Painful sex, known medically as dyspareunia, affects around 1 in 13 sexually active women in the UK at any one time, and many more at some point in their lives. Many women stay silent about it, or are told simply to relax. Pain during sex has a cause, and most causes can be treated.
Where Does It Hurt?
Where you feel the pain is a useful clue.
Pain at the entrance to the vagina when penetration starts is often linked to dryness or skin conditions, or to vulvodynia or vaginismus, which are explained below
Deep pain, felt inside the pelvis, is more often linked to conditions inside the pelvis such as endometriosis
Common Causes
Vaginal dryness. Low oestrogen makes the vaginal tissue drier and more fragile. This happens after menopause and also while breastfeeding, and some women find certain hormonal contraceptives affect lubrication too. Our article on vaginal dryness after menopause covers treatment in detail.
Vaginismus. This is when the muscles around the vagina tighten on their own as penetration is attempted, making it painful or impossible. It is a reflex you cannot control at will. It often develops after a painful or difficult experience, although sometimes there is no clear trigger.
Vulvodynia. Vulvodynia means ongoing pain in the vulva, the outer genital area, for at least three months, with no visible cause such as an infection or skin condition. It often feels like burning or stinging. The pain is real and is thought to involve oversensitive nerves in the area.
Endometriosis. Endometriosis, where tissue similar to the womb lining grows elsewhere in the pelvis, commonly causes deep pain during sex, often worse around a period.
Infections and skin conditions. Infections such as thrush, and skin conditions such as lichen sclerosus, which causes itchy white patches on the vulva, can both make sex painful.
After birth. Pain in the months after birth is common, often from healing tissue or the low oestrogen levels that come with breastfeeding. It should improve with time, and if it has not, it is worth having it checked.
What Helps
Treatment depends on the cause, so a proper examination is the first step. Options include:
Lubricant during sex, and a regular vaginal moisturiser if dryness is a problem
Pelvic health physiotherapy to relax tight muscles. This sometimes includes vaginal dilators, smooth cone-shaped devices in increasing sizes that help the muscles relax step by step
Treating any infection or skin condition
Psychological or sex therapy, which can break the cycle where expecting pain makes the muscles tighten and the pain worse
Specialist care for endometriosis
Many women keep having sex through pain, which can make the problem worse over time as the body learns to expect it. Pausing and seeking help is the better route, and a partner can be part of that conversation.
If sex hurts, you deserve a proper examination and a plan for treatment.