What is painful sex?

Painful sex is discomfort before, during or after sex. Many females experience painful sex at some point in their lives.

Pain during or after vaginal intercourse is also called dyspareunia. It may feel dull, sharp, burning, aching or itching.

Painful sex is often described as:

• deep pain — felt deep inside your pelvis during or after penetration. It may happen when a penis, fingers or a sex aid move deeper into your vagina.
• superficial or entry pain — pain at the entrance of your vagina rather than deep inside. This type of pain may happen before penetration or when something first enters the vagina.

This article relates to people who were assigned female at birth.

What causes painful sex in females?

Painful sex can have physical, emotional or psychological causes. Sometimes more than one factor is involved.

Vaginismus

One of the leading causes of painful sex is vaginismus.

This happens when your pelvic floor muscles tighten or contract without your control.

This can make vaginal penetration difficult, painful and sometimes impossible.

Because penetration may be painful, you may start to avoid sex due to fear or anxiety about pain. This can create a cycle where fear leads to muscle tightening, which causes more pain.

Physical conditions

Painful sex may also be caused by medical conditions affecting the vagina or pelvis, such as:

• vaginal dryness
• vaginal or genital infections — such as fungal infections, herpes simplex virus or genital warts
• gynaecological conditions — such as endometriosis, fibroids or pelvic inflammatory disease (PID)
• conditions affecting the vulva or vaginal opening
• skin conditions affecting the genital area — such as eczema, psoriasis or dermatitis
• previous surgery or radiation treatment
• other health issues — such as bladder or bowel problems, urinary tract infections, prolapsed uterus or injury from trauma or childbirth

Emotional factors

Emotional factors may also lead to painful sex, including:

• anxiety about penetration
• negative experiences with sex or medical examinations
• sexual trauma
• beliefs or attitudes about sex learned from family, culture or religion

These factors can influence how your body responds to sexual activity, including causing the pelvic floor muscles to tighten.

When should I see my doctor?

If you have painful sex, see your doctor to help find the cause. Choose a doctor you feel comfortable speaking with.

You do not have to continue having sex if it causes pain.

How is painful sex in females treated?

Treatment depends on the cause of your pain. Your doctor may ask questions about your symptoms and examine you to help find the cause. Sometimes tests are needed, such as:

• a vaginal swab
• tests for sexually transmitted infections (STIs)
• imaging such as an x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) or an ultrasound

Self-care at home

There are some things you can do to make sex less painful. These steps may help reduce pain during sex:

• Use water-based lubricants during sex to reduce friction.
• Use vaginal moisturisers to improve vaginal comfort.
• Allow more time for arousal and foreplay before penetration.
• Try sexual positions that feel more comfortable.
• Avoid products that may irritate the genital area, such as scented soaps or sprays.
• Practise pelvic floor relaxation exercises.
• Talk openly with your partner about any discomfort or pain during sex.

Medicines

Some medicines may help treat painful sex, depending on the cause. This may include vaginal creams or gels to improve vaginal health. Medicines may also treat infections or other underlying medical conditions.

Talk to your doctor about the treatment options that may work best for you.

Other treatment options

You may benefit from other treatments or specialist care, such as:

• pelvic floor physiotherapy to help relax tight pelvic muscles
• sex therapy or counselling to help address pain, anxiety or relationship concerns
• treatment for underlying conditions such as pelvic floor disorders and vulvar skin conditions
• specialist treatments for some conditions, such as laser therapy

Your doctor may refer you to a specialist, such as a gynaecologist, pelvic floor physiotherapist or sexual health therapist.

What are the complications of painful sex in females?

Painful sex may:

• lead to ongoing sexual problems, such as avoiding sex or reduced sexual desire
• cause fear of sex, stress or distress
• affect intimate relationships
• lower your confidence, self-image or self-esteem

Can painful sex in females be prevented?

It may not always be possible to prevent painful sex. Treating underlying health conditions and maintaining vaginal health may help lessen the chance of pain during sex.

Resources and support

• Jean Hailes for Women's Health has information about a range of things that can affect your sex life, including painful sex.
• Pelvic Pain Foundation of Australia offers information on painful sex.
• Sexual Health and Family Planning provides information on painful sex.
• The Australian Menopause Society offers fact sheets on how menopause may affect your sex life.
• The Australian Government provides sexual health contacts.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

• Jean Hailes for Women's Health provides fact sheets in several languages to help you learn about sexual health.
• Sexual Health Victoria has translated resources on various sexual health topics.
• The Australian Government Department of Health, Disability and Ageing has translated resources on various sexual health topics.

Information for sexually and gender-diverse families

• QLife has free LGBTIQ+ peer support and referral, so you can talk about sexuality, gender, bodies, feelings or relationships.
• ACON offers information on sexual health topics for sexually and gender-diverse people.