Advise Me

What Should You Do if Sex Is Painful?

Sex is meant to be a pleasurable and enjoyable experience. But what happens when joy and pleasure turn to pain? 

If you are experiencing discomfort during sex or avoiding sex altogether because of it, know that you’re not alone. 

“Pain during sexual intercourse, also known as dyspareunia, is a common concern that affects many people at some point in their lifetime,” said Robin Giles, a certified obstetrics-gynecology nurse practitioner with Banner – University Medicine. 

Painful sex can affect both men and women of all ages, and the pain can be felt just before, during and after sex. It may affect your emotional and physical well-being as well as intimacy with your partner.

Although experiencing pain during sex is common, it isn’t normal. Read on as we share some of the causes of painful sex and possible solutions to help you reclaim joy and connection during sex.

What causes painful sex?

People experience pain during sex for many different reasons. But one of the most common reasons is vaginal dryness.

“Lack of lubrication can lead to pain during sex,” Giles said. “Often, this is related to hormonal changes after childbirth (postpartum) or during menopause.”

Dips in estrogen levels during perimenopause and menopause can cause the vaginal lining to become dry, thinner and inflamed and lead to pain during sex.

In other cases, your pain may be caused by one of the following:

  • Infections: Bacterial infections, yeast infections, urinary tract infections (UTIs) or sexually transmitted infections (STIs) can cause pain during sex and other symptoms. “STIs such as gonorrhea, chlamydia or trichomoniasis can cause tenderness of the cervix and uterus,” Giles said. “It’s important to get treated to prevent pelvic inflammatory disease, which can cause long-term problems with fertility if left untreated.”
  • Medical conditions: Endometriosis, pelvic inflammatory disease (PID), fibroids, hemorrhoids and ovarian cysts can all cause pain during intercourse.
  • Skin sensitivity: Conditions like dermatitis or vulvodynia can cause pain near the vaginal opening. These can be brought on by reactions to perfumed soaps, lubricants, condoms and douches. Lichen sclerosis is another condition where the skin of the genitals becomes scaly and inflamed.
  • Physical factors: Structural issues, such as pelvic floor dysfunction or pelvic floor muscle spasms (vaginismus), can lead to discomfort during sex. 
  • Injury: An accident to the genitals, pelvic surgery or a tear or cut (episiotomy) from childbirth can lead to problems during sex.
  • Psychological issues: Anxiety, depression, stress or a history of trauma or sexual abuse can impact sexual well-being and desire.

Treatment options for painful sex

Don’t suffer alone. There are some things you can do at home to relieve pain during sex, but it’s important to remember the right solution depends on the cause of your pain. If you have chronic pelvic pain or pain during sex, see your health care provider for proper diagnosis and treatment.

“Due to the numerous causes for painful sex, a thorough medical history, physical and pelvic exam are necessary to develop a treatment plan,” Giles said. “What works for your friend may not work for you. Your treatment plan depends on the problem and your goals.”

Some treatment options may include one or more of the following depending on the cause of your pain:

  • Lubricants: Use water-based or silicone-based lubricants to help with dryness and reduce friction and discomfort. “Stay away from scented or warming products as these can cause problems or irritation,” Giles noted.
  • Physical therapy: A referral to a pelvic floor physical therapist may be recommended to help with muscle tension or weakness that contributes to pain.
  • Medications: Depending on the cause, your provider may prescribe medications such as estrogen-based products (like a ring, pill or cream) and pain relievers like lidocaine. If you have an STI or UTI, your provider will prescribe medicine to treat the infection.
  • Vibrators and dilators: Vibrators can be used to increase blood flow and reduce tension in the pelvic area. Dilators are often used to help gradually stretch and relax the pelvic muscles.
  • Counseling or therapy: “Sometimes cognitive behavioral therapy can help with relaxation and healing of past trauma,” Giles said. If you have suffered from sexual abuse or trauma, your provider may refer you to a licensed behavioral health specialist.
  • Communication: Open communication is important. Discuss any discomfort or changes in your sexual desire (libido) with your partner. “Imbalances in desire can lead to arguments if not addressed,” Giles said. “We often forget to make time for our partners in our busy lives. Connecting on many different levels is important to maintaining a healthy relationship.”
  • Changes in sexual technique: Try sexual activities or positions that do not cause you pain.

Bottom line

Don’t live with painful sex. If pain during sex has led to physical discomfort, emotional distress and loss of intimacy, contact your health care provider or a Banner Health specialist. Don’t feel embarrassed about your symptoms. Getting help can pave the way toward a more comfortable and fulfilling sex life. 

For more sexual health articles, check out:

Women's Health Gynecology Sexual Health