• Sexual Health
• Pain
• STDs
• Urinary Tract Infection (UTI)

Why Does My Vagina Hurt During Sex? 13 Causes of Painful Intercourse

While sex should be a time of pleasure and intimacy, for many women, it can become uncomfortable and painful.

Instead of feeling close to your partner, you may find yourself tensing up and bracing for the pain you know is coming.

This pain isn’t just physical; it takes an emotional toll as well, leaving you feeling anxious, frustrated, and even fearful of intimacy. 

If you’re wondering why you’re experiencing pain during sex, you’re not alone. Painful sexual intercourse affects approximately 10 to 20% of women in the U.S.

In this article, we’ll explore the common causes of vaginal pain during sex and what you can do to reclaim your confidence and comfort in the bedroom.

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What is Dyspareunia?

Dyspareunia is a medical term for persistent or recurrent pain experienced during or after sexual intercourse. 

This condition can affect women of all ages and can be triggered by a variety of physical and psychological factors.

The pain can be felt in different regions of the body, including the vagina, vulva, or deep within the pelvis.

The symptoms of dyspareunia include:

• A sharp pain during penetration

• Deep pain during thrusting

• Throbbing or aching of the vagina and pelvis after sex

• Pelvic cramping

• Muscle tightness or spasms

• Bladder pain

The Different Types of Dyspareunia

There are three main types of dyspareunia that women may experience:

Entry pain

This type of sexual pain is felt at the entrance of the vagina during initial penetration. Causes of entry pain can include vaginal dryness, infection, and hormonal changes.

Positional pain

Positional pain is when sexual intercourse is painful in certain positions, and it’s usually related to a woman's pelvic floor muscles, vaginal dryness, or infection.

Deep pain

Also known as collision dyspareunia, this pain occurs during deep penetration. 

It may feel worse in certain sexual positions and can be linked to bladder issues, bowel conditions, or pelvic floor dysfunction.

What Causes Painful Sex for Women?

There are several reasons why women may experience genital pain during sexual intercourse:

Medical conditions

Certain medical conditions, especially those that affect nearby organs and other parts of the body, can cause painful sex.

Endometriosis

This condition occurs when tissue similar to the uterine lining spreads to other parts of the reproductive system. The abnormal tissue growth causes chronic inflammation in the pelvic area, which can make pelvic tissue more sensitive to pain during sex.

Skin disorders

Skin disorders such as dermatitis cause the skin to become red, swollen, and irritated. 

In the genital area, where the skin is particularly sensitive, this inflammation can lead to significant discomfort.

During sex, the friction between the inflamed skin and your partner’s body — or clothing and condoms — can exacerbate the irritation, leading to painful intercourse.

Pelvic floor dysfunction

Pelvic floor dysfunction refers to a group of conditions that affect the muscles, ligaments, and connective tissues that support the pelvic organs. 

When the pelvic floor muscles are too tight or in a state of constant contraction — known as hypertonic pelvic floor — it can result in pain during penetration. 

The muscles may spasm during or after sex, leading to sharp pain or a burning sensation in the vagina or deep within the pelvis.

Bowel problems

Conditions that cause inflammation in the bowels can make sex painful. Irritable bowel syndrome (IBS), for example, causes significant bloating and abdominal pain. 

This bloating can increase pressure on the pelvic organs and may lead to pain during deep penetration. 

Bladder problems

Bladder conditions such as a urinary tract infection (UTI) cause inflammation of the urethra and bladder. During sex, the movement and pressure can irritate these inflamed tissues, leading to pain and discomfort. 

The irritation from a UTI may also extend to surrounding areas, including the vaginal regions, which could result in a burning or stinging sensation during sex.

Hormonal changes

Hormonal fluctuations, such as those experienced during perimenopause, can affect the moisture levels and elasticity of the vaginal tissues due to decreasing estrogen levels.

When estrogen levels decline, the vaginal walls produce less lubrication, leading to dryness. 

Vaginal dryness can cause increased friction during sex, leading to irritation, discomfort, and pain. This lack of natural lubrication can also make penetration difficult and uncomfortable.

Nervous system concerns

Conditions such as a pinched nerve in the back and nerve inflammation may cause pain during sex. 

This is because the nerves in the back play a crucial role in sending signals to and from the pelvic region. If a nerve in the back is pinched or inflamed, it can send pain signals to the vagina, causing discomfort.

A pinched nerve in the lower back can cause referred pain that radiates to the pelvic area, including the vagina, lower abdomen, and inner thighs. 

This referred pain can make sexual activity unpleasant, even if the pelvic region isn’t directly affected.

Breastfeeding

During breastfeeding, the body produces higher levels of prolactin, the hormone responsible for milk production. Elevated levels of prolactin suppress the production of estrogen, which is essential for vaginal health.

As mentioned earlier, reduced estrogen levels can lead to vaginal dryness, which can make sex painful due to increased friction.

A decrease in estrogen can also cause the vaginal walls to become thinner, less elastic, and more fragile, resulting in a condition known as vaginal atrophy. 

This thinning makes the vaginal tissues more susceptible to irritation and microtrears during intercourse, leading to pain. 

Vulvodynia

Around 16% of all women in the U.S. will be affected by vulvodynia at some point in their lives.

Vulvodynia is a chronic pain condition characterized by pain or discomfort of the vulva, the external part of the female genitalia. This pain is often described as burning, stinging, itching, or tenderness.

Women with vulvodynia often have heightened sensitivity in the vulvar area, and this can make even gentle touch or pressure painful.

Genitourinary syndrome of menopause (GSM)

This is a collection of symptoms and physical changes that occur in the female genital and urinary systems due to decreased estrogen levels during menopause. 

More than 85% of women over 40 experience GSM and this condition affects the vagina, vulva, urethra, and bladder.

Due to decreased estrogen production, women may experience vaginal dryness. As discussed above, this can cause painful sex due to increased friction.

Lower estrogen levels also lead to vaginal atrophy, and this can make the vagina feel tighter and less accommodating during sex, leading to discomfort and pain, especially with deep penetration.

Vaginismus

Vaginismus is a condition characterized by involuntary muscle contractions of the pelvic floor muscles surrounding the vaginal opening, making penetration difficult, painful, or even impossible.

These spasms are beyond a woman’s control and can occur during attempts at vaginal penetration, gynecological exams, or when trying to insert a tampon.

Many women with vaginismus develop anxiety or fear around sexual activity due to the anticipation of pain. This fear can intensify muscle contractions, creating a cycle where anxiety leads to more intense spasms and greater pain during intercourse.

In some cases, past trauma, such as sexual abuse or painful medical procedures, may contribute to the development of this condition.

Trauma or injury

Having intercourse too soon after childbirth can be significantly painful for women, which is why most doctors recommend waiting at least six weeks after giving birth to have sex again. 

This allows the body to heal and recover from issues like vaginal tears.

Injuries like a vaginal tear from childbirth or an episiotomy, a cut made in the perineum (the area of skin between the vagina and anus) to aid vaginal delivery, can also make sex painful for women.

Infection

Conditions such as yeast infections, bacterial vaginosis (BV), or sexually transmitted infections (STIs) can cause painful sex for women. 

These infections cause inflammation of the vaginal tissues, which can lead to swelling, redness, and increased sensitivity. 

During sex, the friction from penetration can aggravate these inflamed tissues, leading to pain or discomfort.

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What Can I Do about Painful Intercourse?

The first step to treating dyspareunia is to consult a healthcare professional. 

There are many ways a doctor can treat your symptoms, but these methods depend on the cause of your vaginal pain.

For example, if pelvic floor dysfunction is causing the pain, pelvic floor physical therapy may be the treatment your healthcare provider suggests.

Some treatments for pain during intercourse due to menopause include prescription medication, estrogen creams, and vaginal rings or tablets.

Your doctor can also prescribe medications to treat pain due to infection or underlying medical conditions.

How Do I Manage Dyspareunia? 

Here are a few things you can do to make sex more comfortable and avoid vaginal pain:

• Lubricant: Use a water or silicone-based lubricant to help with vaginal dryness.

• Positioning: Try different sexual positions or activities until you find ones that don’t cause you pain.

• Pain relievers: Take over-the-counter (OTC) pain medications before sex.

• Relaxation: Find time to relax before sex and consider trying some breathing exercises. 

• Ice packs: Apply an ice pack to your vulva after sexual intercourse to alleviate discomfort and pain.

Where Can I Learn More about My Sexual Health?

At LifeMD, you can consult a board-certified physician or nurse practitioner to learn more about your sexual health.

We can connect you with healthcare professionals who can provide expert medical advice, treat various conditions, and order lab work.

Our consultations are conducted online through our telehealth platform, so you can get medical treatment anywhere at a time that suits you.

Make an online appointment today to get started.

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