Experiencing some pain or discomfort before, during or after sex can affect women of all ages. But there are treatments available, and you can seek help. If you find that sex is often painful, you should visit your doctor to check there are no underlying causes.

What is painful sex and what can cause it?

Pelvic pain before, during or after vaginal intercourse is called ‘dyspareunia’.

Painful sex can be caused by physical or psychological problems. Psychological causes (such as relationship problems, stress and anxiety) can make painful sex worse.

Painful sex falls in to 2 categories: deep pain and superficial pain.

Deep pain

Deep pain is when you feel pain deep inside your pelvis, such as when your partner thrusts, or when the penis, fingers, sex aid or toy is fully inside you. The pain can be a burning, tearing or aching feeling.

Common causes of deep pain include conditions such as:

• endometriosis — a condition where cells that line the uterus (womb) grow in other parts of the body
• adenomyosis — a condition where cells that line the uterus (womb) grow in the muscle around the uterus
• prolapsed uterus — when the womb drops down towards the vaginal opening
• fibroids — growths in the womb
• ovarian cysts — fluid-filled sacs in the ovary
• irritable bowel syndrome

Other common causes of deep pain include:

• bladder infection
• Urinary tract infection
• sexually transmitted infections (STIs) such as chlamydia or gonorrhoea
• pelvic inflammatory disease (PID) — a condition where the uterus, fallopian tubes, and ovaries may become inflamed
• having a dry vagina
• recent childbirth
• ectopic pregnancy — where the foetus grows outside of the womb
• previous surgery or radiation treatment to the pelvis

Superficial pain

Superficial pain is when you feel pain before the penis, fingers or sex toy has fully entered your vagina. For example, at the entrance of your vagina rather than deep inside.

Common causes of superficial pain include:

• skin irritation or a condition like eczema
• thrush
• a condition called vaginismus (see below), which causes the muscles around the vagina to spasm
• injury to part of your vagina
• a foreign body being inside the vagina
• having a dry vagina (this often happens around the time of menopause or after childbirth)
• not enough lubrication (this may be due to lack or arousal, hormone changes or certain medicines)
• STI’s such as genital herpesor trichomoniasis
• having a partner with a large penis
• having an intact or thickened hymen

Vaginismus

Vaginismus is a condition that causes the muscles around the vagina to tighten by themselves. It usually occurs when the genital area is touched. This can be before or during sexual intercourse, when attempting to insert a tampon, or during a pelvic examination.

When should I see my doctor about painful sex?

You do not have to have sex if it is painful. Go to see a doctor you can talk to openly. Often it can take a while for the problems that cause painful sex to go away. Still having sex while it’s painful may delay your recovery.

If you have painful sex, it is important to see your doctor to check what the cause is.

How is painful sex and its causes diagnosed?

Your doctor will ask about your symptoms and how long you have had them. They may ask what triggers the pain. They may ask about your other medical conditions and any other symptoms you have had.

Your doctor will probably do a physical examination and may suggest some tests. They may refer you to a specialist doctor for tests or treatment.

Depending on the cause, you may also be referred to a specialist pelvic floor physiotherapist, sex therapist or psychologist.

What treatments are there for painful sex?

The right treatment depends on the cause of the pain.

Simple treatments may involve advice on using a lubricant, longer foreplay or changing sexual technique.

For some women, seeing a physiotherapist who specializes in pelvic floor physiotherapy helps. For others, a psychologist can talk to you about psychological problems or relationship issues that may be contributing.

Your doctor will recommend treatment of any underlying condition that may be causing painful sex. Your doctor may prescribe a medication or ointment to treat the cause of the pain. They may also recommend a change in contraception.

Talk to your doctor about the most appropriate treatment for you.