What Causes Painful Sex?

December 20, 2021

Do you live in fear of painful sex? Is pain during or after sex ruining your sex life? Are you worried about what may be causing it?

Any pain or discomfort you feel in the pelvic region, vagina, or labia during or after sex is known as dyspareunia. The word derives from Greek, meaning “difficulty mating.” A man clearly coined this term because women have sex for pleasure, not purely for procreation.

But if pain plagues your life – either during intercourse or for hours or sometimes even days after the event – then sex isn’t pleasurable at all. It’s miserable.

In fact, many women suffer from painful sex so much that the anxiety about it before sex even happens stops them from having sex altogether, which can put an intense strain on your relationship and contribute to a reduction in your quality of life – if you’re not able to have sex with your partner when you want to.

Most young women having sex for the first time usually have pain for the first one or two times. This pain is a standard and socially accepted topic amongst young women—a coming of age event – discussing your first, exciting sexual adventure with your girlfriends. However, painful sex in mid-life and beyond is more of a taboo subject. We consider it a sign that we’re all “dried up” and past our prime, right?

Wrong.

Symptoms of painful sex vary from woman to woman. But, thankfully, with physical therapy and sometimes: modern medicine, most causes of painful intercourse are treatable.

Even if the root cause is the declining estrogen levels associated with perimenopause and menopause, society leads us to believe it. Still, the natural end of our fertile years shouldn’t signal the end of sex too. Sex in and after menopause should be just as enjoyable (if not more so) than it was when you were younger.

What Is Painful Intercourse?

Pain during sexual intercourse can be vaginal pain, pain in the labia or vulva, or deep pelvic pain that occurs while having sex. For you, it could be a burning sensation, sharp pain, or deep pain.

Where do you feel it?

What Causes Painful Sex?

Painful sex is among the leading causes of sexual dysfunction among women, with some citing the possible reasons for its rise as:

Modern-day changes in women’s sexual behavior
More willingness to talk about sex-related medical issues
A rise in STIs (sexually transmitted infections)

Make what you will of that list. The most likely explanation is that we’re more willing to talk about sex-related medical issues, which reflects in the stats. But, unfortunately, women have most likely been suffering in silence for millennia.

But regardless of what the stats say about why it’s more common now, here are the leading causes of painful sex in women:

Women suffering from “vulvodynia” experience pain during sex in the vulvar area, which occurs due to no known cause
Women that go through menopause report it is more painful due to declining estrogen levels and the associated dryness and thinning of the vaginal walls.
Vaginal irritation or injury
Infections – including sexually transmitted infections and infections in the urinary tract
Vaginal wall muscle spasms – known as “vaginismus.”
Skin ailments in the genital region

What Are the Symptoms of Painful Sex?

Symptoms related to pain during sex occur during or directly after intercourse. They include:

Pain on entry – felt as burning pain or sharp stabbing sensation
Pain deep within the vagina – around the cervix
Muscle tightness or cramps in the pelvic region
Muscle spasms in or around the vagina

Pain during sex is then categorized further to include:

Primary Pain – experienced throughout a woman’s sexual life.
Secondary pain – happens further down the line at a later stage.
Complete pain – occurs from the initial point of penetration and lasts for the duration of intercourse.
Situational pain – happens with a specific stimulation or particular partner.
Finally, entrance Pain – is experienced during penetration.
Deep Thrust Pain – is located at the cervix or in the lower abdominal area and is noticeable during or after penetration.

You may also perceive pain during intercourse even without any physical cause. This type of sexual pain without an apparent physical reason is often psychological in nature.

When should I seek help from my doctor for painful sex?

You should always consult a health care professional if you are experiencing new or worsening pain, bleeding, or discharge following intercourse.

Pain-related to intercourse is a condition that you should most appropriately discuss (in the first instance) with a primary health care doctor or OG-GYN (gynecologist). You may also need to consult with other specialists, such as a psychiatrist, psychologist, or urologist, depending on the underlying cause of your pain.

When you feel mild pain during intercourse, it is most likely not an emergency. But you should seek care in a hospital emergency department if you experience any of the following signs and symptoms:

New pain or pain that is more intense than previous episodes or pain that lasts for more than a couple of minutes.
Bleeding that starts after painful sex, particularly new-onset or severe pain.
Nausea, vomiting, or rectal pain following intercourse

How Do Doctors Diagnose the Cause of Painful Sex?

Your doctor will ask you about your pain history – when it started, how long it lasts, what triggers it, etc. This history, along with an extensive physical examination, will usually reveal the most probable cause of your pain.

If you report pain at the vaginal opening, the cause may be for one of the following reasons:

Not enough lubrication during the arousal phase (may be associated with hormonal changes: declining estrogen levels or certain medications)
Inflammation at the entrance to the vaginal canal
Painful muscle spasms in the vagina that prevent intercourse

If you report pain that feels like it covers the entire vaginal area, that may indicate:

Vulvar muscle degeneration
Chronic vulvar pain
A vaginal infection (fungal, parasitic, or bacterial)

At times, you may identify a specific area of discomfort, which may suggest that there may be a cause for the pain that is unrelated to sex. For example, it could be inflammation of the urethra (the tube that takes urine from the bladder to exit the body).

Deep thrust dyspareunia refers to pain that occurs with deep repetitive vaginal penetration by a male partner. Most women report that it feels like he is “banging” something inside their vagina with every thrust. It’s a common complaint. This particular type of pain may suggest abnormalities of the pelvic organs, such as endometriosis, adhesions, or uterine prolapse.

If you report pain in the middle of the pelvis, it may suggest that your pain originates from your uterus. However, pain on one or both sides of the pelvis suggests a problem involving the fallopian tubes, ovaries, or ligaments.

Your doctor will perform an extensive examination of your pelvis, abdomen, and lower back to understand your anatomy and find the source of your pain. The exam also allows you to guide your OG-GYN to the exact location of your discomfort because it’s sometimes difficult to describe it verbally.

Part of this exam may include a rectal exam or rectovaginal exam. In addition, they may perform a Pap smear and collect vaginal or cervical fluids for culture or an analysis of the urine (urinalysis) and other laboratory tests.

In some cases, your doctor may order medical imaging tests, such as:

A CT scan, MRI
scan, or pelvic ultrasound
An X-ray of the urinary tract, which is called a Urethrogram
An X-ray of the bladder, which is called a cystogram

Another diagnostic procedure that your doctor may use to look for urinary abnormalities is a cystoscopy. This procedure uses a thin probe with a light on the end, so your doctor can see the lining inside of the bladder and urethra. They will usually refer you to a specialist (urologist) for these procedures.

Your doctor will then provide you with a diagnosis based on your history and physical evaluation.

How Pelvic Floor Physical Therapy Can Treat Painful Sex

If there is no apparent physical cause (that would require specific medical treatment) for you experiencing painful sex or you have a condition that involves the pelvic floor – such as a pelvic organ prolapse, then physical therapy with a pelvic floor specialist can be revolutionary to cure painful sex and revive your sex life. So, if you have any pelvic pain – even if it isn’t related to sex, we can help.

Stress and tension can be powerful contributory factors with painful sex and non-specific pelvic pain. It is even more so when you spend time worrying about why things hurt down there. But this anxiety is even more reason to seek help from a trained professional – instead of “guessing” what is going on or putting it down to childbirth.

At LEVEL4 PT & Pilates, we specialize in women’s health, so you’re in incredibly safe hands. We help women, just like you. Women who struggle with incontinence, digestive issues, and pelvic pain, so your energy and attention can shift back to all the things you live to do.

Get in touch with us through our contact page, book a free phone consultation, enquire about our free discovery session, or come and see us at our Encinitas clinic.

And remember, this condition is nothing to be ashamed of. We are here to help you, we do not judge or cast doubt. Let’s get you back to health, together!

Author
Recent Posts

Dawn Andalon, DPT, MTC, CPI

Pelvic Floor Physical Therapist at LEVEL4 PT & Pilates

Dr. Dawn Andalon is a physical therapist, educator, author, and co-founder of LEVEL4 PT & Pilates. She is known as a leading spine and women’s health specialist in the San Diego area.

Prior to living in Carlsbad, CA, she worked at Nike Headquarters in Portland, OR as a physical therapist and consultant. She has always enjoyed fitness and working with the athletic population as a former dancer and gymnast. Dawn has also completed certification through Polestar Pilates which she has implemented with elite and Olympic athletes, surfers, golf pros, and the weekend warrior to enhance their chosen sport. After having 2 kids she saw a need for more highly skilled programs for women who are struggling with common body struggles after having a baby so she went on to seek more training in Pelvic floor rehab and the female athlete through Herman & Wallace Institute. As a spine specialist with a Manual Therapy Certification from University of St. Augustine and Pilates background she has helped men and women of all ages stay active and feel their best.This combined with her passion to educate women, especially the peri and post-menopausal women who want to resolve their physical concerns as they age.

Latest posts by Dawn Andalon, DPT, MTC, CPI (see all)