What Causes Painful Sex?
Do you live in fear of painful sex? Is pain during or after sex ruining your sex life? Are you worried about what may be causing it?
Any pain or discomfort you feel in the pelvic region, vagina, or labia during or after sex is known as dyspareunia. The word derives from Greek, meaning “difficulty mating."
But if pain plagues your life - either during intercourse or for hours or sometimes even days after the event – then sex isn’t pleasurable at all. It’s miserable.
In fact, many women suffer from painful sex so much that the anxiety about it before sex even happens stops them from having sex altogether, which can put an intense strain on your relationship and contribute to a reduction in your quality of life – if you’re not able to have sex with your partner when you want to.
Painful sex in midlife and beyond is often treated as a taboo subject. We consider it a sign that we're all "dried up" and past our prime, right?
Wrong.
Symptoms of painful sex vary from woman to woman. But, thankfully, with physical therapy and sometimes modern medicine, most causes of painful intercourse are treatable.
Even if the root cause is the declining estrogen that comes with perimenopause and menopause, it isn't what society leads us to believe. The natural end of our fertile years shouldn't signal the end of sex, too.Sex in and after menopause should be just as enjoyable (if not more so) than it was when you were younger.
What Is Painful Intercourse?
Pain during sexual intercourse can be vaginal pain, pain in the labia or vulva, or deep pelvic pain that occurs while having sex. For you, it could be a burning sensation, sharp pain, or deep pain.
Where do you feel it?
What Causes Painful Sex?
Here are the leading causes of painful sex in women:
Women suffering from “vulvodynia” experience pain during sex in the vulvar area, which occurs due to no known cause
Women that go through menopause report it is more painful due to declining estrogen levels and the associated dryness and thinning of the vaginal walls.
Vaginal irritation or injury
Infections - including sexually transmitted infections and infections in the urinary tract
Vaginal wall muscle spasms - known as “vaginismus."
Skin ailments in the genital region
What Are the Symptoms of Painful Sex?
Symptoms related to pain during sex occur during or directly after intercourse. They include:
Pain on entry – felt as burning pain or sharp stabbing sensation
Pain deep within the vagina – around the cervix
Muscle tightness or cramps in the pelvic region
Muscle spasms in or around the vagina
Pain during sex is then categorized further to include:
Primary Pain - experienced throughout a woman's sexual life.
Secondary pain - happens further down the line at a later stage.
Complete pain – occurs from the initial point of penetration and lasts for the duration of intercourse.
Situational pain - happens with a specific stimulation or particular partner.
Finally, entrance Pain - is experienced during penetration.
Deep Thrust Pain - is located at the cervix or in the lower abdominal area and is noticeable during or after penetration.
Sometimes pain continues even when no injury or infection can be found. That doesn't mean it's in your head. Once sex has hurt, your body can learn to brace for it: the pelvic floor muscles tighten in anticipation, and that tension creates pain of its own. It's real, and it's treatable.
When should I seek help from my doctor for painful sex?
You should always consult a health care professional if you are experiencing new or worsening pain, bleeding, or discharge following intercourse.
Pain related to intercourse is a condition that you should most appropriately discuss (in the first instance) with a primary health care doctor or OB-GYN (gynecologist). You may also need to consult with other specialists, such as a psychiatrist, psychologist, or urologist, depending on the underlying cause of your pain.
When you feel mild pain during intercourse, it is most likely not an emergency. But you should get medical care right away if you experience any of the following:
Severe pain that doesn't ease after you stop, or keeps getting worse
Bleeding after sex, particularly if it's new or heavy
Fever, nausea, vomiting, or rectal pain following intercourse
How Do Doctors Diagnose the Cause of Painful Sex?
Your doctor will ask you about your pain history – when it started, how long it lasts, what triggers it, etc. This history, along with an extensive physical examination, will usually reveal the most probable cause of your pain.
If you report pain at the vaginal opening, the cause may be for one of the following reasons:
Not enough lubrication during the arousal phase (may be associated with hormonal changes: declining estrogen levels or certain medications)
Inflammation at the entrance to the vaginal canal
Painful muscle spasms in the vagina that prevent intercourse
If you report pain that feels like it covers the entire vaginal area, that may indicate:
Vulvar muscle degeneration
Chronic vulvar pain
A vaginal infection (fungal, parasitic, or bacterial)
At times, you may identify a specific area of discomfort, which may suggest that there may be a cause for the pain that is unrelated to sex. For example, it could be inflammation of the urethra (the tube that takes urine from the bladder to exit the body).
Deep thrust dyspareunia refers to pain that occurs with deep repetitive vaginal penetration, felt deep in the pelvis rather than at the entrance. This particular type of pain may suggest abnormalities of the pelvic organs, such as endometriosis, adhesions, or uterine prolapse.
If you report pain in the middle of the pelvis, it may suggest that your pain originates from your uterus. However, pain on one or both sides of the pelvis suggests a problem involving the fallopian tubes, ovaries, or ligaments.
Your doctor will perform an extensive examination of your pelvis, abdomen, and lower back to understand your anatomy and find the source of your pain. The exam also allows you to guide your OB-GYN to the exact location of your discomfort because it's sometimes difficult to describe it verbally.
Part of this exam may include a rectal exam or rectovaginal exam. In addition, they may perform a Pap smear and collect vaginal or cervical fluids for culture or an analysis of the urine (urinalysis) and other laboratory tests.
In some cases, your doctor may order medical imaging tests, such as:
A CT scan, MRI scan, or pelvic ultrasound
An X-ray of the urinary tract, which is called a Urethrogram
An X-ray of the bladder, which is called a cystogram
Another diagnostic procedure that your doctor may use to look for urinary abnormalities is a cystoscopy. This procedure uses a thin probe with a light on the end, so your doctor can see the lining inside of the bladder and urethra. They will usually refer you to a specialist (urologist) for these procedures.
Your doctor will then provide you with a diagnosis based on your history and physical evaluation.
How Pelvic Floor Physical Therapy Can Treat Painful Sex
If there is no apparent physical cause (that would require specific medical treatment) for you experiencing painful sex, or you have a condition that involves the pelvic floor - such as a pelvic organ prolapse- then pelvic floor physical therapy with a women's health specialist can make a real difference and help you enjoy sex again. So, if you have any pelvic pain – even if it isn't related to sex, we can help.
Stress and tension can be powerful contributory factors with painful sex and non-specific pelvic pain. It is even more so when you spend time worrying about why things hurt down there. But this anxiety is even more reason to seek help from a trained professional – instead of “guessing” what is going on or putting it down to childbirth.
At Revive PT & Pilates, we specialize in women's health, so you're in incredibly safe hands. We help women, just like you. Women who struggle with incontinence, prolapse, and pelvic pain, so your energy and attention can shift back to all the things you live to do.
This condition is nothing to be ashamed of, and we do not judge or cast doubt. Our team is entirely female, and whatever it is, you will not be the first.
If you live in or near North County San Diego, spend one 60-minute session with a women's health specialist at our Encinitas studio and walk out with a plan built for the body you have now.
Start With a Discovery Visit →
No referral needed. No pressure — just answers and a plan.
