When one of the most pleasurable of human activities causes physical pain, the experience quickly turns frustrating… and emotionally painful as well.

“What’s wrong with me?”

“Why can’t I enjoy this?”

“It’s not supposed to be this way!”

It’s hard to look forward to an activity that causes pain (just as most of us don’t look forward to a flu shot). When intercourse causes a woman pain, she’ll naturally be less enthusiastic about sex, and may even try to avoid it. Needless to say, this isn’t great for her relationship with her partner.

What causes pain during sex for some women… and what can be done about it?

Superficial Pain

The technical term for pain during sex is “dyspareunia,” and there are two types: superficial and deep. Superficial dyspareunia is pain at the lips, at the opening or lower part of the vagina. Pain occurs right away, and usually stops once intercourse stops. There are several types of superficial pain. Let’s examine a few.

Vaginal Dryness

Why does it hurt?

Friction can hurt. Ask anyone who ever got a rug burn.

Usually the Bartholin’s glands in the vagina produce a natural lubricant when a woman is sexually aroused. Sometimes, however, they don’t produce lubricant or enough of it to overcome the dryness of the skin. When that dry skin is pulled or tugged.

The cause might be specific to that instance, for example, if intercourse happened quickly, before foreplay brought on sufficient sexual arousal. General dryness might be caused by exposure of the vagina to soaps, swimming pool or hot tub chemicals, or some laundry detergents. Or there might be a hormonal cause. Lack of estrogen during pregnancy, breastfeeding or menopause can often cause vaginal dryness.

What can be done about it?

Avoid perfumed soaps or sprays. Make sure to give your Bartholin’s glands enough time for arousal and production of sufficient lubrication. If that’s not enough, you can use a local lubricant right before intercourse.

If a lack of estrogen is the issue, you can ask a doctor for estrogen cream, tablets or another local estrogen product to be applied to the vaginal area.

Scar Tissue

Why does it hurt?

Scar tissue is often more sensitive to irritation than unscarred skin. Vaginal scar tissue can occur as a result of childbirth, especially if there was need for stitches to fix tearing.

What can be done about it?

Estrogen creams can sometimes produce positive results. Surgery to remove the tissue can be attempted, but unfortunately, scarring can occur as a result of that surgery, so it does not always work. Another option is injection of a local anesthetic to numb the area and break up the scar tissue.

Swelling of Vaginal Glands (Bartholin’s Cyst)

Why does it hurt?

The Bartholin’s glands, as mentioned above, are the glands that produce lubricant when a woman is sexually aroused. Like any other gland, they can become blocked. Fluid will build up in the gland, causing it to swell and leading to a painful cyst. If the cyst becomes infected, it can cause an abscess.

What can be done about it?

Sitting in sitz baths (2-3 inches of warm water, just enough to cover the vaginal area) several times a day can promote drainage of the cyst.

Especially if the cyst has progressed to an abscess, surgical drainage (usually as a procedure done in a doctor’s office under local anesthetic) may be necessary.


Why does it hurt?

Vaginismus is the involuntary or persistent contraction of vaginal muscles upon contact. It can prevent vaginal penetration, or make it very painful. Muscle spasms in general can be painful, especially if there’s pressure to open the area that’s in spasm.

What can be done about it?

There’s no defined physical cause for vaginismus, and it tends to be linked with emotional factors: past sexual abuse or trauma or past painful intercourse. It can happen after menopause when other conditions like vaginal dryness (see above) make sex painful.

Because of the strong emotional component, treatment usually involves sex therapy and counseling: learning about your body and the reaction you’re having, and working to relax and “reprogram” your responses.

Physical treatments include vaginal dilators, which are cone shaped pieces that get progressively larger in your vagina, gradually helping the muscles become more flexible. Kegel exercises, which strengthen your awareness and control of the muscles in that area, can also be helpful.


Why does it hurt?

Vulvodynia basically means that the skin surrounding the vagina is hypersensitive. It just hurts – with no apparent cause.

What can be done about it?

Treatment methods for vulvodynia pull from many of the treatment methods above, from the physical (kegel exercises and vaginal dilators) to the emotional to the medical (local anaesthetic creams or injections). Some types of anti-depressants or anti-epilepsy medications may also be prescribed to help manage the pain.

Deep Pain

Deep dyspareunia is when sex causes pain in the upper part of the vagina, the pelvis or even the thighs. Pain can continue for minutes or hours after intercourse.

Uterine Fibroids

Why does it hurt?

Fibroids are non-cancerous growths of the uterus, either in the uterine cavity, in the uterine wall, or protruding from the wall into the abdominal cavity. Fibroids – especially large ones – can put pressure on the uterus and the entire pelvic area. Intercourse can exacerbate the feeling of pressure and pain.

What can be done about it?

Fibroids have many available treatment methods. The ideal fibroid treatment method for you will depend on the fibroids’ size, location, presenting symptoms and whether you want to maintain your fertility.


Why does it hurt?

Endometriosis is a condition in which bits of uterine wall tissue become embedded in other areas of the pelvis. During your period, those bits bleed as well. You may have unusually intense pain during your period – or even the entire month. And sex can trigger or exacerbate that pain.

What can be done about it?

Treatments range from anti-inflammatory painkillers to manage the pain, to hormonal medications, to surgery to remove endometriosis tissue or parts of organs affected by endometriosis.

Ovarian Cysts

Why does it hurt?

Ovarian cysts, fluid-filled sacs that develop on the ovaries, are pretty common. Usually you’ll be unaware of it, and it will go away by itself. It the cyst becomes very large, blocks the blood supply to the ovaries or ruptures, it can cause pain in general, and especially during sex.

What can be done about it?

If the cyst is not posing a danger, often waiting to see if it will go away on its own is the first course of action. If disturbing symptoms persist, surgery may be performed to remove the cyst.

Inflammation of the bladder, pelvis or bowel

Why does it hurt?

Inflammation of any of the organs in the pelvic area, whether caused by infection like Pelvic Inflammatory Disease, or by genetic factors and immune system issues like Inflammatory Bowel Disease, can be painful. The pain can be triggered or exacerbated by the pressure sexual intercourse puts on the pelvic area.

What can be done about it?

Treatment will depend on the specifics of the inflammation and its cause. Pelvic Inflammatory Disease, for example, is usually caused by infection, so antibiotics are a significant part of treatment. Inflammatory Bowel Disease is usually managed through dietary or lifestyle changes, medications and sometimes surgery.

Don’t Grin and Bear It

Honestly, grinning usually isn’t even an option when it comes to painful sex. But don’t grimace and bear it either. Pain during intercourse can affect your physical health, emotional health and the health of your most intimate relationship.

Most of the conditions causing painful sex can be treated – sometimes just managed, others cured entirely. If sex is a pain instead of a pleasure, discuss it with your doctor. Give yourself the opportunity to leave the pain behind – and put a real smile on your face.