Painful intercourse in women

Overview

Painful intercourse, also called painful sex, can happen for many reasons. They range from physical issues to emotional concerns. The medical term for painful sex is dyspareunia (dis-puh-ROO-nee-uh). It's pain that happens just before, during or after sex.

Painful sex can affect anyone of any gender. But research has shown that it tends to be much more common in women than in other people. In women, the pain may be felt in or around the opening of the vagina, within the vagina, or throughout the pelvis and nearby areas.

Painful sex can have a big impact on your quality of life, your relationships and the way you feel about yourself. If you often have pain during sex or if you are worried about the pain, talk with a healthcare professional. Treatment that focuses on the cause can often stop or ease this common concern.

Symptoms

Painful sex may include:

• Pain during sexual entry into the vagina, called penetration.
• Pain anytime something goes into the vagina, including a tampon.
• Deep pain within the vagina, pelvis or nearby areas.
• Burning, stabbing or aching pain just before, during or after sex.

The pain may happen every time you have sex. Or it may only happen in some situations but not in others.

When to see a doctor

Make an appointment with a healthcare professional if painful sex happens often, if the pain lasts over time, or if the pain is moderate to serious. Also make an appointment if you have other symptoms along with painful sex, such as bleeding or discharge from the vagina.

Causes

Physical causes of painful sex typically depend on when and where the pain happens. Emotional causes may be linked to many types of painful sex.

Entry pain

Pain at sexual entry into the vagina may be linked to a number of factors including:

• Vaginal dryness. Lower levels of estrogen in the body may make the vagina drier. That can lead to a lack of lubrication during sex. This often affects people who have gone through menopause and those who are breastfeeding.
• Medicines. Some medicines can lower sexual desire or arousal. That can decrease lubrication and make sex painful. Examples include antidepressants, high blood pressure medicines, sedatives, antihistamines and some birth control pills.
• Injury, trauma or irritation. This includes injury or irritation to the genitals, vagina or pelvis. For example, pain during sex may result from injury due to a car accident, pelvic surgery, female genital cutting, a tear during childbirth or an episiotomy. An episiotomy is a cut made during childbirth to help with delivery.
• Inflammation, infection or skin conditions. An infection in the genital area or urinary tract can cause sex to be painful. Eczema or other skin conditions in the genital area also may be the cause.
• Muscle spasms. Spasms of the muscles of the vaginal wall, called vaginismus, can make sex painful.
• Conditions present at birth. Not having a fully formed vagina, called vaginal agenesis, or having a membrane that blocks the vaginal opening, called imperforate hymen, could cause painful sex.

Deep pain

Pain felt deep within the vagina or pelvic area that happens during sex may be caused by:

• Some illnesses and conditions. Certain health concerns can cause pain during sex. Examples include endometriosis, pelvic inflammatory disease, pelvic organ prolapse and uterine fibroids. Other issues such as cystitis, irritable bowel syndrome, pelvic floor conditions, chronic pain syndromes, adenomyosis and ovarian cysts also may cause pain.
• Surgeries or medical treatments. Scarring from surgery in the pelvic area can cause painful sex. For example, scarring can happen after removal of the uterus, called a hysterectomy. Medical treatments for cancer, such as radiation and chemotherapy, also can cause changes that make sex painful.

Emotional factors

Emotions are often intertwined with sex, so they might play a role in sexual pain. Emotional factors may include:

• Psychological issues. Anxiety, depression, concerns about physical appearance, fear of intimacy or relationship issues can lower arousal and interest in sex and lead to painful sex.
• Stress. Pelvic floor muscles tend to tighten in response to stress. This can contribute to pain during sex.
• History of sexual abuse. Not everyone who has pain during sex has a history of sexual abuse. But if you have been abused, it can play a role.
• Fear of painful sex. When the pain first happens, that may lead to fear of it happening again. Then the fear can make it hard to relax during sex, which can lead to more pain.

Risk factors

Many factors can raise the risk of painful sex. They include illnesses, surgeries and other medical treatments, and some mental health issues.