Sex shouldn’t be painful. However, it’s still extremely common with nearly 3 in 4 women experiencing painful sex at some time in their lives. But just because it’s common doesn’t mean you have to live with it.

For many, sex is a sensitive topic, and experiencing painful sex could add an extra layer of worry or even embarrassment to a conversation. Just know that there’s nothing to be embarrassed about. You may not feel comfortable talking about painful sex with your family or peers, but your primary care doctor or women’s health specialist is there to help you find a solution. And don’t worry – they’re no stranger to these conversations.

Keep reading to learn more about painful sex, what may be causing it and how you can reduce, or even stop, your pain.

What is painful sex?

Painful sex, also known as dyspareunia, is a condition where you feel pain before, during or after sex. Both men and women can experience painful sex, but it’s more common in women – with most women having painful intercourse at some time in their lives.

What painful sex can feel like

Dyspareunia falls into two categories – entry pain and deep pain. When it comes to sex and your body, you might put most of the focus on your vagina, but if sex is painful and uncomfortable, you can feel it in other areas as well.

Entry pain is felt during initial penetration, and the pain you feel will be “superficial.” It’s limited to the area that surrounds the opening of your vagina, including your:

  • Vulva – The external genital area
  • Vestibule – The area surrounding the opening of your urethra and vagina
  • Perineum – The area between your vagina and anus

As the name would suggest, deep pain is felt during deeper penetration where you might experience pain in your:

  • Vagina
  • Cervix
  • Uterus
  • Bladder
  • Lower back
  • Pelvic region

When you experience pain in these areas, it could be considered primary or secondary dyspareunia. Primary dyspareunia happens the first time you have sex while secondary dyspareunia means you’ve started developing pain after having experienced pain-free intercourse.

Painful sex can happen for many reasons

Experiencing pain during sex can happen at any time in your life and there are many reasons why it occurs. Pain during sexual activity could be caused by:

Low vaginal estrogen

Estrogen is a hormone that helps your vagina keep its lubrication, elasticity and thickness. Low estrogen levels can cause vaginal atrophy – the thinning, drying and inflammation of your vaginal walls. During sex, secretions from your vaginal glands are supposed to keep your vagina lubricated, reducing friction during penetration and making sex smoother. Friction sounds harmless, but it can cause discomfort, irritation and pain during sex.

Vaginal dryness can happen at any time, but it’s more common if you’re menopausal or postmenopausal. During menopause, your estrogen levels begin to drop.

You can also experience painful sex at other times when your estrogen levels are expected to be low – after childbirth, while breastfeeding or during cancer treatments. Alternatively, it’s possible to experience vaginal dryness without a change in hormone levels. For example, some medications (cold, allergy and antidepressants) can cause vaginal dryness.

Sexually transmitted diseases (STDs)

Sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) are often used interchangeably, but they’re a little different. STIs are infections spread by sexual contact – oral, vaginal and anal. STIs become a disease once symptoms develop.

There may be a taboo around STDs and STIs, but there’s nothing to be ashamed about. Human papillomavirus (HPV) is the most common STI in the U.S., and most sexually active people will get it at some point if they haven’t received the HPV vaccine. And although HPV doesn’t typically present with symptoms, other STDs could be the cause of your painful sex.

Chlamydia is the most commonly reported STD in the U.S. In women, the infection most often affects the cervix, but it can also affect your mouth, reproductive organs, urethra and rectum. STDs like chlamydia and gonorrhea can cause deep pain during intercourse while genital herpes – an STD where blisters and sores can appear on the mouth or genitals – can cause entry pain during penetration.

If you’re sexually active, regular screening and testing for STIs can protect you and your sexual partner. Talk to your doctor to learn more about testing and treatment options if you need them.

Gynecological conditions

There are several gynecological conditions tied to your reproductive system that could be causing your uncomfortable and painful intercourse.

  • Endometriosis – Endometriosis is a chronic disease where your uterine lining grows outside the uterus, including the fallopian tubes, ovaries, vagina, pelvis and cervix. This can cause a buildup of tissue that causes inflammation, cysts, scarring and painful sex.
  • Uterine fibroids – Uterine fibroids are a condition where noncancerous growths develop in the uterus, causing painful intercourse if they’re near your cervix.
  • Ovarian cysts – Ovarian cysts are fluid-filled sacs that form in or on your ovaries. They can cause pain in your abdomen during sexual activities.
  • Vaginismus – Vaginismus is the sudden, uncontrollable tightening of your vagina that makes penetration and intercourse difficult and painful.
  • Vaginitis – Vaginitis is a condition where your vagina is inflamed, and it can cause painful intercourse as well as vaginal itching and irritation.
  • Vulvodynia – Vulvodynia is a pain disorder where you experience vulvar pain for at least three months. It can cause entry pain during penetration.

Other health conditions

Beyond low hormone levels, STIs and gynecological conditions, there could be other health conditions that are causing you to experience pain during sex. They include:

  • Vaginal injury – During childbirth, women may have an episiotomy, a surgical cut made in the perineum to widen the vaginal opening, or experience tears in their perineum that can cause painful penetration and sex for months after delivery.
  • Skin disorders – Some skin disorders or dermatologic conditions, like contact dermatitis, can affect the skin of the vulva, causing ulcers and cracks that can lead to burning and pain during sex.
  • Irritable Bowel Syndrome (IBS) – A condition that can cause bloating, constipation and stomach cramps. It can also cause you to feel deep pain in your pelvis during intercourse.

Conditions like pelvic inflammatory disease (PID) and chronic back pain can also make intercourse more painful and uncomfortable.

Sexual response problems

Sex is as much an activity for your mind as it is for your body. A lack of desire or arousal can make sex painful, and there are a few reasons why this could happen.

Your state of mind and relationship with your partner could cause you to feel anxious, embarrassed or awkward about having sex. These feelings make it hard to feel arousal, and if your body isn’t aroused, it’s harder for your vagina to produce the natural lubrication it needs to make penetration easier.

Certain medical conditions and medications can also decrease your desire and arousal. Arthritis, diabetes, cancer and thyroid conditions, as well as some medications can decrease your libido and affect your sexual response.

When to see a doctor about painful sex

Experiencing painful sex once or twice may not be cause for concern, but if you have frequent or severe pain, schedule an appointment with your doctor.

During your appointment, your doctor may:

  • Review your medical history. Your doctor will go over any signs or symptoms you’re experiencing. They’ll also cover your medical and sexual history, including medications, medical conditions and your past sexual experiences.
  • Perform a pelvic exam or ultrasound. These tests may be necessary to determine the cause behind your painful intercourse.
  • Refer you to another care provider. Depending on what’s causing painful sex, your doctor may refer you to other specialists, such as gynecologists, physical therapists or gastroenterologists, to help treat or manage your symptoms.

Treatment options for painful sex

There isn’t just one standard way to treat painful sex and your doctor can’t offer treatment until they know what’s causing it. Once they do, treatment options may include:

  • Antibiotics – Antibiotics are used to treat STIs and in turn, can treat any STD-related dyspareunia. Medications like azithromycin can treat STIs like chlamydia and help treat gonorrhea.
  • Topical estrogens – When low hormone levels cause vaginal atrophy or dryness, doctors may prescribe topical estrogens to balance your low estrogen levels. This will help your vagina maintain its lubrication and elasticity.

If painful sex is caused by other gynecological conditions, a women’s health specialist can help relieve your symptoms by treating conditions like uterine fibroids, endometriosis and ovarian cysts.

How can I reduce pain during sex?

The best way to reduce painful sex is to go to your doctor, but you can be proactive and make certain adjustments before, during and after sex to boost symptom relief:

  • Take an over-the-counter (OTC) pain reliever before sex.
  • Use a water-soluble or silicone-based lubricant to make penetration smoother and less irritating to your vagina.
  • Apply a cool gel pack on your vulva to relieve burning or sensitivity after intercourse.
  • Try non-penetrative sex or masturbation.

Improve your sex life

Talking about painful sex can be an uncomfortable conversation, but you’re not the only one experiencing it. Hopefully knowing that can give you the courage to feel comfortable talking about it with your peers, and more importantly, with your doctor.

If your symptoms are frequent and severe, schedule an appointment with your primary care doctor or OB-GYN. Not only can they help you figure out what’s causing you to have painful intercourse, but they can guide you through a treatment plan that will give you relief and improve your sexual experiences.