Painful Intercourse: Why Sex Hurts and What Helps

Where it hurts matters

Doctors divide painful intercourse by location, because the causes are different.

Pain at the entrance

Vaginal dryness

Lack of lubrication is the most common cause. It may come from not enough arousal or foreplay, breastfeeding, some contraceptives, antihistamines, antidepressants, and especially menopause. Low estrogen after menopause thins and dries vaginal tissue (vaginal atrophy, part of genitourinary syndrome of menopause). It also follows cancer treatments that lower estrogen.

Infections

• Yeast infection: itching, soreness and thick white discharge.
• Bacterial vaginosis and trichomoniasis: discharge with an odor.
• Genital herpes: painful sores.
• Urinary tract infections: burning on urination and pain with pressure on the bladder.

Vulvodynia

Vulvodynia is chronic burning, stinging or rawness of the vulva lasting at least 3 months without another clear cause. In provoked vestibulodynia, the most common type, touch at the vaginal opening causes sharp pain during sex or inserting a tampon.

Vaginismus and tight pelvic floor muscles

In vaginismus, pelvic floor muscles tighten involuntarily when penetration is attempted, making it painful or impossible. It can follow painful experiences, anxiety about sex, or other causes of pain, which trigger a cycle of pain and guarding.

Skin conditions and injury

Lichen sclerosus, lichen planus and contact dermatitis from soaps or spermicides make vulvar skin fragile and sore. Tears or episiotomy scars after childbirth can cause pain for months.

Deep pain during sex

• Endometriosis: tissue similar to the uterine lining grows in the pelvis. Deep pain during sex is a hallmark, with painful periods and sometimes painful bowel movements.
• Pelvic inflammatory disease: infection of the uterus, tubes and ovaries, often from chlamydia or gonorrhea, with deep pain, discharge and sometimes fever.
• Ovarian cysts, fibroids and adenomyosis: pressure or deep aching.
• Interstitial cystitis (bladder pain syndrome): pain with a full bladder and during sex.
• Bowel conditions: constipation and irritable bowel syndrome.
• Position: certain positions allow deeper penetration and hit the cervix or ovaries; changing position often helps.

Painful intercourse in men

Men can also have pain during sex:

• Infections: balanitis (inflamed head of the penis), urethritis from STIs, and prostatitis, which can cause pain on ejaculation.
• Tight foreskin (phimosis) or a tight frenulum that tears.
• Peyronie's disease: scar tissue that makes the erect penis bend, sometimes painfully.
• Skin conditions: lichen sclerosus, eczema and allergies to latex or lubricants.

Psychological factors

Anxiety, past sexual trauma, relationship stress and fear of pain can all cause or worsen painful sex. Once pain occurs, anticipating it causes muscle tension and less arousal, which leads to more pain. Addressing this cycle is part of effective treatment, alongside treating physical causes.

When to see a doctor

See a primary care doctor or gynecologist if sex is painful more than occasionally. A sexual health clinic is appropriate if you think you might have an infection. For more on how dyspareunia is diagnosed and treated, see the painful intercourse (dyspareunia) condition page.

The doctor will ask where and when it hurts, whether it has always happened or is new, and about periods, discharge, contraception, childbirth, menopause and any history of pain or trauma. A gentle exam, often starting with a cotton swab touch test of the vulva, helps locate the pain. You can ask to stop at any time. Swabs for infection and a pelvic ultrasound may follow.

What can help now

• Use a lubricant: water-based or silicone-based lubricants reduce friction. Avoid oil-based products with latex condoms.
• Vaginal moisturizers used several times a week help ongoing dryness.
• Allow time for arousal: more foreplay increases natural lubrication and relaxation.
• Try different positions, such as you on top, to control depth and pace.
• Avoid irritants: scented soaps, douches, bubble baths and spermicides.
• Empty your bladder before sex.
• Stop if it hurts. Pushing through pain makes the pain cycle worse. Non-penetrative intimacy is fine while you seek help.

Frequently asked questions

Why does sex suddenly hurt?

New pain during sex often comes from infection (yeast, bacterial vaginosis or an STI), dryness from hormonal changes such as breastfeeding, new contraception or approaching menopause, or a new skin reaction to a product. Deep new pain can mean pelvic infection or ovarian cysts and should be checked.

Why does sex hurt deep inside?

Deep pain is often caused by endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids, adenomyosis or bladder pain. Some positions allow deeper penetration and cause pain by touching the cervix. Recurrent deep pain should be assessed by a gynecologist.

Is painful sex after menopause normal?

It is common, but it is treatable. Lower estrogen makes the vaginal lining thin and dry. Lubricants, regular vaginal moisturizers and low-dose vaginal estrogen, which is safe for most women, usually improve comfort significantly.

Can men have painful intercourse?

Yes. Causes include infections of the penis, urethra or prostate, a tight foreskin, Peyronie's disease, skin conditions and allergies to latex or lubricants. Pain on ejaculation often points to prostatitis. A doctor can examine and test for infections.

What can I do to make sex less painful?

Use plenty of water- or silicone-based lubricant, allow more time for arousal, try positions that let you control depth, and avoid irritating products. If pain persists, see a doctor: treatments such as pelvic floor physical therapy and treating infection or dryness work well.