Painful sex may not be easy to talk about. Some women may dismiss it as something that happens occasionally, while others may continue having sex despite discomfort because they assume it is something they have to put up with.
But pain during sex is not something that has to be tolerated. While occasional discomfort can have a temporary explanation, persistent pain or pain that intensifies over time or affects your sexual well-being deserves attention.
There are many possible reasons why sex may hurt, from vaginal dryness and irritation to pelvic floor problems or certain gynaecological conditions. Identifying what may be causing the discomfort can help guide appropriate care.
Not everyone experiences painful sex in the same way. For some women, the discomfort occurs around the vaginal opening as penetration begins. For others, the pain may be felt deeper in the pelvis during intercourse.
The experience may include:
● Burning, stinging or soreness around the vaginal opening.
● Pain or tightness during penetration.
● Deep pelvic pain during certain movements or positions.
● Aching or discomfort that continues after sex.
Pain may occur every time or only occasionally, and sometimes it starts after a period when sex was previously pain-free. These differences matter because the location, timing, and nature of pain can offer useful clues.
There are several possible causes of painful sex in women, ranging from vaginal dryness and irritation to pelvic floor or gynaecological conditions.
When there is not enough natural lubrication, friction during penetration can cause soreness, burning or discomfort. Reduced lubrication may be temporary or recurring, depending on its contributing factors.
Infections or inflammation affecting the vagina or surrounding tissues can make intercourse uncomfortable. Irritation from certain products or vulval skin conditions may also contribute to pain.
Other symptoms, such as itching, unusual discharge, burning or changes in the skin, may sometimes occur alongside the discomfort.
Some causes of painful sex involve conditions affecting the pelvic organs. Deep pain during penetration may be caused by conditions like endometriosis, pelvic inflammatory disease, or certain ovarian cysts.
Because several conditions can produce similar symptoms, the location of the pain alone cannot establish the diagnosis.
The muscles around the vagina and pelvic floor can sometimes tighten involuntarily or remain overly tense, making penetration uncomfortable or painful.
Pelvic floor problems can have various contributing factors, and assessment can help determine whether muscle tension is one of them.
Tissue changes following childbirth, injury or certain pelvic procedures can sometimes contribute to discomfort during sex. Scar tissue, tenderness or changes in the pelvic floor may also be a cause.
The timing and circumstances under which the pain began can therefore be useful information to discuss with your gynaecologist.
Where the pain is felt can sometimes help your gynaecologist understand what may be contributing to it.
Pain around the vaginal opening or during initial penetration may be associated with dryness, irritation, inflammation or tightening of the pelvic floor muscles.
Pain felt deeper inside the pelvis may point towards a different range of possible causes than pain at the vaginal opening. It may also be more noticeable with deeper penetration or in certain positions.
However, the location of pain during intercourse is only one part of the picture. Your doctor will also consider when the pain started, how often it occurs, other symptoms and your medical history before determining what may be causing it.
Yes. Hormonal changes can affect the vaginal tissues and natural lubrication, which may make intercourse uncomfortable for some women.
For example, lower estrogen levels during breastfeeding, perimenopause or menopause can make vaginal tissues drier or more sensitive. This can increase friction and lead to burning, soreness or pain during penetration.
Hormonal changes do not affect everyone in the same way. If dryness or discomfort is persistent, a gynaecologist can assess the contributing factors and discuss appropriate ways to manage them.
There is a common belief that sex is supposed to hurt the first time. Pain, however, is not always the case.
Some women may experience temporary discomfort during first-time penetrative sex. Anxiety or nervousness can make it difficult for the pelvic floor muscles to relax, while insufficient arousal or lubrication can increase friction and discomfort.
It is also important not to assume that first-time pain is simply caused by the hymen “breaking”. The hymen is flexible tissue around the vaginal opening, and its appearance and elasticity naturally vary between individuals.
If penetration is very painful, cannot be comfortably achieved or continues to hurt on subsequent occasions, it is important to speak with a gynaecologist rather than assuming the pain will eventually go away.
Knowing when to seek medical advice can help ensure that persistent or concerning symptoms are appropriately assessed.
Consider making an appointment with a gynaecologist if:
● Pain keeps happening or is becoming worse.
● You are avoiding intercourse because of pain.
● There is unusual bleeding, discharge or other new symptoms.
● Discomfort continues despite addressing an obvious temporary factor, such as dryness.
Some situations need more prompt medical attention. Seek medical care if you develop sudden or severe pelvic pain, particularly if it is accompanied by heavy bleeding, fever, fainting or feeling very unwell.
Finding the reason for pain during intercourse usually begins with a conversation about the pain itself. Your gynaecologist may ask where you feel it, when it occurs, how long it has been happening and whether you have noticed any other symptoms.
Depending on your symptoms and medical history, further assessment may include a physical or pelvic examination, with your consent. Tests for infection, an ultrasound or other investigations may be recommended when clinically appropriate.
Not everyone needs the same tests. The evaluation is guided by your symptoms and what your doctor suspects may be contributing to the pain.
There is no single treatment for painful sex because management depends on what is causing the discomfort.
For example, treatment may involve addressing persistent vaginal dryness, treating an infection or underlying gynaecological condition, or managing pelvic floor muscle problems. When hormonal changes contribute to your symptoms, your gynaecologist can discuss suitable management options based on your individual situation.
Pain during sex should not have to become something you simply learn to live with. If it keeps happening or begins to affect your sexual well-being, understanding what is behind it is more useful than trying to work around it. It is important to come out and talk about it with your gynaecologist.
Deep pain during sex can have several possible causes involving the pelvis. If it happens repeatedly or is significant, a gynaecologist can assess what may be contributing to it.
Some women experience discomfort during first-time penetrative sex due to factors such as nervousness, pelvic floor muscle tightening or insufficient lubrication. However, first-time sex does not necessarily have to be painful. If the pain is severe or persists after several attempts, consider speaking with a gynaecologist.
Yes. Hormonal changes, particularly during breastfeeding, perimenopause or menopause, can affect vaginal lubrication and sensitivity, making sex uncomfortable or painful for some women.
Painful sex itself does not usually cause infertility. However, some underlying conditions that can cause painful intercourse, such as endometriosis or pelvic inflammatory disease, may also affect fertility. If you have recurring pain and concerns about fertility, a gynaecologist can assess both appropriately.
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