Painful Intercourse: What’s Causing It and How To Find Relief

Pain during sex can be troublesome and can also occasionally affect many areas of one’s life, including one’s self-esteem, mental health, efforts to conceive, and relationships with partners.

It is more common in people with vaginas but can affect those with penises as well.

Several physical conditions can be blamed, such as having an infection, not using enough lubrication, recent surgery, or illness.

In this article, we’ll talk about painful intercourse and what can cause it.

Next, we’ll discuss diagnosing and treating the problem.

Lastly, you’ll learn ways to prevent painful intercourse and when it’s time to see a doctor. 

What is Painful Intercourse (dyspareunia)?

Dyspareunia is the medical term for painful intercourse.

The pain can happen at penetration, during intercourse, or it may start after.

It may be felt deep in the pelvis or on the outer part of the genitals.

Burning pain, dull ache, or sharp pain are some common descriptions.

Unfortunately, it is difficult to know the prevalence of dyspareunia as many people don’t discuss it with their medical providers.

As a result, people may experience social isolation. 

Causes in Women

There are several causes of dyspareunia for people with vaginas. 

Vaginal Infections

Infection of the genitals can happen in the vulva or vagina.

The medical terms are vulvovaginitis or vaginitis, which means inflammation or infection.

These infections can cause itching, discharge, pain, and odor.

Vaginitis is especially common in the reproductive years and usually happens when there is a change in the healthy bacteria and yeast balance.

For example, changes can occur when you take an antibiotic, douche, or have a new sexual partner. 

Bacterial vaginosis: The most common vaginitis is bacterial vaginosis. This infection is when there are too many of a certain type of bacteria normally present in the vagina.

It can be caused by:

• Douching
• Having a new sexual partner
• Taking an antibiotic
• Using an intrauterine device (IUD)
• Having many sexual partners

Yeast Infections: Also called candidiasis, yeast infections occur when you have too much candida growing in your vagina. It’s a normal fungus that lives on your skin, but things like antibiotics, pregnancy, diabetes, or corticosteroid medications can cause it to grow too much.  

Vaginal Dryness

Vaginal dryness is when the normally lubricated tissue in the vagina loses its moisture.

There are several reasons why this may happen. 

Estrogen is a hormone that helps the vaginal walls stay full, firm, and moistened with a special clear lubrication fluid.

When estrogen levels drop off, there is a decrease in the vaginal fluid and a shrinking and thinning of the vaginal wall. 

Your estrogen levels may drop because of:

• Menopause
• Hormonal medications
• Removal of your ovaries
• Chemotherapy
• Smoking
• Depression or severe stress
• Sexual arousal disorders

Endometriosis

Endometriosis is when tissues similar to the tissues of the uterus grow in the wrong areas of the body.

For example, it can grow outside the uterus, the fallopian tubes, the ovaries, and other places.

It can cause pain felt deep in the body during sex and after.

Other symptoms include painful and heavy periods, spotting between periods, and stomach issues. 

Fibroids

Uterine fibroids are tumors that form in the muscle layer of the uterine wall.

There can be one tumor or several, and they are almost always not cancerous.

Their size ranges from as small as an apple seed to as big as a grapefruit or larger.

Fibroids are common and, in many cases, don’t have symptoms.

But some women do experience pain or pressure from them. 

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is an infection of the reproductive organs.

Untreated sexually transmitted infections (STIs), especially chlamydia and gonorrhea, are typically the cause.

It is a serious condition that can lead to difficulties getting pregnant.

Risk factors are STIs left untreated, multiple sex partners, douching, you are under 25 and are sexually active, and intrauterine devices. 

Symptoms include:

• Pain
• Foul-smelling discharge from your vagina
• Fever
• Pain with sex
• Burning feeling when you pee
• Spotting between periods

Sexually Transmitted Infections

Sexually transmitted infections (STIs), also called sexually transmitted diseases (STDs), are widespread infections passed through vaginal, anal, and oral sex.

Some STIs don’t have many symptoms, so they are commonly spread.

Most STIs are treatable, so it’s important to get tested if you are sexually active. 

Some of the most common STIs include:

• Bacterial vaginosis
• Chlamydia
• Gonorrhea
• Hepatitis
• Herpes
• HIV/AIDS
• Human papillomavirus (HPV)
• Syphilis
• Trichomoniasis

Other Causes

Other causes of pain during sexual intercourse can be medical conditions such as irritable bowel syndrome and fibromyalgia. 

After giving birth, 17%-35% of people reported they had pain with sexual activity at six months postpartum. 

Having experienced sexual trauma can have a psychological effect, making sex painful for a person. 

There are also anatomical causes such as:

• Pelvic floor muscle dysfunction
• Uterine retroversion
• Hymenal remnant
• Pelvic organ prolapse

Causes in Men

Foreskin Injury

Injury to the foreskin is typically from an accident.

People don’t always seek treatment because of extreme embarrassment; however, delaying treatment can cause further complications. 

The two most common causes of foreskin injury are zippers and penile rings.

While neither of these injuries is very common, they require treatment.

It’s important to see your healthcare provider to get care because it’s better to get early treatment to reduce the risk of further damage. 

Sexually Transmitted Infections

Sexually transmitted infections (STIs) spread from person to person through skin-on-skin contact and sexual fluids.

Some STIs have very mild symptoms that may go unnoticed.

People with penises who have sex with other people with penises are at a higher risk for syphilis and other STIs.

Anal sex and not using a condom also put you at higher risk. 

The Centers for Disease Control and Prevention (CDC) recommends annual testing for several STIs if you are sexually active.

Being sexually active puts you at risk for STIs, but there are some steps you can take to decrease the risk:

• Get the HPV, hepatitis A, and B vaccines
• Use a condom each time you have sex
• Talk to partners about STIs
• Don’t mix alcohol and recreational drugs with sex
• Limit your sexual partners

Peyronie’s Disease

Peyronie’s disease is when there is an abnormal curvature of the penis during an erection.

It is very uncommon and usually happens to people over the age of 40.

The cause of the bend is scar tissue in the penis, typically from an injury, but in some cases, the cause of the scar tissue is unknown. 

Priapism

Priapism is when the penis remains in an erection for a prolonged time, hours or more when there is no sexual stimulation.

Some blood flow disorders, erectile dysfunction medication, and several illicit drugs, including cocaine, are usually the cause.

It can be excruciating and require medical treatment to resolve correct blood flow. 

Diagnosis

If you are having pain while having sex, your body is telling you something is wrong.

Let your provider know so they can diagnose what is causing it and get you treatment.

Remember that your medical provider is used to dealing with these types of issues, and you do not need to be embarrassed.

Medical History

To start, your medical provider will want to review your medical history and what medications, supplements, and vitamins you are currently taking.

Then, your provider will ask you questions about your symptoms and sexual habits. 

Pelvic Exam

The medical provider will also need to perform an exam.

First, they will examine the genitals to look for any sores, changes in the skin, and discharge.

A sample may be taken of any discharge.

For people with vaginas, they will also do an internal examination.

This exam checks the vagina and other surrounding organs such as the urinary system to see if those organs are also tender.

At first, the medical clinician will use their finger to check the internal structures and then may switch to a speculum, which allows them to visualize the internal structures. 

Pelvic Ultrasound

A pelvic ultrasound looks at the organs in your pelvis.

For the procedure, you need a full bladder, and will be instructed to lay on the exam table wearing a gown.

The ultrasound technician will apply some gel to your abdomen and gently rub the probe back and forth on your belly.

It is a painless procedure that requires no downtime and allows your medical provider to see what is going on inside.  

Treatment

Treatment will depend on the diagnosis.

Antibiotics can be taken for bacterial infections and an antifungal cream usually clears up a yeast infection.

Hormone therapy can help in some cases, such as endometriosis and vaginal dryness.

Surgical intervention is sometimes needed for:

• Endometriosis
• Fibroids
• Injuries
• Peyronie’s disease
• Priapism

Some STIs are not treatable and will never go away.

However, some medications can help keep the symptoms minimal and slow down progression. 

At-Home Relief

There are several things you can try at home to get rid of your yeast infection:

• Over-the-counter (OTC) antifungal suppositories are available.

• Probiotics and yogurt can help restore the bacteria and yeast balance.

• Natural remedies like garlic, tea tree oil, and hydrogen peroxide can sometimes clear a fungal infection.

For vaginal dryness, try avoiding scented soaps, lotions, and douches, as they can make the problem worse.

Vaginal creams bought OTC can help keep the vagina moist for a few hours.

Also, using water-soluble lubricants during sex can help ease discomfort. 

If you believe you have an STI, see your medical provider as those require prescription medications. 

Prevention

The Centers for Disease Control and Prevention has some tips for how to stay safe during sex:

• Learn about STIs, including symptoms and how they spread

• Get vaccinated for HPV and hepatitis A and B.

• Reduce your number of sexual partners, if possible

• Be open about STI test results with partners

• Correctly and consistently use condoms

When to See a Medical Professional

If you are having pain during sex, your body is telling you something is not right.

Call your medical provider if you are consistently experiencing pain during sex.

Also, call if you have symptoms such as irregular discharge, burning, itching, or you feel like you have to pee frequently. 

Other signs you need to see your medical provider:

• You need to use lubrication, but it still feels dry
• You are feeling afraid to have sex
• It’s starting to affect your relationships