Painful Sex

What painful sex feels like

Pain during sex can feel different depending on the cause. It may be an ache, a burning sensation, or a sharp pain. You may have pain externally, at the opening of your vagina, or along the walls of the vagina.

It can happen during genital touching, at the beginning of penetration, or during or after intercourse. Other symptoms may include muscle spasms, pelvic cramping, and muscle tightening.

Is sex more painful when you’re ovulating?

Some women have pain during sex when they ovulate. During ovulation, the ovary releases an egg, which can cause a sharp pain on one side of the pelvis. Having sex while this is happening may make the pain worse. Fortunately, ovulation pain usually gets better in a day or two.

Painful sex in men

Painful sex occurs in 1–5% of men (compared to about 20% of women during their lifetime). Symptoms include pain with ejaculation (felt in the penis or testicles), a burning sensation, and chronic pelvic pain. Causes include sexually transmitted infections, prostatis (inflammation of the prostate), scar tissue from previous traumas or infections, and skin conditions like lichen sclerosus.

Common causes

1. Vulvodynia

Vulvodynia is constant pain around the opening of the vagina (vulva) that lasts for 3 months or longer. The pain is severe and can make it very difficult to have sex. It may be triggered by damaged or sensitive nerves near the vulva, inflammation of the vulva, or issues with the pelvic floor muscles. The causes are not well understood, but current theories suggest that an infection or trauma may lead to inflammation.

Common: Vulvodynia is the most common cause of pelvic pain in women [Source: Journal of Sexual Medicine].

Other symptoms you may have:

• Burning sensation of the vulva
• Itching
• Swelling

Treatment and urgency: An ob/gyn can help you treat the problem. There are several types of treatment:

• Pelvic floor physical therapy
• Cognitive behavioral therapy (CBT)
• Trigger point therapy
• Medications such as hormone creams, local anesthetics, and antidepressants

2. Vaginal atrophy

Vaginal atrophy, or atrophic vaginitis, is thinning, dryness, and inflammation of the walls of the vagina. It occurs when levels of estrogen drop. This can be caused by menopause, breastfeeding, surgical removal of the ovaries, and certain types of cancer treatments. Women who smoke or have never given birth vaginally are at greater risk of it.

Common: Vaginal atrophy is the most common cause of pain with sex for postmenopausal women.

Other symptoms you may have:

• Vaginal burning
• Watery discharge
• Burning when you urinate
• Urinary incontinence and urgency
• Increased urinary tract infections
• Light bleeding after intercourse
• Shortening and tightening of the vaginal canal

Treatment and urgency: See an ob/gyn right away. Treatment includes OTC vaginal moisturizers (Replens, K-Y liquibeads) and lubricants (K-Y Jelly, Astroglide). If these treatments don’t help, your doctor may suggest:

• Vaginal estrogen, such as creams or suppositories
• Estrogen pills or patches
• Non-estrogen vaginal inserts (Osphena)
• Oral medication for moderate to severe vaginal atrophy (Intrarosa)

3. Vaginal infections

Bacterial or yeast infections cause vaginal inflammation, which can make sex painful. Examples of bacterial infections are sexually transmitted disease (chlamydia, gonorrhea) and bacterial vaginosis.

Common: More than 9 million women in the U.S. get an STD each year, while 3 out of 4 women will have a yeast infection at some point in their lifetime. [Sources: U.S. Department of Health & Human Services; U.S. Department of Health & Human Services].

Other symptoms you may have:

• Vaginal discharge
• Itching
• Burning
• Foul odor

Treatment and urgency: See an ob/gyn right away. Treatment is based on the type of infection you have and may include antibiotics (for bacterial infections) or antifungal creams and tablets. You can help lower your chance of getting certain infections by practicing safe sex, not douching, and avoiding scented soaps and bubble baths.

4. Vaginismus

Vaginismus is an involuntary tightening of the muscles at the vaginal opening. It causes pain when you try to have sex and may prevent penetration. It’s not known why some women get vaginismus, but some research shows that anxiety disorders, childbirth injuries, and prior surgery may contribute to it. Fear of sex or negative feelings about sex, possibly caused by past sexual abuse or rape, can also play a role.

Uncommon

Other symptoms you may have:

• Loss of sexual desire
• Unable to have a pelvic exam or insert a tampon

Treatment and urgency: See an ob/gyn. There are several ways to treat vaginismus, including:

• Pelvic floor physical therapy
• Vaginal dilators
• Cognitive behavioral therapy
• Sex therapy
• Medications like topical pain relief creams

5. Pregnancy

Some couples avoid sex during pregnancy for fear of harming the pregnancy, but most women can safely continue to have sex while pregnant. As the uterus grows and the body changes, some women may also have back and pelvic pain that can make sex uncomfortable.

Common: About 21% of pregnant women report feeling pain during sex [Source: Journal of Sexual Medicine].

Other symptoms you may have: Vaginal bleeding (due to the increase in blood flow that occurs during pregnancy.)

Treatment and urgency: Talk to your ob/gyn if sex causes pain while pregnant. If sex causes heavy bleeding, call your doctor right away. Trying different sexual positions may help, since your growing uterus can make it harder to feel comfortable in certain positions. You can also ask your ob/gyn if it’s OK to use a lubricant.

6. Painful sex after life events

Several life events and experiences can make sex feel uncomfortable for some women. They may also affect your self-image and desire to have sex. How you feel about yourself, your relationship, and your partner can also make sex uncomfortable. Some life events include:

• Childbirth. Sex can be painful for weeks to months after a vaginal delivery, especially if you’ve had some tearing of the vagina.
• Cesarean section. Sex may feel painful while you recover.
• Abortion, which requires some recovery time.
• Breastfeeding, which can cause vaginal dryness.

Treatments

While you may feel embarrassed talking about painful sex, it’s important to tell your doctor about it. Some causes of painful sex, like STDs, can lead to serious complications, including infertility, if they are left untreated for a long period of time.

Your doctor will suggest treatments based on your symptoms. Many women find that combining several different treatments has the best results.

• Vaginal moisturizers, lubricants, or hormone therapy for pain caused by vaginal dryness.
• Pelvic floor physical therapy, which helps retrain the muscles of the pelvis. It can be very helpful for treating vulvodynia.
• Sex therapy for vaginismus
• Vaginal dilators, which work especially well at treating vaginismus and vaginal atrophy
• Cognitive behavioral therapy for vaginismus and vulvodynia
• Treating the underlying cause, like antibiotics for STDs
• Estrogen treatments and other medications, like Osphena and Intrarosa, for vaginal atrophy
• Some people also find it comforting to learn about their body and how it works. If you have a partner, talking to them about your concerns and what you like sexually can help you avoid or lessen pain.

FAQs about painful sex

What causes stomach pain during sex?

In women, abdominal pain during sex can be caused by endometriosis, fibroids, or infections. If you’re having penetrative sex, pressure on the cervix can feel painful.

Endometriosis is when tissue from the lining of the uterus travels to other areas of the body. This tissue grows and shrinks with the menstrual cycle causing pain wherever it is located. Fibroids can also cause pain in the uterus that can be felt during sex.