Painful Intercourse

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Women's Wellness
Painful Intercourse

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is a Painful Intercourse?

Sexual intercourse should not be painful. Pain during sex and pain after sex, known by the medical term dyspareunia, are signals from your body that something is wrong. Women may experience this pain during or after sex either in the vagina or deeper in the pelvis, depending on exactly what is causing the pain.

Painful sex may be the result of a medical condition such as endometriosis, which may require further investigation, or an infection, such as chlamydia or thrush, which will need to be treated.

It is important for a woman to be aroused before sexual intercourse takes place, as without sufficient vaginal lubrication, sex will cause friction and pain. While physical attraction to your partner and an appropriate amount of foreplay is important in order to avoid pain during sex, sometimes there may be emotional reasons or anxiety at play. If this is the case, then the doctor may recommend some counselling or sex therapy in order to get to the bottom of exactly what is causing your pain during sex.

Sometimes painful sex can be accompanied by other symptoms, such as bleeding after sex or unusual discharge.

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What causes Painful Intercourse?

The are a number of things that may cause painful sex.

Medical conditions

Painful sex is a symptom of a number of underlying medical conditions. These include:

Infection: If you are experiencing pain during sex or pain after sex and additional symptms such as unusual discharge, soreness, itching or, in women, bleeding after sex and between periods, then you may have an infection. This may be a sexually transmitted infection (STI) such as gonorrhoea, genital herpes or chlamydia, one of the most common sexually transmitted infections in the UK, which can also cause pain and swelling of the testicles in men. Although it is not an STI, thrush can be triggered by sexual intercourse and can cause great discomfort to those who have it. Symptoms include odourless white vaginal discharge and irritation and itching around the vagina. Women with thrush may find they experience stinging or soreness when urinating or while having sex. Men can also have thrush, which causes soreness and itching.
Pelvic inflammatory disease (PID): PID is caused by bacteria which has travelled up from the vagina or cervix. Symptoms of PID include pain around the pelvis or lower abdomen and pain or discomfort after sex which is felt deep inside the pelvis.
Fibroids: Fibroids are benign growths made up of muscle and fibrous tissue that develop in or around the uterus. They vary in size from the size of a pea up to the size of a melon. Some women may not even be aware that they have fibroids, but around one in three will experience fibroids symptoms including abdominal or lower back pain and pain during sex.
Pelvic organ prolapse: Women who have pelvic organ prolapse can experience frequent pain or discomfort, including a heavy or ‘dragging’ feeling around the lower stomach and genitals. Some women won’t experience any pain. It depends on the severity and nature of the prolapse.
Endometriosis: Endometriosis is a medical condition where tissue similar to that found in the lining of the uterus is found growing outside of this space, such as on or in the fallopian tubes, ovaries, vagina or intestine. Symptoms vary from woman to woman but can include pain during sex.
Prostatitis: Prostatitis is a painful swelling of the prostate gland in men. Symptoms of chronic prostatitis include sexual problems, including pain during sex, pain when ejaculating and erectile dysfunction.
Vaginismus: This condition sees the muscles in or around the vagina close tightly when you try to insert something into it. This causes pain in the vagina and can sometimes make sex impossible. However the condition can be treated.

Physical reasons

Menopause: Menopause is when a woman’s periods stop as a result of falling hormone levels. This usually happens somewhere between the ages of 45 and 55. One of the common symptoms of menopause is vaginal dryness, which is caused by a change in oestrogen levels which can affect vaginal lubrication. Vaginal dryness can make it difficult or painful to have vaginal sexual intercourse.
Irritation: Perfumed soaps or bubble baths, perfumes, talcum powder, nylon underwear, sanitary pads or panty liners, lubricants or spermicides can irritate this delicate part of the body and cause problems such as vulvar dermatitis or vulvitis to develop, which can cause pain during sex.
Irritable Bowel Syndrome (IBS): IBS is a common condition that affects the digestive system. It can cause constipation, bloating, stomach cramps and diarrhoea. All of these can make sex feel painful.
Lack of arousal: If a woman is not sufficiently aroused before having sex, this can lead to pain.

Psychological reasons

There is not always a physical reason for painful sex. Sometimes an emotional reason, past trauma or anxiety may be the reason why sex is painful.

Painful sex in men and women

Pain during or after sex can affect anyone or any age. However it is generally more common in women than it is in men. Women can experience this pain externally in the vulvar region towards the labia or at the opening to the vagina. Sometimes pain during sex can be felt deep within the pelvis, in the cervix, uterus or lower abdomen.

Just like women, men can find sex painful if there is not enough lubrication, but this can also be caused by certain penile disorders such as an overly-tight foreskin or tiny cuts or tears on the foreskin. Just like women, men can also find that the pain they experience during sex may be caused by psychological or physical factors. However sometimes psychological factors such as anxiety and depression can stop a man from having an erection, preventing sex all together.

Sexually transmitted infections (STIs) and thrush can affect men and women and can make sex a painful experience for both. If one partner has been diagnosed with an STI or thrush, it is important that both are treated.

When should I be concerned about pain during sex?

If the pain is getting worse and is accompanied by symptoms such as bleeding after sex, difficulty urinating, itching or burning around the vulva, frequent urinary tract infections, vaginal tightness or frequent vaginal infections, then it is time to visit the doctor. If the pain is so bad that you are afraid to have sex, or if it is affecting your relationship with your partner, then you should seek medical advice. If you are menopausal and vaginal lubricants are no longer helping, the doctor will be able to prescribe hormones.

What treatment options are available?

Treatment depends on the diagnosis, but options may include:

Lubricants and moisturisers: Vaginal moisturisers and water-based lubricants can treat vaginal dryness, vastly improving comfort during sex. Only moisturisers that are specifically designed for use on the vagina should be used, as perfumed products could potentially make symptoms worse.
Antivirals: There is no cure for herpes, but outbreaks can be treated with antiviral medicine to stop the symptoms getting worse.
Antifungal medication: Thrush is treated with antifungal medicine. The doctor may prescribe this in tablet, pessary or cream form. Thrush should clear up within seven to 14 days of starting treatment.
Antibiotics: Infections such as chlamydia and pelvic inflammatory disease (PID) will need to be treated with a course of antibiotics.
Systemic hormone therapy: Hormone replacement therapy (HRT) can help with falling oestrogen levels in menopausal women. HRT is given in pill form and taken orally. This contains a higher dosage of oestrogen which is taken to other parts of the body, not just the vagina.
Vaginal oestrogen therapy: This treatment involves delivering oestrogen directly into the vagina. This can be done via the application of a cream, vaginal suppository or a vaginal oestrogen ring, which releases a consistent dose of oestrogen over the course of three months.
Dilators: Dilators are used to dilate (widen) the vagina to allow you to return to having sex. Narrow dilators are used at first, progressing to larger sizes over time until the vagina is wide enough to accomodate a penis for sex without pain. This treatment can be used in conjunction with vaginal oestrogen therapy.
Pelvic floor exercises: Pelvic floor exercises, which involve squeezing and releasing exercises to gain control of the vaginal muscles, can sometimes help if vaginismus is a problem.
Avoiding irritants: If products such as perfumed soaps, talcum powder or spermicides are responsible for irritating the delicate genital area, leading to painful sex, then it is adviseable to avoid using these products.
Therapy: If there is an psychological reason why sex is causing pain, then counselling or sex therapy can help.

How can I reduce pain during sex?

Longer foreplay can stimulate your natural lubrication and ensure that your body is fully ready for sex, lessening the likelihood of painful intercourse. If you need a little help, a good-quality water-based lubricant can vastly improve comfort during sex. There are plenty of brands available on the market and it is important to find one that suits you. Vaseline, vitamin E, olive and coconut oils and mineral oils should not be used in order to avoid irritation and infection.

If you do experience pain during sex, then it may be a good idea to change positions, for example, a woman on top can better control the depth of penetration. It is important that you are able to communicate with your partner so they know what feels good for you and what to avoid. Don’t be afraid to speak out if you need things to slow down - if sex is painful, you don’t have to put up with it.

Ultimately sex should be a fun and pleasurable experience, not a painful one. If you are experiencing pain during sex or pain after sex, it is important that you see a specialist to obtain a diagnosis and treatment to help make sex something to look forward to again.

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