Pain During Sex: The Real Reasons and What You Can Do
You tense up before it even starts. Or you push through hoping it will get better. Or you have quietly started avoiding sex altogether because the pain is not worth it and you feel guilty about that, too. Maybe you have mentioned it to a doctor and been told to "just use more lubricant." Maybe you have never mentioned it at all because you assumed it was just how things are for you.
Pain during sex medically called dyspareunia is one of the most common and most under-reported symptoms in women's health. Studies suggest that up to 75% of women experience painful sex at some point in their lives, and a significant number deal with it on an ongoing basis. Yet it remains one of the most dismissed, minimized, and under-investigated complaints women bring to healthcare appointments.
Pain during sex is not normal. It is common but common and normal are not the same thing. And more importantly, it almost always has a cause. A real, identifiable, treatable cause.
This post covers the most important reasons sex can be painful, what each one feels like, and what you can actually do about it.
Two Main Types of Pain During Sex
Understanding where and when the pain occurs helps narrow down the cause significantly.
Superficial or entry pain (dyspareunia)
Pain at or near the vaginal opening during attempted penetration. Often described as burning, stinging, tearing, or rawness.
Deep pain
Pain felt deeper in the pelvis during penetration, thrusting, or certain positions. Often described as pressure, aching, cramping, or a sharp internal pain.
Some women experience both. The location of pain is one of the most useful pieces of information you can give a provider.
Common Causes of Pain at the Vaginal Opening
Vaginal Dryness and Insufficient Lubrication
One of the most common and easily addressed causes of entry pain is insufficient lubrication. When the vagina is not adequately lubricated, friction during sex causes burning, tearing, and rawness.
Causes of dryness and insufficient arousal lubrication include:
Hormonal changes low estrogen from menopause, perimenopause, postpartum, or breastfeeding.
Certain birth control pills that lower estrogen or testosterone.
Antidepressants and antihistamines, which can reduce natural lubrication.
Not enough arousal time before penetration.
Stress and anxiety, which suppress the physical arousal response.
Using a high-quality, body-safe lubricant can make an immediate difference. Water-based lubricants are safe with condoms and most toy materials. Silicone-based lubricants last longer and are excellent for vaginal dryness. Avoid anything with glycerin, fragrances, or warming agents, which can irritate sensitive tissue.
Vulvodynia
Vulvodynia is chronic vulvar pain with no identifiable cause no infection, no skin disease, no visible reason for the pain. It is estimated to affect up to 16% of women at some point in their lives, making it far more common than most people realize.
Types of vulvodynia include:
Generalized vulvodynia pain throughout the vulvar area, not specifically triggered by touch.
Vestibulodynia (formerly vulvar vestibulitis) pain specifically at the vaginal entrance, almost always triggered by touch or pressure. This is the most common type and the one most often associated with painful sex.
Vulvodynia pain is typically described as burning, stinging, rawness, or a knife-like sensation. It can be constant or triggered only by contact.
Treatment options include pelvic floor physical therapy, topical medications, nerve blocks, cognitive behavioral therapy, and in some cases surgical procedures. Working with a specialist in vulvar disorders is important.
Vaginismus
Vaginismus is an involuntary spasm or tightening of the pelvic floor muscles around the vaginal opening in response to attempted penetration. The muscles contract protectively often in anticipation of pain making penetration painful, difficult, or impossible.
Vaginismus can be:
Primary present since the first attempt at penetration.
Secondary developing after a period of pain-free sex, often after a traumatic experience, infection, or other trigger.
Treatment for vaginismus almost always involves pelvic floor physical therapy, gradual desensitization with dilators, and often psychological support to address the anxiety and anticipatory pain response that develops over time.
Vaginal Infections
Active vaginal infections BV, yeast, trichomoniasis, or STIs can cause significant pain, burning, and irritation during sex. Inflamed, irritated vaginal tissue is much more sensitive to friction.
If pain during sex is new and came on suddenly, a vaginal infection should always be ruled out first. This is the quickest and most straightforward cause to diagnose and treat.
Skin Conditions of the Vulva
Several skin conditions affect the vulva and can cause significant pain during sex:
Lichen sclerosus a chronic skin condition that causes thinning, whitening, and scarring of vulvar skin; can make penetration extremely painful; requires diagnosis and treatment with topical steroids.
Lichen planus an inflammatory skin condition that can affect the vulva and vagina.
Contact dermatitis rritation or allergic reaction to products like soaps, lubricants, laundry detergent, or condom materials.
Vulvar skin conditions are often missed or misdiagnosed as recurrent yeast infections for years. If you have persistent vulvar pain, burning, or visible skin changes, a referral to a dermatologist or vulvar specialist is worth requesting.
Common Causes of Deep Pain During Sex
Endometriosis
Endometriosis is one of the most common and most underdiagnosed causes of deep pelvic pain during sex. It occurs when tissue similar to the uterine lining grows outside the uterus on the ovaries, fallopian tubes, bladder, bowel, and other pelvic structures.
Deep pain with sex, particularly in certain positions or around ovulation and menstruation, is a hallmark symptom. The pain is often described as deep, aching, or sharp sometimes accompanied by significant pelvic heaviness after sex.
Endometriosis affects an estimated 1 in 10 women of reproductive age and takes an average of 7–10 years to diagnose. If you have deep pain with sex plus painful, heavy periods, this diagnosis is worth pursuing.
Pelvic Inflammatory Disease (PID)
Active or previous PID can cause deep pelvic pain during sex, particularly if scarring or adhesions have formed in the pelvis. Even after treatment, some women experience ongoing deep pain from the structural changes caused by PID.
Ovarian Cysts
Ovarian cysts fluid-filled sacs on the ovaries can cause deep, sometimes sharp pelvic pain during sex, especially in certain positions that put pressure on the ovary. Most ovarian cysts resolve on their own, but persistent pain warrants evaluation.
Uterine Fibroids
Fibroids are non-cancerous growths in or on the uterine wall. Depending on their size and location, they can cause deep pelvic pressure or pain during penetration and thrusting.
Pelvic Floor Dysfunction
Tight, hyperactive pelvic floor muscles can cause both entry and deep pain during sex. The pelvic floor is a group of muscles that supports the uterus, bladder, and bowel. When these muscles are chronically tense which can happen due to stress, trauma, injury, or simply learned guarding patterns they can make penetration painful and cause internal pressure or aching during sex.
Pelvic floor physical therapy is one of the most effective treatments available for this type of pain and is appropriate for women at any age.
The Psychological Component of Pain During Sex
It is important to acknowledge that pain during sex has a real psychological dimension not because the pain is "in your head," but because the anticipation of pain creates a very real physical response.
When sex has been painful repeatedly, the body learns to protect itself. Muscles tighten, lubrication decreases, and anxiety builds before sex even begins. This is a normal protective response but it makes the pain worse over time.
Addressing this cycle often requires working simultaneously on:
The physical cause of the pain.
The pelvic floor muscle response.
The psychological and relational impact.
Sex therapy, couples counseling, and trauma-informed therapy can all play a meaningful role alongside physical treatment.
What You Can Do Right Now
While you are working toward a diagnosis and treatment plan, a few things can help immediately:
Use lubricant generously. Even if dryness is not your primary issue, added lubrication reduces friction and can reduce pain significantly.
Spend more time on arousal before penetration. Natural lubrication and vaginal expansion (called "vaginal tenting") take time and increase with arousal.
Experiment with positions. Some positions create less pressure on tender areas. Shallow penetration positions may reduce deep pain.
Communicate with your partner. Your partner cannot help manage the situation if they do not know what is happening.
Stop when it hurts. Pushing through pain repeatedly reinforces the pain-fear-tension cycle and can make the underlying condition worse.
When to See a Provider
See a healthcare provider about painful sex if:
Pain is new or has gotten significantly worse.
Pain is happening consistently, not just occasionally.
You have other symptoms like unusual discharge, bleeding, pelvic pain outside of sex, or heavy periods.
Pain is affecting your relationship, mental health, or quality of life.
You have been told "everything looks normal" but the pain continues.
You are allowed to seek a second opinion. You are allowed to ask for a referral to a pelvic floor physical therapist, a vulvar specialist, or a gynecologist with expertise in endometriosis or pelvic pain. You deserve care that takes your pain seriously.
“This article is based on current medical guidance and research from the following trusted sources:”
Resources & Sources
American College of Obstetricians and Gynecologists (ACOG) When Sex Is Painful -
acog.org
Mayo Clinic — Painful intercourse (dyspareunia) -
mayoclinic.org/diseases-conditions/painful-intercourse
National Vulvodynia Association Understanding Vulvodynia -
nva.org
Endometriosis Foundation of America Endometriosis and Painful Sex -
endofound.org
National Institutes of Health (NIH) / PubMed Dyspareunia and pelvic floor dysfunction research -
pubmed.ncbi.nlm.nih.gov
Cleveland Clinic Dyspareunia (Painful Sex): Causes and Treatment -
clevelandclinic.org
Have you ever been dismissed when you brought up pain during sex? Share your experience in the comments. Every woman who speaks up makes it easier for the next one to do the same.
Author
Becky Freeman is the founder of BVTalks® and Bee Vee Clean. She focuses on women’s intimate health, vaginal microbiome education, and creating practical, easy-to-understand content for everyday care.
Disclaimer: This post is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider for diagnosis and treatment.
