Pain During Intercourse

When a woman feels pain during sexual intercourse, it is called dyspareunia. Painful sex is fairly common, with nearly two out of three women experiencing it at some time during their lives. The pain can range from very mild to severe. Pain during sex is a sign that there may be a problem, but proper treatment can help you enjoy your sex life.

Your Reproductive Organs

To understand the causes of painful sex, it helps to know about the female body. The vagina is a passage that leads from the uterus to the outside of the body. The cervix is the lower, narrow end of the uterus, protruding into the vagina. The outside of the female genital area is called the vulva, and at the opening of the vagina are the inner and outer labia, or lips. The clitoris, located at the top of the inner lips, is a center of sexual pleasure for most women. The perineum is the area between the anus and the vagina.

Why You May Feel Pain

Painful sex can have both physical and emotional causes. To understand why the pain occurs, you should know what happens to your body during sex.

A woman’s body follows a regular pattern during sex, which includes four stages:

1. Desire: The feeling that you want to have sex.
2. Arousal: Physical changes take place. Your vagina and vulva become moist, and the muscles of the opening of the vagina relax. The clitoris swells and enlarges, and the uterus lifts while the vagina becomes deeper and wider.
3. Orgasm: The peak of the response. The muscles of the vagina and uterus contract, creating a strong feeling of pleasure. The clitoris can also experience orgasm.
4. Resolution: The vagina, clitoris, and uterus return to their normal state.

The arousal stage is important because this is when your vagina prepares itself for your partner to enter you. If any part of this natural pattern does not occur, you may feel discomfort or pain during sex.

Types of Pain and What You Can Do

During sex, a woman may feel pain in the vulva, at the opening of the vagina, within the vagina, or deep inside. Vulvar pain is pain felt on the surface (outside) of the vagina. Deep pain can occur in the lower back, pelvic region, uterus, and bladder.

Different types of pain have different causes, and it’s important to find the cause because you may have problems that need medication, surgery, or counseling.

Vulvar Pain

Pain can occur when some part of the vulva is touched. The vulva may be tender or irritated from using soaps or over-the-counter vaginal sprays or douches. Other causes include scars, cysts, or infections.

Vaginal Pain

The most common cause of pain inside the vagina is lack of moisture or vaginal dryness, which can occur with certain medications, medical conditions, or when not aroused. It can also occur during certain times of life, such as during or just after pregnancy, while breastfeeding, or near or after menopause.

Around menopause, lower estrogen levels can cause vaginal tissue to become thinner and drier, leading to discomfort during sex. Some menopausal women take estrogen therapy to relieve the dryness, and water-soluble lubricants can also help.

Another cause of vaginal pain is vaginitis, an inflammation of the vagina that can be caused by yeast or bacterial infections. Vaginismus, a spasm of the muscles at the opening of the vagina, can also cause pain during sex and may be due to medical causes or emotional factors.

Deep Pain

Pain that starts deep inside may be a warning sign of an internal problem, such as pelvic inflammatory disease (PID), problems with the uterus, endometriosis, or ovarian cysts. A pelvic exam and laparoscopy may be used to evaluate and treat these issues.

How Emotions Play a Role

Pain during sex can also be linked to emotional factors such as memories or fears, guilt, fear of pregnancy or STDs, or past traumatic experiences like rape or sexual abuse. Counseling may help address these emotional factors and improve your sex life.