Painful Sex

Upset couple

How common is painful sex? 

Pain during intercourse is very common-nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem.

What causes pain during sex? 

Pain during sex may be a sign of a gynecologic problem, such as ovarian cysts or endometriosis. Pain during sex also may be caused by problems with sexual response, such as a lack of desire (the feeling of wanting to have sex) or a lack of arousal (the physical and emotional changes that occur in the body as a result of sexual stimulation).

Where is pain during sex felt? 

You may feel pain in your vulva, in the area surrounding the opening of your vagina (called the vestibule), or within your vagina. The perineum is a common site of pain during sex. You also may feel pain in your lower back, pelvic region, uterus, or bladder.

When should I see a health care provider about painful sex?

If you have frequent or severe pain during sex, you should see a health care provider. It is important to rule out gynecologic conditions that may be causing your pain. Your health care provider also can help you address problems with sexual response.

What causes sexual response problems?

The following reasons are among the most common:

  • Your state of mind-Emotions such as fear, guilt, shame, embarrassment, or awkwardness about having sex may make it hard to relax. When you cannot relax, arousal is difficult, and pain may result. Stress and fatigue can affect your desire to have sex.
  • Relationship problems-Problems with your partner may interfere with your sexual response. A common relationship issue is a mismatch between partners in their level of desire for sex.
  • Medications-Many medications can reduce sexual desire, including some birth control methods and antidepressants. Many pain medications also can reduce sexual desire.
    • Medical and surgical conditions-Some medical conditions can indirectly affect sexual response. These conditions include arthritis, diabetes, cancer, and thyroid conditions. Some women who have had surgery find that it affects their body image, which may decrease their desire for sex.
    • Your partner-If your partner has a sexual problem, it can make you anxious about sex. If your partner is taking a drug for erectile dysfunction, he may have delayed orgasm, which can cause long, painful intercourse.

What kinds of gynecologic conditions can cause pain during sex?

Pain during sexual intercourse can be a warning sign of many gynecologic conditions. Some of these conditions can lead to other problems if not treated:

  • Skin disorders-Some skin disorders may result in ulcers or cracks in the skin of the vulva. Contact dermatitis is a common skin disorder that affects the vulva. It is a reaction to an irritating substance, such as perfumed soaps, douches, or lubricants. It may cause itching, burning, and pain. Treatment of skin disorders depends on the type of disorder.
  • Vulvodynia- This is a pain disorder that affects the vulva. When pain is confined to the vestibule (the area around the opening of the vagina), it is known as vulvar vestibulitis syndrome (VVS). There are many treatments available for vulvodynia, including self-care measures. Medication or surgery may be needed in some cases.
  • Hormonal changes-During perimenopause and menopause, decreasing levels of the female hormone estrogen may cause vaginal dryness. Hormone therapy is one treatment option. Using a lubricant during sex or a vaginal moisturizer also may be helpful.
  • Vaginitis-Vaginitis, or inflammation of the vagina, can be caused by a yeast or bacterial infection. Symptoms are discharge and itching and burning of the vagina and vulva. Vaginitis can be treated with medication.
  • Vaginismus-Vaginismus is a reflex contraction (tightening) of the muscles at the opening of your vagina. Vaginismus may cause pain when you try to have sexual intercourse. Vaginismus can be treated with different forms of therapy.
  • Childbirth-Women who have had an episiotomy or tears in the perineum during childbirth may have pain during sex that may last for several months. Treatments include physical therapy, medications, or surgery.
    • Other causesPelvic inflammatory disease, endometriosis, and adhesions are all associated with pain during sex.

What can I expect when I see my health care provider about pain during sex?

Your medical and sexual history, signs and symptoms, and findings from a physical exam are important factors in determining the cause of your pain. Sometimes, tests are needed to find the cause. A pelvic exam or ultrasound exam often gives clues about the causes of some kinds of pain. Further evaluation, sometimes involving a procedure called a laparoscopy, may be needed.

You also may be asked about medications that you are taking, whether you have any medical conditions, and past events that may affect how you feel about sex, such as sexual abuse. Other health care providers may be consulted for further evaluation and treatment, such as a physical therapist or a dermatologist (a specialist in diseases of the skin).

Are there things a woman can do on her own to help with pain during sex?

If you have pain during sex, see a health care provider. However, there are some self-help measures you can try to relieve pain during sex:

  • Use a lubricant. Water-soluble lubricants are a good choice if you experience vaginal irritation or sensitivity. Silicone- based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break.
  • Make time for sex. Set aside a time when neither you nor your partner is tired or anxious.
  • Talk to your partner. Tell your partner where and when you feel pain, as well as what activities you find pleasurable.
    • Try sexual activities that do not cause pain. For example, if intercourse is painful, you and your partner may want to focus on oral sex or mutual masturbation.
    • Try nonsexual, but sensual, activities like massage.
      • Take pain-relieving steps before sex: empty your bladder, take a warm bath, or take an over-the-counter pain reliever before intercourse.
      • To relieve burning after intercourse, apply ice or a frozen gel pack wrapped in a small towel to the vulva.