9 Reasons Sex Hurts (and What to Do About It)
You deserve to experience pleasure again–here’s how.
In a world where there are simply too many things to worry about, sex shouldn’t be one of them. And yet, for many women, the very opposite is true–their sex lives are fraught with discomfort. The American College of Obstetrics & Gynecology estimates that three-quarters of women have experienced pain during sex at some point. Sometimes, this problem persists for years.
Sex isn’t always an easy thing to talk about, so it can be intimidating to seek out treatment or advice from an expert. Your OB/GYN is supposed to be your go-to source for sexual health questions, but not all doctors are eager to get so personal. One survey of doctors in The Journal of Sexual Medicine found that just 40% of OB/GYNs routinely ask about sexual problems, and fewer than 30% ask about sexual satisfaction and pleasure.
Maureen Whelihan, M.D., a fellow of the American Congress of Obstetricians and Gynecologists, gynecologist, and sexual medicine practitioner in Palm Beach County, FL, explains that the hesitation is real on both sides. “I think doctors would love if the patient would bring it up, but I think patients would love if the doctor would bring it up,” she says. Talk about a catch-22!
To help you feel empowered and better prepared to have “the talk” with your M.D., let’s go through the most common reasons for pain during sex. This is by no means an exhaustive list–the body is complicated and there are a million factors at play–so it’s best to take specific questions to a doctor who knows your history. Possible causes of pain during sex include:
1. Hormonal Changes
A lack of lubrication in your vaginal area can lead to more pain and friction during sex. "Women have varying amounts of vaginal lubrication for many reasons, including hormonal changes during the menstrual cycle, the postpartum period, [or] menopause,” says Stephanie Buehler, Psy.D., licensed psychologist specializing in sex therapy at The Buehler Institute in Laguna Beach, CA. Prescription creams and medications can help you get your groove back–or if you want something simpler, try a lubricant. “There are many kinds of lubricant available,” Buehler says. “The best kind is the one that the woman and her partner like, but it should be scent- and irritant-free.”
2. Vaginal Atrophy
As a woman gets older, her body naturally produces less estrogen, a hormone involved in regulating your biological sexual response. “The [vaginal] tissue, as it loses estrogen, doesn’t stretch anymore,” Dr. Whelihan says. This can result in something called vaginal atrophy, which around 50% of women experience in their postmenopausal years. It is treatable with things like estrogen therapy and vaginal moisturizers–oh, and having more regular sex can help, too.
3. Anxiety, Trauma, or Lack of Sexual Arousal
Stress can also lead to a lack of biological preparedness for sex, Buehler explains. Just like a man gets an erection when his body is ready for sex, a woman’s body produces lubrication to prepare her vaginal area for sexual activity. A lot of this involves being in the right headspace for intimacy with your partner. You should never feel pressured to have sex if you don’t truly want to. And when you do want to get busy in the bedroom, 15 to 20 minutes of foreplay can help your body relax and prepare.
Surprisingly, the real culprit here might be your brain. “Sometimes pain can become anticipatory,” Dr. Whelihan explains. Emotional turmoil can cause something called vaginismus, a condition where the pelvic muscles involuntarily contract whenever sex is attempted.
If you are uncomfortable with having sex for any reason–whether it be previous trauma, extreme fatigue, or external stressors in your life or your relationship–you’re just not going to enjoy sex, and it may even be physically painful for you. These psychological concerns are valid and serious, and they can be addressed with the help of a trained sex therapist.
4. An Infection or Skin Inflammation in Your Genital Area
As you can imagine, any kind of inflammation or infection in your genital area puts a serious damper on your sex life. “Infections can cause pain,” Buehler says, “particularly yeast infections, as well as sexually transmitted infections like herpes.” Urinary tract infections are also common in women–more than half of women will experience at least one UTI in their lifetime. Dr. Whelihan adds two skin conditions that can irritate the genital area: lichen planus and lichen sclerosus.
If you fear you might have an infection or skin condition of some kind, talk to your doctor. These kinds of things can get worse over time and should be treated aggressively from the outset to avoid complications.
Endometriosis is a chronic reproductive condition affecting 11% of American women of childbearing age. It occurs when the tissue that typically lines the uterus begins to grow in other areas of your body, such as your ovaries, vagina, or rectum. “Endometriosis is a common cause of deep dyspareunia, or deep pain with sex,” Dr Whelihan says. It can also cause painful menstrual cramps as well as pain in your pelvis area. When it affects the ovaries, endometriosis can contribute to the formation of ovarian cysts (endometriomas).
Endometriosis has no cure, but there are treatments that can ease your symptoms, such as birth control, over-the-counter pain medication, or surgery in more serious cases.
6. Uterine Fibroids
Fibroids are tumors, usually benign, that grow around your uterus. Somewhere between 20% and 80% of women develop fibroids by the time they reach middle age. They come in all shapes and sizes, some smaller than a penny and others as large as a grapefruit. Many women have no symptoms at all from their fibroids, but depending on where they are located, they can sometimes cause discomfort in your abdominal region that may lead to pain during intercourse. If your fibroids do require treatment, medication or surgical intervention can help.
7. Vulvar Vestibulitis or Vulvodynia
These two pain disorders are related and somewhat mysterious in their origin, but they’re both related to inflammation around your vulva (the outer part of the vagina). Dr. Whelihan explains that a patient with vulvar vestibulitis might feel a stabbing sensation whenever she and her partner attempt sexual contact. She treats this using a steroid cream to restore the health of the vaginal tissue. Other types of medications and therapies (both hormonal and non-hormonal options) can also help.
8. Pressure or Sensitivity in Your GI Area
Folks with IBD or another digestive disease have probably experienced this at some point–if you’re feeling bloated, the last thing you want is more pressure on your abdominal area. While the physical act of sex may not be painful, the movement and friction around your gastrointestinal area could exacerbate existing pain in that area.
Someone with a history of abdominal surgery, such as a bowel resection, may also have sensitive spots from scar tissue, Dr. Whelihan notes. Simple things like changing sex positions can help ease abdominal pain or soreness.
9. Chronic Pain
Chronic pain makes so many aspects of your life more difficult, and intimacy is one of those things. Even if your condition doesn’t directly affect sexual function, stiff joints and sore muscles can make the act of sex super uncomfortable (to say the least). Since everyone’s pain is unique to them, this is where a condition expert can really help you.
Even if your doctor never directly asks about sex, don’t be afraid to have that conversation. Your doctor is your number one resource to help figure out the cause and treatment options for your pain. The same goes for talking to your partner. “Many women keep painful sex a secret because they are afraid their partner will blame themselves or think the woman is exaggerating,” Buehler says. This is usually far from the truth. “Most partners are genuinely concerned and will want to do whatever is necessary to make intercourse comfortable.”
Repeat after us: I deserve a great sex life! (Now, louder for the people in the back?) Pain during sex is real and very discouraging, but it’s also not your destiny. With some communication and the right interventions, you can experience your body’s full range of pleasure again.
Painful Sex Prevalence: American College of Obstetricians and Gynecologists. (2017.) “When Sex Is Painful.” acog.org/womens-health/faqs/when-sex-is-painful
Survey of Doctors: Journal of Sexual Medicine. (2012.) “What We Don’t Talk About When We Don’t Talk About Sex: Results of a National Survey of United States Obstetricians/Gynecologists.” ncbi.nlm.nih.gov/pmc/articles/PMC3387502/
Vaginal Atrophy: Mayo Clinic Proceedings. (2010.) “Vulvovaginal Atrophy.” ncbi.nlm.nih.gov/pmc/articles/PMC2800285/
UTIs: Sultan Quaboos University Medical Journal. (2013.) “Recurrent Urinary Tract Infections Management in Women.” ncbi.nlm.nih.gov/pmc/articles/PMC3749018/
Endometriosis: U.S. Department of Health & Human Services, Office on Women’s Health. (n.d.) “Endometriosis.” womenshealth.gov/a-z-topics/endometriosis
Uterine Fibroids: U.S. Department of Health & Human Services, Office on Women’s Health. (n.d.) “Uterine Fibroids.” womenshealth.gov/a-z-topics/uterine-fibroids