5 Causes for Painful Sex

by Anne Windermere Patient Advocate

Most of us think of sex as an experience that should be physically and emotionally pleasurable. But what happens when sex hurts? According to some reports as many as many as 16% of women experience painful intercourse in their lifetime. In some cases the pain is so extreme that some women give up on having sex entirely. In this post we are going to explore some of the reasons for painful sex or dyspareunia among women. If you are experiencing painful sex please know that you are not alone and that there is usually treatment and support for your condition. The first step is a proper diagnosis of the underlying condition causing the pain.

The following is a list of possible reasons for feeling pain during sexual intercourse. This is by no means an exhaustive list so always seek the expert advice of your doctor or gynecologist for any symptoms of vaginal pain.

Underlying Conditions Which May Cause Pain During Sex - Vulvar Skin Conditions: It is not commonly known that it is possible to have chronic skin problems in the vaginal area. Two related vulvar skin conditions which can cause considerable pain including itching, burning, irritation, lesions, and even cracked and bleeding skin include lichen planus and lichen sclerosus. These auto-immune skin conditions can mimic other gynecological problems including herpes and yeast infections. Many women suffer needlessly from these vulvar skin conditions because they go undiagnosed for years despite the fact that they are common especially among peri-menopausal and menopausal women. For example, according to the Harvard Health Newsletter one in 30 older women may have lichen sclerosus. The good thing about these skin disorders is that despite there being no cure, the symptoms can be easily treated especially in the early stages.

For more information on this topc please refer to my article: Vulvar Skin Conditions Which Mimic a Yeast Infection or Genital Herpes. http://www.healthcentral.com/sexual-health/c/824092/143455/conditions

  • Vaginismus: This is a condition where vaginal muscles involuntarily contract causing any type of penetration, whether it be from inserting a tampon to sexual intercourse painful and sometimes impossible. Vaginismus may be associated with psychological issues including a prior history of either rape or sexual abuse but not in all cases. This condition may also be caused by vaginal infections and vaginal injuries sustained during episiotomy repair. The symptoms of vaginismus can include burning, stinging, and an extreme tightness of the vagina.

Depending upon whether the cause is mostly psychological or medical determines the type of treatment provided. Some women will benefit from psychological or sex therapy. Other women may find relief by doing pelvic floor muscle contraction and relaxation exercises (Kegel exercises) and some doctors will recommend vaginal dilation exercises using plastic dilators which slowly open the vagina.

For more information on vaginismus please refer to our information page on general causes of vulvar or vaginal problems.

  • Infection: Both yeast infections and urinary tract infections can cause irritation, burning, and pain during intercourse. Yeast infections can usually be cured with an antifungal cream or suppositories. Urinary tract infections usually require an antibiotic.

For more information about yeast infections please read: All You Ever Wanted to Know About Yeast Infections.

  • Having a tipped Uterus: Some women have what is known as a tipped or tilted uterus where the uterus is tipped back towards the back of the pelvis instead of being in a straight or vertical position. In a lot of cases there is no underlying cause for a tipped uterus but in other cases a tipped uterus can be caused by endometriosis or uterine fibroids. Some of the symptoms of a tipped uterus is pain during sexual intercourse and during menstruation. Back pain, urinary tract infections, and difficulties inserting tampons may also accompany having a tipped uterus. It is estimated that a quarter of women have a retroverted uterus. While some women experience no symptoms as a result, painful during intercourse can be a symptom.

The sexual position most preferred by women who feel pain during sex is to be on top. However, if you have a tipped uterus, being on top may be more painful than other positions. Surgery is one option to correct a tipped uterus especially if it causes painful symptoms.

  • Endometriosis: Endometriosis is a benign condition in which endometrial tissue (the inner lining of the uterus) grows outside the uterus. This can lead to adhesions or scarring of the ovaries and fallopian tubes. One of the first symptoms of endometriosis can be infertility or the failure to conceive. Other symptoms can include heavy or painful periods, and painful intercourse which is felt deep within the pelvis and can continue hours after sex.

Treatment options include excision of the endometrial cysts or ablation (laser surgery). In extreme cases some women opt to have a hysterectomy as the pain of their endometriosis may not be cured any other way.

For more information on endometriosis from a firsthand perspective please read the series of posts written by Health Central writer Jennifer Rackley about her experience being diagnosed with endometriosis and her subsequent hysterectomy:

Please note that there are many other causes of painful intercourse in addition to the ones listed here. In future posts we will explore more of these underlying causes.

We would like to hear from you now. Do you ever experience physical pain during sex? Have you found the cause? Tell us your story. You just may help someone else who is going through the same thing.

Anne Windermere
Meet Our Writer
Anne Windermere

These articles were written by a longtime HealthCentral community member who shared valuable insights from her experience living with multiple chronic health conditions. She used the pen name "Merely Me."