Painful sex, known medically as dyspareunia, is far more common than most people realize. Studies estimate that nearly 75% of women will experience pain during intercourse at some point in their lives.
Despite how common it is, many women hesitate to bring it up with their doctor. But pain during sex is not something you should try to ignore or accept as normal. It is your body’s way of signaling that something deserves attention.
Hormonal Changes and Vaginal Dryness
One of the most frequent causes of painful intercourse is vaginal dryness. When estrogen levels drop, the vaginal tissues become thinner, less elastic, and produce less natural lubrication. This can make sex feel uncomfortable, irritating, or outright painful.
Estrogen levels naturally decrease during perimenopause and menopause, but dryness can also affect younger women. Breastfeeding, certain birth control methods, and some medications can all reduce estrogen levels enough to cause discomfort during sex. Over-the-counter lubricants and vaginal moisturizers can provide relief for mild cases, while prescription options like low-dose vaginal estrogen may be appropriate for more persistent vaginal dryness.
Pelvic Floor Tension and Muscle Spasms
The pelvic floor is a group of muscles that support your bladder, uterus, and rectum. When these muscles become too tight or go into spasm, penetration can feel painful or even impossible. This condition, sometimes called vaginismus, involves involuntary tightening of the vaginal muscles during attempted intercourse, tampon insertion, or pelvic exams.
Pelvic floor tension can develop after childbirth, surgery, or trauma. It can also be related to stress or anxiety around sex, and may overlap with ongoing pelvic pain. Pelvic floor physical therapy is one of the most effective treatments, helping you learn to relax and strengthen these muscles in a controlled way. Your OB/GYN can evaluate your symptoms and refer you to a specialist if needed.
Endometriosis and Other Underlying Conditions
Deep pain during sex, especially in certain positions, can sometimes point to endometriosis. This condition occurs when tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, or pelvic lining. Endometriosis can cause inflammation, scarring, and significant pain that tends to worsen around your period.
Other conditions that may contribute to painful intercourse include uterine fibroids, ovarian cysts, and adenomyosis. Infections like yeast infections, bacterial vaginosis, or sexually transmitted infections can also cause pain, burning, or irritation during sex. Each of these conditions has its own set of treatment options, which is why it’s important to first get an accurate diagnosis.
Skin Conditions and Vulvar Pain
Sometimes the source of pain is not inside the vagina but on the vulva, the external tissue surrounding the vaginal opening. Conditions like vulvodynia cause chronic burning, stinging, or rawness that can make any contact with the area painful. Skin conditions such as lichen sclerosus or contact dermatitis from soaps, detergents, or personal care products can also cause irritation.
If you notice redness, itching, or burning on the outside of your genitals, mention it to your provider. These conditions are treatable, but they are often overlooked when patients focus only on internal pain.
What to Expect at Your Appointment
If you bring up painful sex at your appointment, your provider will likely start by asking about your symptoms, including when the pain started, where you feel it, and whether it happens every time or only in certain situations. A pelvic exam may be performed to check for signs of infection, dryness, muscle tension, or other physical causes.
Depending on your diagnosis, your provider may recommend lab work, an ultrasound, or a referral to a pelvic floor therapist. Treatment will depend on the underlying cause and might include hormone therapy, physical therapy, medication, or lifestyle adjustments. The goal is always to identify the cause of the symptoms and help you get better.
You Deserve Answers and Relief
Pain during sex is not something you have to live with, and you don’t need to feel embarrassed to discuss it with your doctor. Whether the cause is hormonal, muscular, or related to an underlying condition, effective treatments are available. The first step is simply starting the conversation, and sexual health counseling can be a comfortable place to begin.
The providers at Legacy For Women are experienced in diagnosing and treating the many causes of painful intercourse, and they are committed to helping you feel comfortable and heard. Schedule an appointment by calling (725) 777-0414 or visiting legacyforwomenobgyn.com/request-appointment.
