10 causes of painful sex and what to do about them

Experiencing pain during sex is more common than many people realize, yet it remains a topic with a lot of stigma. Oftentimes, folks–especially those socialized as girls–are taught to expect pain as a part of sex. Because of this, many people are hesitant to speak up when something doesn’t feel right. We’re here to tell you, sex should feel good!

Pain during sex, also known as dyspareunia, can be caused by conditions such as vulvodynia, vaginismus, and sexually transmitted infections (STIs). Each of these conditions involves complex physical and psychological factors, but they are treatable. Understanding the cause of pain during sex and seeking treatment can help you take back your sexual health and well-being. 

The bottom line? Sex shouldn’t hurt. Here are 10 common causes of pain during sex and what you can do to feel better.

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1. Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs), such as herpes, chlamydia, and gonorrhea, can cause painful sex due to sores and inflammation. Herpes, in particular, results in painful blisters and sores in the genital area. While there is no cure for herpes yet, antiviral medications can shorten how long an outbreak is and how frequently you have them. For bacterial STIs like chlamydia and gonorrhea, antibiotics are effective treatments. Practicing safe sex and getting regular STI screenings are crucial for prevention and early detection.

2. Vulvodynia

Vulvodynia is chronic (long-term) pain around the vulva without a clear reason, and can include burning or stinging. This condition can make daily activities, including sex, extremely painful. Vulvodynia is usually a symptom of something else, and may be caused by nerve damage, hormonal changes. or skin conditions. Finding an ISSWSH provider can help you determine the source of your pain as they specialize in sexual health and have extensive training on the best treatments for sexual pain and dysfunction. Treatment options may include medication, physical therapy, changing your diet, and counseling from a sex-positive mental health professional. 

3. Vaginismus

Vaginismus happens when the muscles in the vagina spasms spontaneously, making penetrative sex painful or even impossible. This condition is often linked to psychological factors such as anxiety, fear, or past trauma related to sex. For many individuals, the pain of vaginismus creates a cycle of anticipation and anxiety, which can make the muscle spasms worse. 

Treatment for vaginismus includes a combination of approaches. Sex therapy can help address anxiety and trauma surrounding sex. Pelvic floor physical therapy teaches techniques to relax the pelvic muscles. Vaginal dilators can help individuals gradually become more comfortable with penetration. With the right support and treatment, many people with vaginismus enjoy a fulfilling and enjoyable sex life​.

4. Vaginal dryness

Vaginal dryness can be caused by hormonal changes like menopause, breastfeeding, certain medications (including birth control, cold and allergy medications, and antibiotics), or lack of arousal. This lack of natural lubrication can cause friction and pain or discomfort during sex. Many people feel embarrassed when they feel aroused but don’t have enough vaginal lubrication, but you’re not alone! Vaginal dryness affects up to one-third of people with vaginas (and is even more common among postmenopausal people).

Over-the-counter lubes and vaginal moisturizers can provide immediate relief, while hormone replacement therapy may help people during and after menopause. Before penetrative sex, encourage your partner(s) to spend more time on foreplay, paying special attention to erogenous zones like your nipples, inner thighs, ears, or anywhere that feels sensual to you to increase vaginal lubrication. A sex therapist may be able to help you work through any fears or anxieties that stand in the way of your most pleasurable sex. 

Remember, lube is your friend! Studies show that even if you don’t have vaginal dryness, using lube can increase your sexual satisfaction. Here are some tips for choosing the best lubricant for you.

Water-based lube

Water-based lube dries faster than other lubes, so you may need to reapply more frequently during sex. It is also:

• Condom compatible
• Silicone toy compatible
• Sensitive skin-friendly for most people*
• Not underwater friendly

*While water-based lube is friendly for most people with sensitive skin, it contains an ingredient called glycerin which can cause vaginal irritation in some people. Pro tip: always test a bit of product on your arm before you put it in or on your vagina to see if it causes irritation.

Silicone-based lube

Silicone lube sticks around, so you need soap and water to wash it off your body. It may also stain sheets and clothes and is:

• Condom compatible
• Not silicone toy compatible
• Sensitive skin friendly
• Underwater friendly

Oil-based lube

Oil-based lube may remain in the body and cause irritation, so it’s preferable for external use. It is also:

• Not condom compatible
• Not silicone toy compatible
• Not sensitive skin friendly
• Underwater friendly

Natural lubes (like coconut oil)

Coconut oil is thicker than traditional lubes, but you can mix a little water in to dilute it. Look for 100% coconut oil on the ingredients label, avoiding preservatives and additives. It is also:

• Not condom compatible
• Not silicone toy compatible
• Not sensitive skin friendly
• Underwater friendly

5. Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, causing pain, especially during sex. This tissue thickens, breaks down, and bleeds with each menstrual cycle, leading to inflammation and scarring. Treatments for endometriosis range from pain management and hormone therapies to surgery that reduces or removes endometrial growths. Early diagnosis and having a personalized treatment plan can significantly improve the quality of life for those with endometriosis.

6. Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection of the sexual organs, often caused by STIs like chlamydia or gonorrhea. PID can cause chronic (long-term) pelvic pain during sex due to inflammation and scarring. Symptoms include fever, unusual vaginal discharge, and painful urination. Early detection and antibiotic treatment are crucial to prevent severe complications such as infertility. Regular STI screenings, safe sex practices, and prompt medical attention can help manage and prevent PID.

7. Infections 

Infections including yeast infections, bacterial vaginosis, and urinary tract infections (UTIs) can lead to painful sex due to inflammation and irritation. Yeast infections cause thick, white discharge and intense itching, while bacterial vaginosis results in an unusual-smelling discharge and discomfort. UTIs cause burning during urination, frequent urges to urinate, and pelvic pain. Treatments include over-the-counter antifungals for yeast infections and antibiotics for bacterial vaginosis and UTIs. Over-the-counter pain relievers like ibuprofen can help manage UTI symptoms until the infection clears. If you have one of these infections, you can get treatment, with Hey Jane from the comfort and convenience of your phone. Just fill out our intake form online, and if you’re eligible for care, we’ll send your prescription to the local pharmacy of your choice for fast pick up.

8. Scarring or injury

Scarring or injury from surgeries, childbirth, or trauma can lead to painful sex due to less flexible scar tissue. Episiotomies (a surgical cut made at the opening of the vagina during childbirth), a birth using forceps, or tears during childbirth can cause significant scarring. Treatment options include physical therapy to improve tissue flexibility, surgical removal of scar tissue, and lubricants to reduce friction. 

9. Psychological factors

Psychological factors such as anxiety, depression, past trauma, and relationship problems can contribute to painful sex. Emotional health is closely linked to sexual well-being, and stress or unresolved mental health issues can manifest as physical pain during sex. Sex-positive counseling, sex therapy, kink exploration, and open communication with your partner(s) are all tools you can use to address these underlying issues and increase your pleasure during sex.

10. Fibroids

Fibroids are noncancerous growths in the uterus that can cause pressure and pain during sex. These benign tumors vary in size and number, leading to symptoms like heavy menstrual bleeding and pelvic pain. Treatments include hormonal medications, non-invasive procedures like uterine artery embolization, and surgical options such as myomectomy (a surgery to remove fibroids) or hysterectomy (a surgery to remove the uterus). Early diagnosis and treatment can manage symptoms and improve quality of life.Remember, sex does not have to involve penetration (for many folks, it doesn’t). If penetration causes pain or discomfort, explore external stimulation of the genitals and other erogenous zones with fingers, tongues, soft objects like feathers, or whatever feels good. If you enjoy penetration, but deep penetration causes pain, donut-shaped sex toys that sit around the base of a penis or dildo allow you to control the depth of penetration. Everyone deserves to have pleasurable sex free from pain, so don’t hesitate to make an appointment with a healthcare provider about how you can have safe, pain-free sex.