Painful Sex (Dyspareunia): Causes and Solutions
Understand why sex might hurt and what you can do about it. Medical and practical solutions.
When Sex Hurts (And What You Can Do About It)
Pain during sex is one of those things people often suffer through in silence. They assume it's normal, or they're embarrassed to bring it up, or they've mentioned it to a doctor who dismissed them.
So let's be clear: sex should not hurt. If it does, something is causing that pain, and in most cases, that something is fixable.
You don't have to accept pain as the price of intimacy. You deserve pleasure, not endurance.
Types of Pain
Pain during sex presents differently depending on the cause.
Entry pain happens right at penetration—that initial moment when something enters the vagina. It might feel like burning, stinging, or hitting a wall.
Deep pain happens with deeper penetration. It might feel like pressure, aching, or sharp stabbing sensations.
Pain after sex lingers once the activity is over. Burning, throbbing, or aching that continues for hours or even days.
Identifying which type you're experiencing helps narrow down the cause.
Common Causes: Lubrication Issues
The most common and most easily fixed cause of painful sex is inadequate lubrication.
This might happen because you're not fully aroused before penetration begins. Solution: more foreplay, slower progression, waiting until you're actually ready.
It might happen because of hormonal changes—menopause, breastfeeding, certain medications, birth control. Solution: lubricant, and potentially vaginal estrogen if dryness is severe and persistent.
It might happen because of dehydration or other systemic factors. Solution: drink more water, check whether medications might be contributing.
Lubricant is not a failure or a crutch. It's a tool. Use it generously.
Vaginismus: When Muscles Won't Relax
Vaginismus is an involuntary tightening of the vaginal muscles that makes penetration painful or impossible. It's like the body has decided that nothing's getting in, regardless of what your brain wants.
It can be primary, present from the first attempt at penetration, or secondary, developing after a period of pain-free sex. It often has a psychological component—anxiety, past trauma, fear of pain—but the physical response is very real.
Treatment typically involves vaginal dilators, graduated tubes that help the muscles learn to relax. You start with the smallest size, using it for short periods with plenty of lubricant, and gradually work up. The process teaches the muscles that penetration doesn't have to mean pain.
Pelvic floor physical therapy is often essential. These specialists can assess your muscle tension, provide hands-on treatment, and guide you through exercises.
Psychological support matters too. If anxiety or trauma is involved, working with a therapist who specializes in sexual issues can address the root causes.
Vaginismus is highly treatable. It takes patience and consistent work, but most people who commit to treatment see significant improvement.
Vulvodynia: Chronic Pain Without Clear Cause
Vulvodynia is chronic pain in the vulvar area without an identifiable cause like infection or skin disease. It might be constant, or it might be triggered by touch. It might feel like burning, stinging, rawness, or aching.
Diagnosis often comes after ruling out other causes. If your vulva hurts and tests keep coming back normal, vulvodynia may be the answer.
Treatment varies because the condition varies. Options include topical medications, nerve blocks, physical therapy, oral medications that modulate pain signals, and sometimes surgery for specific subtypes.
Finding a provider who takes vulvodynia seriously is crucial. This condition has been dismissed by doctors for years. If your provider doesn't believe you, find a new provider.
Endometriosis and Internal Issues
Deep pain during sex can indicate endometriosis, where tissue similar to the uterine lining grows outside the uterus. It often causes pain with deep thrusting, particularly at certain times in the menstrual cycle.
Ovarian cysts, fibroids, and pelvic inflammatory disease can also cause deep pain. These require medical diagnosis and treatment.
If deep penetration hurts consistently, it's worth investigating what's happening internally. This isn't something you should just live with.
Infections and Skin Conditions
Yeast infections, bacterial vaginosis, and STIs can all cause pain during sex. If pain is accompanied by unusual discharge, odor, or irritation, get tested.
Skin conditions like lichen sclerosus or lichen planus can affect the vulva, causing pain, itching, and changes in the tissue. These need dermatological treatment.
What You Can Do Right Now
Use more lubricant. If you're already using it, use more.
Extend foreplay. Your body needs time to become aroused, and arousal changes the vagina—it elongates, lubricates, and becomes more receptive. Rushing past this stage invites pain.
Change positions. Some positions allow better control over depth and angle. Being on top lets you control everything. Positions that restrict depth can help if deep penetration is the problem.
Communicate. Tell your partner what hurts. Stop when you need to stop. Pain should not be pushed through—that just creates a cycle of anticipating pain, tensing up, and experiencing more pain.
Avoid irritants. Scented products near the vulva, harsh soaps, douching—all can contribute to irritation. Keep things simple and gentle.
When to See a Doctor
If pain persists despite adequate lubrication and arousal.
If pain is severe or getting worse.
If you notice any other symptoms—unusual discharge, bleeding, or visible changes.
If self-help measures aren't working.
The right provider matters. A gynecologist is a good start, but for persistent issues, you might need a specialist—a urogynecologist, a pelvic pain specialist, a pelvic floor physical therapist.
The Psychological Impact
Pain during sex doesn't just hurt physically. It affects your relationship with your body, with sex, with your partner. Anxiety about pain can become self-fulfilling. Avoidance can create distance in relationships.
Addressing the emotional aftermath matters. Whether through individual therapy, couples counseling, or working with a sex therapist, processing the impact of painful sex is part of healing.
You deserve sex that feels good. Keep looking for answers until you find them.