Why Does Sex Hurt?
- Michael Frey, MD
- Oct 16, 2021
- 4 min read
Updated: May 7
Pain during sex can lead to issues in a couple's sexual relationship and result in negative emotional impacts alongside the physical discomfort. There are numerous causes and various treatment options.
Causes of pain during sex?
Vaginal dryness/Lack of lubrication: In many cases, a woman can experience pain during sex if there is not sufficient vaginal lubrication. This can worsen after menopause.
Fibroids: Benign growths in the uterus.
Vaginismus: Spasms in the vaginal muscles, mainly caused by the fear of being hurt or prior trauma.
Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
Sexually transmitted infections (STIs): These may include genital warts, herpes sores, or other STIs.
Vaginal infections: These conditions are common and include yeast infections.
Injury to the vulva or vagina: These injuries may include a tear from childbirth or a cut from shaving.
Narrow Vagina: Virginal women, post-menopausal women, and women who have undergone radiation therapy may suffer from a narrow vaginal tube. Other symptoms may include bleeding after sex.
Medical conditions: Such as a urinary tract infection, constipation, or irritable bowel syndrome.
Emotional and psychological factors: Anxiety, fear, and depression can inhibit sexual arousal and contribute to vaginal dryness or vaginismus. Stress can trigger a tightening of the pelvic floor muscles, resulting in pain. A history of sexual abuse or sexual violence may contribute to dyspareunia.
Vulvodynia: A chronic pain condition that affects the vulva -- including the labia, clitoris, and vaginal opening.
Loss of desire for sex: This is a separate problem in and of itself but when the desire goes, sex becomes a stressor rather than a pleasure. This can lead to pain with intercourse, which can negatively affect sexual desire.
Skin disorders affecting the genitalia, such as eczema, lichen planus, lichen sclerosis, or other skin problems in the genital area. Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products may also cause pain.
Tests that may be ordered
pelvic ultrasound.
culture test to check for infection.
urine test.
counseling to determine the presence of emotional causes.
How dyspareunia is treated Treatment varies based on the cause of the pain.
Vaginal moisturizers:
These are used 2-3 times a week at night before bed. Examples include:
Replens
Sex lubricant:
-Lubricants for when you're having sex. These are all available online.
Wet Platinum Premium Lubricant: A silicone-based lubricant with minimal chemical additives. Be aware that silicone-based lubricants will stain sheets.
Überlube Luxury Lubricant: Silicone-based lubricant with Vitamin E.
Organic Glide: Oil-based lubricant made with olive fruit oil, argania kernel oil, and resveratrol ferment extract. Very popular with my patients because it lasts a long time and works well.
Good Clean Love: This vegan-friendly water-based lubricant is free of parabens.
Myomectomy or medications like Orilissa are options for pain due to fibroids.
Vaginal infections or STI:
antibiotics.
antifungal medicines.
topical or injectable corticosteroids.
Myfembree, Orilissa, or Lupron may be helpful.
Pelvic floor PT.
Estrogen therapy:
Low estrogen levels cause dyspareunia in some women. A prescription tablet, cream, or flexible ring can deliver a small, regular dose of estrogen to the vagina.
A Hormone-free vaginal insert for painful sex due to menopause.
A hormone-free oral pill for dryness and pain due to menopause.
Intercourse too soon after surgery or childbirth:
Pelvic rest.
Injury to the vulva or vagina:
Surgical repair may be necessary.
Narrow Vagina:
Vaginal Dilators - If your vaginal tube is too narrow for your partner's penis. Dilate to one size larger than your partner's girth. Then, maintenance dilation twice a week. Dilate before sex.
Emotional and psychological factors:
Anti-depressants, anti-anxiety medications, and possible referral for therapy with a mental health provider.
Vaginismus+Vulvodynia:
options include
Amitriptyline
Cymbalta
Vaginal Valium
Vagicaine
Topical Gabapentin
Estrogen cream
Pelvic floor PT
Skin disorders affecting the genitalia:
May require a skin biopsy
Topical steroids
Vagicaine
Dermatology consultation
What else can you do to reduce symptoms
Have sex ONLY when you and your partner are relaxed.
Be-Fore play: get yourself in the mood before your partner is even in the bedroom. Read something that turns you on, watch something that turns you on, self-stimulate. Build up desire before you are with your partner. That way, you are both ready to go.
Have sex when you are not exhausted.
Communicate openly with your partner about your pain.
Empty your bladder before sex.
Take a warm bath before sex.
Take an over-the-counter pain reliever before sex.
Apply a Vagikool ice pack to the vulva to calm the burning after sex.
After childbirth, wait at least six weeks before resuming sexual intercourse.
Encourage natural vaginal lubrication with enough time for foreplay and stimulation.
Sex positions
In general, you should seek a position that does not cause discomfort during intercourse and, if you are seeking pregnancy, have sex on fertile days. Control the depth of penetration. Avoid "girl on top" position if it is painful. The best positions are usually: missionary and spooning.
Consider additional erotic activities that don’t include penetration. Penetration can be the side dish for sex while the other activities dominate. Pleasure is the goal, so creatively figuring this out is key. Manual stimulation using your hands on your partner’s external parts is a stellar alternative to internal penetration.
Outlook
Alternatives to sexual intercourse may be useful until underlying conditions are treated. You and your partner can use other techniques for intimacy until penetration is more comfortable. Sensual massage, kissing, oral sex, and mutual masturbation may be satisfying alternatives.
