Sex should always feel good—and when it’s painful, your body could be trying to tell you that something is seriously wrong.
If you felt a sharp pinch, pressure, tightness, soreness, or cramping during your last romp, you’re not entirely alone: About 30% of women report feeling pain during vaginal intercourse, according to a 2015 study published in The Journal of Sexual Medicine. That number skyrockets to 72% during anal sex. “If you’ve been aroused and rarin’ to go only to find that attempting intercourse results in burning, knife-life, searing, and/or pinching pain, then you’ve experienced dyspareunia, the medical word for painful intercourse,” explains Lauren Streicher, M.D., the medical director of the Northwestern Center for Menopause and the Northwestern Center for Sexual Health. There are two kinds of dyspareunia, she says:
- Superficial dyspareunia refers to pain limited to the entry and walls of the vagina
- Deep dyspareunia is when the penis or a sex toy can enter the vagina just fine, but any thrusting movement causes pain that ranges from achy to sharp to intolerable.
Pain can cause issues outside of the bedroom, too. “Pain during sex not only ruins the moment, it can have much greater consequences: fear of sex, lowered sex drive, and overall loss of intimacy,” says Debra Herbenick, Ph.D., a professor, director, and researcher at Indiana University’s Center for Sexual Health Promotion.
Just because pain is common doesn’t mean you should have to put up with it. You might feel awkward speaking up, but you’re doing yourself a disservice if you dismiss it. “Too many women continue to have sex to please their partners despite the severe pain,” Dr. Streicher says.
“Women need to know that pain is real, no matter what its ultimate cause,” says sexual health expert Dennis Fortenberry, M.D., professor of pediatrics at Indiana University’s School of Medicine.
There are plenty of things that could be messing with your time in between the sheets. Talk to your gynecologist, says Dr. Streicher: “They may be able to figure out the cause, but many women need to see a specialist. Your gynecologist may not be thinking about things like irritable bowel syndrome, while a gastroenterologist may not be thinking about endometriosis. It may be worth finding a gynecologist who deals specifically with sexual pain.”
Here are 10 possible reasons you feel pain during sex, so that you can find relief. “The bottom line is that no one should have pain with intercourse,” says Dr. Streicher.
You skipped foreplay
Women are slower to get aroused than men, and there’s a grain of truth in the stereotype that women need more foreplay—but figuring out what works for you is half the battle.
“Foreplay needs to be exciting to you,” says Herbenick. That might mean kissing and rolling around with our partner, giving or receiving oral sex, or even watching porn together. Everyone is different, and what gets you going won’t always work for someone else.
Understanding what feels good is key to starting the natural process of blood flow to your genitals, which increases lubrication (an absolute must for pain-free sex). Herbenick points out that some women don’t actually know when they’re aroused, which can be a major hurdle. In this case, staying focused on the moment can be helpful. “Notice how it feels to touch your partner and be touched,” she advises.
You didn’t use lube
You can be ready to go, but if you’re not sufficiently slippery, penetration is going to be painful. Plus, your vagina doesn’t get lubricated until 5 to 7 minutes after your brain is already in the game.
Other factors, like taking certain medications, can also lead to vaginal dryness. “Allergy pills [like antihastimines] have the same effect on vaginal tissues as they do on other mucus membranes, and low-dose hormonal birth control pills can also dry you out,” Herbenick says. Other medications that can affect your ability to lubricate naturally include antidepressants, blood pressure meds, and sedatives.
The fix? Be sure you have a personal lubricant ready for action. Even if you don’t need it most of the time, having it on standby means you won’t need to go searching for it in the middle of things (which is sure to ruin the moment).
You’re super stressed
You have a million things to do in a day, and you take that tension to bed with you. “Relaxation is an important part of feeling ready for and interested in sex,” explains Herbenick.
The best thing you can do is de-stress before you get busy. Herbenick suggests that couples give each other massages. If rub-downs aren’t your thing, there are other ways to help your mind—and thus your body—prepare for sex. “Try a yoga class—a lot of people also find meditation or mindfulness useful,” she says.
Your partner is too big
For a small number of people, “genital fit” can be a cause of pain during intercourse—meaning your partner’s quite large, and you’re extra petite.
Lube can help in some cases, but “in situations where the penis is hitting the cervix, or causing an uncomfortable level of stretch, it can help to change sex positions,” says Herbenick. “A lot of times women don’t feel confident saying, ‘slow down’ or ‘be more gentle.’” Try switching things up with positions like woman-on-top, since it gives you more control over the speed and depth of thrusting.
You have some kind of infection down there
A number of genital infections—most commonly, genital herpes, trichomoniasis, and yeast infections—can make intercourse painful. Even women who don’t experience any symptoms or are unaware of their infections can have small changes in their vulva or vagina that can contribute to pain.
The good news is, most genital infections are easily controlled or curable, and the tests are simple. If you’re experiencing pain, the most important thing is to communicate with your doctor and get tested appropriately, advises Dr. Fortenberry.
You have endometriosis
This condition, where the tissue that lines the uterus starts growing in other areas, affects an estimated 200 million worldwide, according to the Endometriosis Foundation of America. “It can lead to pain with intercourse and vaginal penetration, and can be really intolerable,” says Dr. Fortenberry.
Unfortunately, endometriosis may require laparoscopic surgery, but identifying the source of pain is a big part of the battle. If you have painful periods, pain during sex, or have female relatives who have experienced similar symptoms—you should ask your doctor for an ultrasound screening.
You’re experiencing IBS complications
True, very few people like to contemplate sex and poop in the same thought, but IBS is another common but sneaky possible cause of pain. Dr. Fortenberry suggests that if you have the most common signs of irritable bowel syndrome—periods of intestinal cramping, and cyclic constipation, or diarrhea—in addition to painful sex, the two might be linked.
Talk to your primary care physician about how you can manage your IBS—there are many ways to reduce symptoms, including changing your diet, medication, stress reduction, and behavioral therapy. “No one knows why, but it appears that when IBS is treated, vaginal pain during intercourse gets better as well,” says Dr. Fortenberry.
You’re going through menopause
Changes in the vagina during menopause involve more than just lubrication, especially after menopause is completed. “Parts of the vagina and vulva may become additionally sensitive,” says Dr. Forteberry, which can explain why something that used to feel good can now just plain hurt.
“There are many ways to mitigate the unwanted symptoms of menopause,” says Dr. Fortenberry. “Start by having a conversation with your primary care provider or your gynecologist about the possible causes and treatments that may help.”
You have a skin disorder
About 30 percent of the population has some form of eczema, an umbrella term for several skin diseases. In some cases, eczema can strike down there, leaving your vulva itchy, red, and inflamed—and intercourse painful as a result. The good news is, vulvar eczema is highly treatable. Often, it’s as simple as switching out your soap or laundry detergent or wearing loose-fitting clothing. Your doctor may recommend a corticosteroid cream or an antihistamine while your skin heals up.
You have vaginismus
Vaginismus is a rare condition characterized by spasms and contractions of the vagina during intercourse (it can also happen when you try inserting a tampon or getting a pap test at the gynecologist’s office). It’s thought to be a psychological condition stemming from things like a fear of sex, past abuse or trauma, or anxiety. If you experience pain during sex or even while trying to insert a tampon, talk to your doctor ASAP to ensure an accurate diagnosis.
Keely's writing on science and health has appeared in numerous publications and anthologies. In addition to being a writer, scientist, health fanatic and mom, she is a world traveler and tireless seeker of knowledge. After years of pushing, Keely finally passed 40, renewing her interest in improved health and longevity through nutrition and exercise.
