia.
Endometriosis
With endometriosis, tissue similar to the lining of the uterus attaches to the outside of pelvic organs including the uterus, ovaries, and fallopian tubes. Growths from endometriosis tissue can irritate nearby organs and tissue, resulting in scarring. Endometriosis commonly triggers pain during or after sex.
Vulvovaginitis
Vulvovaginitis is irritation of the vulva and vagina that can be the result of fungal and bacterial infections or skin disease. In addition to discharge, itching, and odor, vulvovaginitis also causes pain with sex.
Pelvic adhesions
Adhesions are scar tissue that can develop as a result of pelvic surgery, pelvic inflammatory disease (PID), or endometriosis. If the scarring becomes too thick, it can lead to pain during sex.
Ovarian cysts
Ovarian cysts are growths that form in or on your ovaries, the pelvic organs that contain eggs and produce the hormones estrogen and progesterone. Normally painless and benign, one of the symptoms you may have from an ovarian cyst is painful sex.
Pelvic inflammatory disease (PID)
Most commonly the result of untreated sexually transmitted infections, PID is a severe infection of your reproductive system — the ovaries, uterus, and fallopian tubes. At first, the symptoms of PID may be mild or not noticeable, but pain during sex is one of them.
Uterine prolapse
Uterine prolapse is a condition in which the tissue and ligaments holding the uterus in the abdominal cavity collapse and cause your uterus to drop into the vaginal canal. Age is a risk factor for uterine prolapse as is more than one vaginal delivery. The further your uterus falls into your vagina, the more likely you are to feel symptoms such as pain during sex.
Retroversion of the uterus
Commonly referred to as a "tipped" uterus, retroversion of the uterus occurs when the organ tilts backward not forward. Pelvic adhesions or scarring sometimes causes the condition, which is usually symptomless. However, during sex the penis can bump up against the tilted reproductive organs, which can hurt. Sexual positions where the woman or person AFAB is on top typically cause more pain, and uterine ligaments may be injured or torn during particularly energetic sex.
Medical Treatment for Painful Vaginal Intercourse
Treatment of pain during intercourse depends on the cause and when and where you feel pain. Dyspareunia treatment for deep thrust pain includes two strategies:
- Checking for pelvic adhesions (tissue that has become stuck together, sometimes developing after surgery) that may cause pain with intercourse and surgically removing them.
- Checking for ovarian cysts, pelvic inflammatory disease, endometriosis, uterine prolapse, or retroversion of the uterus (where the uterus tilts backward instead of forward). Pain at initial penetration may be treated when the cause is identified.
Other treatments for painful sex include the following:
Lubricants
Treatment of inadequate lubrication depends on the cause. Treatment options include water-soluble lubricants (for use with condoms; other types of lubricants may damage condoms) or other substances such as vegetable oils. If arousal does not take place, more extensive foreplay might be needed before sex.
Hormone replacement therapy
Entrance pain caused by atrophy is common among postmenopausal women who do not take hormone replacement medication. Blood flow, lubrication, and tissue thickness and elasticity respond directly to hormone replacement. The fastest relief of atrophy comes from applying topical estrogen vaginal cream directly to the vagina and its opening. This cream is available by prescription only. Over-the-counter lubricants and moisturizers can also be helpful. An oral drug taken once a day, ospemifene (Osphena), makes vaginal tissue thicker and less fragile, resulting in less pain for women during sex. The FDA warns that Osphena can thicken the endometrium (the lining of the uterus) and raise the risk of stroke and blood clots.
Estrogen is sometimes used to treat vaginal strictures as well.
Antibiotics
Your doctor may prescribe low-dose antibioticsfor urethritis and urethral syndrome. Vulvovaginitis stemming from an infection such as chlamydia, an STD, or a urinary tract infection calls for antibiotic treatment as well.
Antidepressants
Antidepressants are regularly used to treat chronic pain conditions such as interstitial cystitis as well as conditions such as urethritis and urethral syndrome that have symptoms such as the frequent or urgent need to pee in addition to painful intercourse.
Vaginal relaxation exercises
If you have vaginismus, a physical therapist can show you how to relax the muscles in your pelvis to ease pain during sex.
Surgery
If you have vaginal stricture, you may have a type of surgery called vaginoplasty to remove excess or scar tissue. Vaginal adhesions can be treated with laparoscopic or traditional surgery. Discuss with your doctor the risks and benefits of this surgery for vaginal adhesions, as around 70% of the time, additional adhesions may develop.
Cystoscopy
If your doctor suspects you have interstitial cystitis (IC), they may use an instrument called a cystoscope to examine the inside of your bladder and urethra. During the procedure, your doctor may stretch the bladder to examine the bladder wall. Doctors are unsure why this sometimes eases the symptoms of IC but think it may be due to increased bladder capacity or disruption of pain signals in the bladder.
Prescription medication
Medicines such as amitriptyline (Elavil), nifedipine (Procardia), pentosan polysulfate sodium (Elmiron), or other prescription drugs can be used to treat pain caused by interstitial cystitis.
Bladder washing
In this procedure (also called bladder instillation), doctors fill your bladder with a medical solution for a period ranging from a couple of seconds to 15 minutes. This is done to either coat the bladder with a protective layer or treat the inflammation of interstitial cystitis.
Transcutaneous electric stimulation (TENS)
This procedure uses mild electrical impulses to ease pelvic pain such as that caused by interstitial cystitis. Doctors are unsure how it works, but it's thought that TENS may improve blood flow to the bladder or release materials that block pain.
Acupuncture
Also used for interstitial cystitis, studies have shown that acupuncture can significantly lessen the pain of interstitial cystitis as well as other symptoms.
Get tested for sexually transmitted infections (STIs)
Treatment of STIs, such as herpes or genital warts, may ease the pain you feel during sexual intercourse. Use protection when you have sex and practice good hygiene.
Home Remedies for Painful Intercourse
Applying lubricating gels to the outer sexual organs, including the vulva and labia, and in the vagina, may be helpful to women and ease pain during intercourse. Intercourse position changes may also help. Sex toys, such as vibrators, may also be useful. A woman should talk with her health care provider before using a vaginal dilator.
Alternatives to Penetrative Sex
If sex is too painful or you are healing from a condition that causes painful sex, there are still ways for you and your partner to engage in sexual intimacy without vaginal penetration. Other ways and methods of sexual pleasure include massage, masturbating together, manual stimulation with a hand or finger, and oral sex. You and your partner should experiment with the kinds of touch that bring sexual pleasure and ease stress as well.
Takeaways
Many people experience painful sex, also known as dyspareunia, at some time in their sexual lives. You may only feel pain upon entry of a penis or even a tampon (penetration) or when your partner thrusts. The pain may be fleeting or severe and may linger hours after sex. If your sexual pain is ongoing or interfering with your sex life, talk to a doctor, who can examine you and perform other diagnostic tests to uncover the source of your pain.
Painful Vaginal Intercourse FAQs
What role do hormonal changes play in painful sex?
In perimenopause, the period that precedes menopause, levels of the reproductive hormone estrogen begin to drop. Estrogen is the hormone that keeps your vaginal lining thick and moist. It's this drop in estrogen that leads to classic menopausal symptoms including vaginal dryness, when the lining of your vagina dries and thins (vaginal atrophy). Vaginal atrophy is one cause of painful sex.
How effective are different treatment options for easing pain during sex?
Because pain before, during, and after sex can have multiple causes, there are many ways to treat it. The more candid you are with your doctor about where your pain is located, how often it occurs, how long you've had had it, how the pain feels, and even what medications you're taking, the more likely they'll arrive at an effective diagnosis and treatment plan for you.
Are there lifestyle changes or self-care techniques that can help?
There are some measures you can try on your own to see if they lessen pain during sex, including:
- Position changes: If your partner's thrusting causes pain, try another position such as on top, where you can control how deep your partner penetrates.
- Lubrication: Try a lubricant for more comfort if you think your pain is due to vaginal dryness.
- Increase foreplay: Engage in foreplay until you're fully aroused and your body is naturally lubricated. Penetration at full arousal may ease pain too.
- Talk to your partner: Tell them what hurts and what feels pleasurable. Tell them if they need to go slower.
- Pelvic floor exercises: Toning your pelvic floor muscles may reduce dyspareunia caused by poor muscle tone or relax tense muscles.
