SEXUAL HEALTH CONCERN

Painful Sex

Also called: painful sex, pain during intercourse, discomfort during sex, dyspareunia, pain during sex, pain when having sex, hurts during sex, sex is painful, uncomfortable during sex, sore after sex

Painful sex, medically known as dyspareunia, refers to recurring or persistent pain before, during or after sexual intercourse.

TYPICALLY OCCURS

Dryness, hormonal changes, pelvic conditions and muscle tension

TREATED BY

Surgery when indicated, medication, pelvic floor therapy and lubricants

ALSO LINKED TO

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Why it happens?

Pain during sex can originate around the entrance to the vagina or from deeper within the pelvis. Pain at or near the vaginal opening may be associated with insufficient lubrication, irritation, infection, inflammation or conditions affecting the vulval skin. Hormonal changes are another common contributor. Lower oestrogen levels during and after menopause, after childbirth or during breastfeeding can make vaginal tissues thinner, drier and less elastic, potentially causing burning, soreness or pain with penetration. Some medications and hormonal treatments can also contribute to vaginal dryness.

Deeper pain during intercourse can have different causes. Conditions such as endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids and other pelvic or gynaecological conditions may produce pain during certain positions or deeper penetration. Previous pelvic surgery, childbirth injuries or scar tissue can also contribute. Pelvic floor muscles may become unusually tight or contract involuntarily, making penetration painful or difficult. Conditions involving the bladder or bowel can sometimes cause symptoms that are experienced as sexual or pelvic pain as well.

Emotional and psychological factors can also influence pain without making the symptoms any less physical. Anxiety, fear of pain, stress or previous painful experiences can cause the pelvic floor muscles to tighten, which may increase discomfort and create a cycle in which anticipating pain makes penetration more difficult. Sexual arousal also influences natural lubrication and muscle relaxation. Painful sex therefore frequently has more than one contributing factor, and identifying where the pain occurs, when it began and whether other symptoms are present can help determine the underlying cause.

How far along is it?

Early

Mild pain or discomfort occurs occasionally, perhaps because of temporary dryness, irritation, insufficient lubrication or particular sexual positions.

Moderate

Pain becomes more frequent and may occur with penetration, deeper intercourse or afterwards. Sexual activity may begin to require modification or avoidance because of anticipated discomfort.

Advanced

Pain occurs regularly or makes penetration difficult or impossible. Symptoms may substantially affect sexual wellbeing, relationships or quality of life and warrant investigation for an underlying physical or pelvic condition.

What addresses it?

Treatments that address this

Sexual pain disorders→Perineal repair→

Professional assessment is worthwhile when pain during or after sex repeatedly occurs, becomes more severe or begins affecting sexual activity or wellbeing. Painful sex is common, but persistent pain should not simply be accepted as normal.

It is particularly important to seek advice if sexual pain occurs alongside abnormal vaginal bleeding, unusual discharge, persistent pelvic pain, sores or skin changes, urinary symptoms, irregular periods or other new symptoms. Bleeding after sex that repeatedly occurs should also be medically assessed.

Seek prompt medical attention for sudden severe pelvic or abdominal pain, particularly if accompanied by heavy bleeding, fever, vomiting, dizziness or fainting, or if pregnancy is possible.

Quick Questions:

Why does sex hurt even when there is enough lubrication?

Lubrication is only one factor. Pain can also result from pelvic floor muscle tension, infections, vulval conditions, endometriosis, ovarian cysts, fibroids, pelvic inflammation or other conditions affecting the reproductive or pelvic organs.

Why does sex become painful during or after menopause?

Declining oestrogen levels can make vaginal and vulval tissues thinner, drier and less elastic. These changes can contribute to burning, irritation and discomfort during penetration.

What causes deep pain during sex?

Deep pelvic pain can be associated with conditions such as endometriosis, ovarian cysts, fibroids or pelvic inflammatory disease. Pelvic floor problems and previous pelvic surgery can also contribute.

Is painful sex normal?

Occasional discomfort can happen, but recurring or persistent pain during sex should not be considered something that simply has to be tolerated. Assessment can help identify whether a physical, hormonal, muscular or psychological factor is contributing.