Pain during sex isn't totally uncommon—we've all felt the cringe that follows not using enough lube. But for some of us, it happens more often: In fact, according to a 2021 study, between 10% and 20% of US women report persistent pain during sex. Deborah Coady, MD, a New York City ob-gyn and author of Healing Painful Sex, says there are many more who experience periodic pain.
If you do have any pain during the action, it's important to pay attention. First things first: Determine whether the pain is transient (an occasional occurrence) or consistent (a regular problem you've had more than two or three times in a row), says Dr. Coady. Next, analyze the situation when the pain occurs: What's going on in your body in that moment? Are you in an uncomfortable position? What is your emotional comfort like? Do you have any infections? Where are you in your cycle? That will help your ob-gyn figure out for sure what's going on.
Here are the most common reasons you might feel pain during sex with insight from Dr. Coady, physical therapist Amy Stein, DPT, of Beyond Basics Physical Therapy, and gynecologist Dr. Dena Harris. These experts break down what might be causing you pain—and when to talk to your doctor.
1. You’re not lubricated enough.
Having sex when you're not fully lubed up can be seriously uncomfortable. (There's a reason “Use more lube” appears on every list of anal sex tips.) “The tissues are not engorged and lubricated and ready,” says Dr. Coady. Luckily, there's a pretty easy fix. If you're not getting naturally aroused, spend more time on foreplay. But even with foreplay, some people need a little extra help (and that's totally okay). Look for a lube that's water-based (i.e., formulated without oil) if you're using condoms.
2. You used a new personal care product.
Another major culprit of transient pain is certain personal care products, says Dr. Coady. These include “creams and douches and contact irritants such as soaps,” she says. For females, these products are often full of chemicals that can be irritating to the super-sensitive skin on your vulva and inside your vagina. If you have any sort of issue, ask for a recommendation from your gyno, and if you have any sort of irritation or, worse, an allergic reaction after trying a new product, stop using it immediately and call your doctor.
3. You have an infection.
Yeast infections and urinary tract infections can make sex really uncomfortable. While these things are generally easy to treat on their own, Dr. Coady says they can be exacerbated (or first made evident) by sex. Your doctor will likely advise you to forgo sex while you're being treated for the infection. If the pain doesn't resolve, don't be afraid to head back to your doctor for a follow-up. “If there's pain in the bladder and it's consistent and antibiotics don't work, that should really be evaluated,” Dr. Coady says. Yeast infections are easily treatable, Dr. Harris adds, unless it’s a kind of resistant yeast. A doctor will do tests to help you figure that out.
4. You’re constipated or bloated.
Both of these issues—especially bloat—can cause pelvic pain during sex. But, as Dr. Coady points out, they should be short-lived. If it's a consistent problem, let your doctor know.
5. You have a condition called vestibulodynia.
In some cases, the pain is more constant than situational, which could be a sign of a chronic issue like vestibulodynia—“an inflammatory disorder or process that occurs in the tissue at the vaginal opening,” says Dr. Coady and adds that 80% of consistent sexual pain in women (premenopause) is caused by vestibulodynia. The condition causes pain when the sensitive area is provoked in any way, sexual or not—even by a tampon. If you're having pain at the opening of your vagina on a regular basis, get it checked out to know for sure whether this is the case, and to get treatment.
6. You’re having a reaction to birth control pills.
“Some young women—about 5%—have some reaction to birth control pills where they have some type of atrophy in that area,” says Dr. Harris. “Sex can be painful, and they cannot have penetration. Treatment for that is to stop birth control pills and apply an estrogen-testosterone compound and some physical therapy. Usually, after three to six months, they're feeling much better.” She adds that this could be the case for people who have experienced painful intercourse after using the pill in the first year, who have slowly felt pain after using it for many years or at any time.
7. Your pelvic-floor muscles are shortened, overactive, or in spasm.
The muscles in your vagina might tense up due to vestibulodynia, but it can also be a sign of more serious conditions like interstitial cystitis or painful bladder syndrome. These conditions can cause the muscles to become shortened or overactive, Dr. Coady says, because they're reacting to another issue in your body. Your doctor may refer you to a pelvic floor physical therapist.
“When the muscles spasm,” says Amy Stein, DPT, “they tighten and they don't allow you to empty your bladder or defecate normally because they're too tight, too spasmed, and/or they don't allow you to have penetrative sex. It's too painful, because they're too tight.” A physical therapist can help you heal pelvic muscles in spasm by figuring out what works for you, whether it be massage, heat and ice, gently stretching the muscles, or some other combination.
8. You’re not working out the right way.
Pain during sex can also come from using your core incorrectly during workouts. “During exercise, if there is a muscle imbalance anywhere in the body, there is a higher chance of pulling a muscle or straining a muscle,” Stein says. “If one muscle's too tight and one's too long, they're both working at nonoptimal levels. It could be that they're overworking and getting irritated by a specific exercise or workout.” Pelvic floor muscles connect to the hip, so if one hip is tighter or your core is imbalanced, it could cause pelvic and thereby sexual pain. If there’s a musculoskeletal problem, a physical therapist can help you figure it out and fix it.
9. You’re tensing your muscles and don’t know it.
According to Stein, most people don’t even notice they’re doing this. “Some people have a really hard time relaxing the muscles because, again, they're too tight so they're not relaxing fully,” she says. “You should be able to gently bulge or push out at the pelvic floor muscles.” Learning how to relax your muscles and use them appropriately will be important here, or you could have pain during sex and upon emptying your bladder and bowels.
10. You have another undiagnosed problem.
Whether there's an ongoing issue or not, it's important to “know your anatomy,” Dr. Coady says. “Know how you look and know your baseline of feeling fine.” If you feel something outside of that baseline, always get it checked out. “Never ignore pain,” she says, or symptoms like consistent bleeding after sex.
More important, don't let anyone tell you it's just in your head. “The most important thing is self-advocacy,” Dr. Coady says. “If your doctor says they don't see anything and it must be in your head, the mistake would be to not change doctors. Anyone who says they can't help you, or that there's nothing there, is not the right doctor.”
This article was originally published in 2019.
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