7 reasons why sex might feel painful

Sex should feel good. Unless you’re into pain, in which case, go ahead bb. But unexpectedly painful sex not only seriously kills the mood, but could also be a sign of an underlying health issue. Unfortunately, women have been socialized to expect pain as part of sex. Sex should NOT hurt, and if it does, that means there’s a problem, whether it’s a simple lack of lube or a more serious health condition. 

Pain during sex, or dyspareunia, is unfortunately very common. According to the American Congress of Obstetricians and Gynecologists, nearly three out of four women experience painful sex at some point. For many women, this pain is temporary, but between 7 and 22% of women report consistent pain during sex. The wide range in this statistic may be due to the fact that many women don’t bother to tell their doctor about painful sex. 

Even though painful sex is common, it is not normal. There are several reasons why sex might hurt. Some women experience pain with arousal, upon initial or deep penetration, during orgasm, and/or following sex. This pain is usually experienced either in the vagina or deeper in the pelvis (below your belly button), and ranges from mild to severe. The most common explanation is a lack of arousal or lubrication, which can usually be solved with some foreplay and lube. However, pain can also be caused by temporary issues such as certain positions, infection, allergy, or irritation, as well as more serious causes, such as pelvic floor issues or conditions such as fibroids or endometriosis. 

The myth persists that having sex for the first time hurts, but it does not have to. This myth often specifically refers to “breaking” the hymen, but this terminology is flawed; the hymen does not break, but actually stretches when something is inserted into the vagina. Sometimes this stretching can cause small tears, especially if the opening in the hymen is small, which may lead to some bleeding. If you have never experienced penetration before, especially with an object larger than a tampon or finger, it will feel comparatively more uncomfortable, but it should not be painful. 

Yes, really. If sex hurts, many women begin to anticipate the pain, which increases the pain response and further lessens lubrication and libido. The good news is that there are ways to make sex less painful and more fun. Sometimes the solution is relatively straightforward and easy, but it can be more complicated due to the multiple systems needed to maintain vaginal health, from hormones to pelvic floor muscles. 

For this article, we are focusing on penetrative vaginal sex (sex involving a toy, finger, or penis entering the vagina). People with penises can also experience painful sex for a variety of reasons, including infection, tightness or small tears in the foreskin, inflammation of the prostate, etc. But for now, here are some reasons why sex might be painful if you have a vagina — and what you can do to prevent them.

1. Lack of lubrication 

Even though your vagina naturally self-lubricates, if you haven’t had enough foreplay to warm up, you could experience dryness, which can cause painful friction during sex. Or your brain is ready to go, but your body isn’t getting the message. That’s totally ok, sometimes you might not get wet no matter how aroused you feel. Vaginal dryness can also be caused by hormones, medication, breastfeeding, menopause, or even stress. 

The solution: First try foreplay — make sure you are properly warmed up, and communicate with your partner about what turns you on. Take as long as you need. Next, use lube (remember, use a water-based formula instead of oil-based if you are using condoms). For chronic dryness issues, talk to your healthcare provider.

2. Allergies 

Allergic reactions to latex condoms, lube, spermicides, or even certain soaps can throw off your vagina’s delicate pH balance and cause irritation.

The solution: Luckily, this is a pretty easy fix. Once you’ve identified what you’re allergic to, stop using it and find an alternative. Before trying new products, test your reaction on a smaller patch of skin far away from your genitals. 

3. Infection 

Yeast infections, urinary tract infections, and STIs can cause inflammation or irritation of the vulva and vaginal canal, making entry and penetration painful. Some infections can also affect the cervix and uterus, which may cause deeper pain with thrusting. Other STI symptoms, such as itching and burning, can also be quite painful. If an STI goes untreated and spreads, you can develop pelvic inflammatory disease, an infection of the reproductive organs that can cause pain during sex. 

The solution: Often STIs have no symptoms at all, so the best way to tell if an infection is responsible for pain is to get tested. There are plenty of medications to treat STIs and other infections. You can avoid yeast infections by wearing cotton underwear and not using douches. To prevent urinary tract infections, pee and clean your genitals before and after sex. 

4. Injuries or irritation 

The skin of the vulva and vaginal opening is very delicate and sensitive, making them more vulnerable to injuries. If you have tears or scarring, sex can be very painful, especially if you are not fully healed. Ingrown hairs or certain skin conditions such as eczema can also cause irritation or lesions that can hurt when there is friction. 

The solution: Wait to have sex until you have healed properly, or ease into it with extra lube. And make sure your partner cuts (and files!) their fingernails and washes their hands before insertion so as not to inflict or infect tears.  

5. Pelvic floor issues 

The pelvic floor muscle supports your pelvic organs and helps maintain continence. If your pelvic floor muscle becomes hypertonic (constantly contracted), it can lead to myofascial trigger points (knots), nerve sensitivity, or overall tightness, making sex very painful. 

The solution: Pelvic floor physical therapists can help with hypertonic muscles and other issues.  Also- kegel balls!

6. Medical condition 

There are a handful of medical conditions that can make sex feel painful.

Vaginismus 

Vaginismus, or genito-pelvic pain/penetration disorder, causes involuntary spasms of the muscles in response to penetration, making penetration excruciatingly painful or impossible. Vaginismus often has a psychological background related to trauma or abuse. 

Vulvodynia 

Vulvodynia, or chronic vulvar pain, is often described as stabbing or shooting pain in the inner and outer labia around the opening of the vagina. Any sort of pressure, from sex to even bike riding, tight pants, or sitting too long, can cause pain. Vulvodynia is also commonly associated with sexual trauma. 

Endometriosis 

Deep pain during sex can be a sign of endometriosis, a condition where the tissue that normally lines the uterus grows elsewhere in the body. Pain during sex is caused by bleeding and swelling of the endometrial growths. 

Ruptured cyst 

Cysts can develop on the ovaries during ovulation, but they usually go unnoticed and resolve on their own. Sometimes, deep penetration can cause these cysts to rupture, resulting in sudden, sharp pain. Usually these will resolve on their own, but if pain is accompanied by bloating, nausea, and bleeding that is not menstrual, see a healthcare provider. This could mean a blood-filled cyst has burst, which can cause internal and external bleeding.

Fibroids 

Uterine fibroids are benign tumors that grow in the walls of the uterus. Almost two-thirds of women will develop uterine fibroids at some point, but they only cause symptoms in about 25% of these cases. In addition to painful sex, symptoms include heavy periods, constipation, and abdominal bloating.

Cervicitis 

Cervicitis, or inflammation of the cervix, can happen for many reasons. Allergies, STIs, a yeast infection, or bacterial vaginosis can cause the tissue to be extra sensitive, making penetration extremely painful.

The solution: Each of these conditions has different treatment options, but the first step is seeing your healthcare provider to develop a plan. If you are trying to determine whether you have a condition, keep a journal tracking your symptoms before you visit a specialist. If your condition is linked to sexual trauma, consider seeing a psychologist or therapist as well. 

7. Positions

Not every position works for everyone because everyone’s vagina is a different shape and size. For some people, especially if you have a shallow or tilted cervix, certain positions and angles can hurt if their cervix is touched. The size and curvature of your partner’s penis can also make certain positions more or less comfortable. 

The solution: Get creative with positions! If a penis is so large that penetration hurts, try working up to it with foreplay, toys, manual stimulation, or simple moves like missionary.