When Sex Hurts...

Possible Causes of Painful Sex, When It's Normal, and What Can Be Done

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Many women who experience painful sex remain silent. Don't do this. Take courage and speak out. i love images / Getty Images

Sex shouldn’t be painful. However, anywhere between 30 to 50% of women will experience some sort of painful sex in their lifetime.

Pain during sex can interfere with getting pregnant in a couple ways.

For one, painful sex may indicate an underlying medical condition that is negatively affecting your fertility.

Second, painful sex itself can make getting pregnant difficult to impossible. If you can’t tolerate sexual intercourse, especially around the time of ovulation, you won’t be able to get pregnant.

Learn what's normal and what's not when it comes to sexual pain, what medical conditions may cause painful intercourse, and what you should do if you're facing this problem.

Note: While this article is focused on sexual pain in women, it’s important to state that men can also experience sexual pain. Sexual pain in men can also cause difficulties with conception.  

Can Pain During Sex Ever Be Normal?

Occasional discomfort during sex can be normal.

For example, the first time a woman has sex may involve some discomfort. This may be due to inexperience and anxiety for both partners.

However, a first sexual encounter isn’t supposed to hurt. The myth that sex for the first time “should” cause pain and bleeding is untrue. Even first time sex can feel good.

Another possible normal cause of painful sex is having sex in an uncomfortable position.

Positions that allow for deep thrusting can lead to the cervix getting bumped, which can be painful.

Changing positions or avoiding uncomfortable ones can resolve this issue easily.

Another possible normal cause of discomfort during sex is not taking enough time for foreplay.

The reproductive organs actually shift during sexual arousal. This shift makes sex more comfortable.

With all that said, pain and occasional discomfort are not the same things. Pain that is consistent or prevents you from having sex is another ball game altogether.

Causes of Painful Sex That May Affect Fertility

The medical term for painful sex is dyspareunia. Painful sex can be a symptom of an underlying medical condition. Some of those conditions can negatively impact fertility or make staying pregnant more difficult.

Here are some possible causes of painful intercourse that may also impact fertility:

  • Vaginal dryness: This can range from a slight discomfort issue to a pretty intense pain, especially when combined with overall low estrogen levels. This pain tends to occur upon vaginal entry. Read more about vaginal dryness.
  • Endometriosis: Painful sex with endometriosis may be worse around ovulation and near menstruation. This pain is usually felt deeper, rather than upon entry. Read more on endometriosis symptoms.
  • Pelvic Inflammatory Disease (PID): PID is another possible cause of painful sex, typically pain felt deeply as opposed to upon entry. Learn more about PID symptoms.
  • Ovarian cysts: Most ovarian cysts will eventually disappear on their own, but 5 to 10% may require surgery. Ovarian cysts don’t usually cause painful sex, but more problematic ones can. A cyst alone is not necessarily a fertility issue, but cysts can be caused by conditions (like PCOS and endometriosis) that do impact fertility.
  • Adhesions: Adhesions are bands of tissue formed between or within organs. They can lead to pain during sex, as well as infertility and repeated miscarriage. Also known as Asherman's syndrome, uterine adhesions can be caused by intrauterine procedures, like a D&C, a procedure sometimes performed after a miscarriage, or after a hysteroscopic myomectomy. If you began to experience pelvic pain after intrauterine surgery, let your doctor know.
  • Fibroids: Fibroids are non-cancerous tumors that grow on or inside the uterine walls. They can cause painful intercourse. Fibroids can occur anywhere on the uterus, but those that grow by the cervix are most likely to cause painful intercourse. They may also lead to spotting during or after sex.
  • Vaginal agenesis: Also known as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, vaginal agenesis is when the vagina is not fully developed. It’s rare – with about 1 in 5,000 women being born with the condition – and it can cause painful sex. Surgery can help create a “neovagina,” allowing for a normal sex life. Many women with this condition also have malformations or a complete absence of the uterus. They can’t get pregnant. If they have ovaries, they may be able to have a biological child via surrogacy.
  • Intact or especially tight hymen: The hymen is a thin membrane that encircles the opening of the vagina. It does not totally cover the vaginal open but has a small hole that stretches out over time. (Though in rare cases, the hymen does completely cover the opening.) Sometimes, the hymen doesn't naturally stretch or is unusually thick or tight. This can cause painful intercourse. This can be corrected with surgery and will not affect your future fertility. 

While infertility related to these conditions may not easily be dealt with, the pain caused by them should be treatable with medications, physically therapy, lifestyle changes, or surgery.

Don’t assume you have to learn to live with the pain. Talk to your doctor about your options.

When Painful Sex Itself Makes Getting Pregnant Difficult

Sometimes, the cause for painful sex doesn’t directly affect fertility—but the fact that sex is painful makes getting pregnant difficult to impossible.

Two common sex pain conditions are vulvodynia and vaginismus.

Vulvodynia is pain in the vulva area or near the entrance of the vagina. The pain may be present all the time, sometimes, or just when touched. 

About 15% women experience vulvodynia for up to three months at some point in their lifetime. It’s unclear what causes vulvodynia. Treatment frequently requires some experimentation. What works for one woman may or may not work for another.  

Another common sex pain condition is vaginismus. Women with vaginismus experience pain upon penetration of the vagina. Some describe the pain as a “tearing” or feeling as if they are being “ripped open.”

Between 5 and 42% of women have experienced vaginismus. (The wide range of percentage is because it frequently goes under reported, making it difficult to research.)

The pain condition may seem to always have been present or may begin after months or years of pain-free experiences.

Like vulvodynia, vaginismus is not quite understood.

It was once thought to be an involuntary contraction of the vaginal muscles, leading to pain during penetration. However, this theory has been called into question.

Treatment of both conditions may require help from multiple specialists.

Medical professionals who may be able to help include gynecologists, physical therapists, pain specialists, sex therapists, and psychologists.

Talking About Painful Sex With Your Doctor

According to a study conducted in Sweden, only 28% of women with severe sexual pain ever mention it to their doctors.

Please, talk to your doctor about your pain. You do not need to suffer. There are possible treatments available.

When you talk to your doctor, be ready to share when, how, and where it hurts. This will help your doctor determine the possible cause.

If talking about the pain with your doctor would be too difficult, consider writing down the answers to the following questions ahead of time:

  • Does sex hurt during entry? Or is the pain a deeper kind of pain?
  • If it’s a deeper kind of pain, does sexual position matter? Is the pain sharp or dull?
  • Does the pain occur only during sexual intercourse? Do you experience it others times as well?
  • Does the pain seem to occur or worsen during certain times of your cycle? For example, does it hurt more around ovulation? Or around menstruation?
  • Are you breastfeeding? Did the pain start after childbirth?
  • Is the pain different depending on what is being touched? For example, do you experience pain in the vulva area, before penetration is even attempted?
  • If penetration is what causes pain, does it matter what is being inserted into the vagina? For example, can you use tampons? Does finger insertion also hurt or only penile insertion?
  • Are gynecological exams painful, too?  (Please tell your doctor if so, as she may be able to do things to make it more comfortable for you.)
  • If you hope to get pregnant, has the pain prevented you from having sex frequently enough to conceive?
  • Are you interested in alternative options for conception, like insemination?

Pain during sex is not your fault. It is not something you should feel ashamed of. It’s a medical condition. It doesn’t define you.

Unfortunately, not every doctor knows how to properly respond to or treat pain conditions. If your doctor can't help, go to someone else. Keep speaking up until you find the help you deserve.

More things to know about your body:


Diseases and Conditions: Vaginal agenesis. MayoClinic.org. Accessed March 19, 2015. http://www.mayoclinic.org/diseases-conditions/vaginal-agenesis/basics/definition/CON-20037373

Furukawa AP, Patton PE, Amato P, Li H, Leclair CM. “Dyspareunia and sexual dysfunction in women seeking fertility treatment.” Fertil Steril. 2012 Dec;98(6):1544-8.e2. doi: 10.1016/j.fertnstert.2012.08.011. Epub 2012 Sep 6. http://www.ncbi.nlm.nih.gov/pubmed/22959459

Laufer, Marc R. Diagnosis and management of congenital anomalies of the vagina. UptoDate.com. Accessed March 20, 2015. http://www.uptodate.com/contents/diagnosis-and-management-of-congenital-anomalies-of-the-vagina

LORI J. HEIM, LTC, USAF, MC, Eglin Air Force Base, Florida. “Evaluation and Differential Diagnosis of Dyspareunia.” Am Fam Physician. 2001 Apr 15;63(8):1535-1545. http://www.aafp.org/afp/2001/0415/p1535.html#afp20010415p1535-b7

National Vulvodynia Association. Treatment. Accessed March 20, 2015. http://www.nva.org/what-is-vulvodynia/treatment/

Ovarian cysts. Womenshealth.gov. Accessed March 20, 2015. http://www.womenshealth.gov/publications/our-publications/fact-sheet/ovarian-cysts.html

Painful intercourse (dyspareunia). Diseases and Conditions. MayoClinic.org. Accessed March 20, 2015. http://www.mayoclinic.org/diseases-conditions/painful-intercourse/basics/causes/con-20033293

Society for Women's Health Research. (2007, November 13). Top Cause Of Painful Sex Uncovered. ScienceDaily. Accessed March 19, 2015. http://www.sciencedaily.com/releases/2007/11/071109190251.htm

Sexual Dysfunction and Infertility. American Society of Reproductive Medicine. http://www.asrm.org/FACTSHEET_Sexual_Dysfunction_and_Infertility/

Stewart, Elizabeth Gunther. Differential diagnosis of sexual pain in women. UptoDate.com. Accessed March 20, 2015. http://www.uptodate.com/contents/differential-diagnosis-of-sexual-pain-in-women

Stewart, Elizabeth Gunther. Treatment of vulvodynia.  UptoDate.com. Accessed March 20, 2015. http://www.uptodate.com/contents/treatment-of-vulvodynia

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