There can be many reasons for pain during sexual intercourse. They have coined a special medical term for this phenomenon — dyspareunia. This term includes constant or recurrent genital pain that arises immediately before, during, or after intercourse.

It should be noted that intercourse is understood as vaginal penetration, so pain may be caused by the penetration of the penis, fingers, sex toys, and even tampons.

How this pain is felt

The pain itself can be felt in different ways.

  • Pain only during penetration of the penis or phallus imitator.
  • Pain during any penetration, including tampon insertion.
  • Pain deep in the pelvic area during penetration.
  • Burning or aching pain.
  • Pulsating pain that lasts for long hours after intercourse.

Pain sensations are further classified in the following way:

  • primary pain — a situation where a woman feels pain throughout her sexual life;
  • secondary — develops randomly at different periods of life;
  • total — a woman experiences pain throughout the entire intercourse;
  • situational — arises from a specific partner or a particular type of stimulation;
  • superficial — felt only during penetration;
  • deep — the pain focal point is located in the cervix or lower abdominal cavity, felt during or after penetration;
  • pain during intercourse that arises without direct physical contact (may have a psychological origin).

How common this phenomenon is

According to various data, dyspareunia affects one-third of women at different times in their lives. The difficulties in assessing it more accurately stem from the fact that, firstly, many women do not consider pain sensations an abnormal part of sex and therefore do not seek medical help. Symptoms of others go unnoticed by doctors themselves.

Some studiesPain experienced during vaginal and anal intercourse with other-sex partners: findings from a nationally representative probability study in the United States show that 30% of women experience pain during vaginal sex; others show that 8–21% are affected specifically by diagnosed dyspareunia, and 15% of it is chronic. Finally, 30% of women experienceConsultation about Sexual Health Issues in the Year after Childbirth: A Cohort Studyconstant pain during sex a year after childbirth.

In Russia, the situation is similar. Medical Doctor, obstetrician-gynecologist Tatiana Rumyantseva reported that about 30% of women consult a doctor with complaints of unpleasant sensations during sex.

Frequent causes of pain

1. Lack of lubrication

Most often, vaginal dryness is caused by insufficient foreplay. But there are other reasons: hormonal imbalance or taking medications. These include antidepressants, blood pressure-lowering medications, sedatives, antihistamines, and some contraceptives.

A drop in estrogen levels after menopause, childbirth, or during breastfeeding can also be a cause.

If you are not taking the above medications and have had a blood test for hormone levels, try to prolong the foreplay.

Clinical Professor of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine Dr. Jane Minkin states that at least 20 minutes are required to produce the necessary amount of lubrication.

This time is necessary for the labia, clitoris, and vaginal canal to begin to become erect. It is possible that a woman naturally lacks natural lubrication: one way to cope with the problem includes the use of water-soluble lubricants.

2. Surgery, injury, irritation

This can be an injury from an accident, pelvic surgery, episiotomy (cutting the vagina during childbirth to enlarge the birth canal), female circumcision, anatomical changes such as endometriosis, ovarian cysts, or surgical scars.

All of this can cause very painful sensations, especially if there is a wound that has not completely healed.

In this case, you will have to stop vaginal sex, take the time for proper treatment, and resume sexual activity only when the doctor decides that the wound has indeed healed or the injury will not bother you.

3. Inflammation, infection, irritation

An infection in the genital area or urinary tract can lead to painful intercourse. Eczema, allergic reactions, irritation from new soap, inflammation, and irritation from thrush — all of these are also reasons why penetration into the vagina becomes painful.

If irritation appeared after starting everyday use of something new, it is worth eliminating the introduction and seeing if the irritation or allergic inflammation goes away. Here’s what can provoke such symptoms:

  • perfumed soap;
  • douching;
  • vaginal perfumes;
  • bubble baths or bath bombs;
  • scented toilet paper;
  • thongs or other tight synthetic underwear.

4. Vaginismus

Vaginismus is painful spasms during vaginal opening. It can be an involuntary response to stimuli such as painful previous sexual experience, experienced violence, unresolved conflicts regarding one's sexuality (for example, strong complexes), or feelings of shame regarding sex due to conservative upbringing.

This condition, where involuntary muscle contractions of the vagina and pelvic floor can be so strong that insertion of even a tampon is impossible.

Dr. Shannon Chavez (Shannon Chavez), a licensed clinical psychologist and certified sex therapist, states that since the muscle contraction is involuntary, it can happen even in cases where a person is aroused and wants to have sex. According to her, many women with vaginismus do not share this with either doctors or loved ones.

Vaginismus can be triggered by both physical and psychological factors or a combination of them. A gynecologist can help to relax or retrain the muscles. And it is very likely that the help of a psychologist or psychotherapist will be needed to cope with the anxiety and stress that sexual intercourse causes.

5. Congenital anomalies

For example, there is Mayer-Rokitansky-Küster-Hauser syndrome, a rare disorder of sexual development, in which a fully developed vagina is absent or the vagina is completely absent. Or a person is born with incomplete reproductive organs.

In these cases, attempts at penetration can be very painful. According to Dr. Minkin, treatment will be related to surgery or the use of vaginal dilators.

6. Vaginal muscle atrophy due to menopause

Pain caused by vaginal muscle atrophy (thinning of its walls) is common among postmenopausal women who do not take estrogen replacement medication.

The secretion of natural lubrication completely depends on changes in estrogen levels. The quickest solution to the problem is the use of estrogen vaginal cream. But of course, you need to consult a doctor and choose the most appropriate solution together with them.

7. Interstitial cystitis

This condition refers to chronic inflammation of the bladder with no known cause. Painful intercourse is a common symptom.

The doctor can perform cystoscopy (a procedure for internal examination of the bladder) and stretch the bladder wall to try to improve the patient's condition. Other treatment methods include bladder washing with dimethyl sulfoxide, as well as oral medications.

8. Vulvodynia

This disease causes chronic pain in the area of the vulva. Moreover, according to Dr. Minkin, pain is caused not only by penetration but also by any other actions that put pressure on the vulva. For example, cycling or even just sitting.

Minkin states that doctors do not know the exact medical cause, but believe it may be inflammation of the nerves that causes hypersensitivity and pain.

There is no treatment for vulvodynia, but symptom relief is possible. It is quite a common phenomenon, faced by up to 9% of women at some point in their lives.

9. Endometriosis

Endometriosis is also one of the most common causes of severe pain deep in the pelvic area during sex.

On average, it takesEndometriosis fact sheet 9.28 years for a woman to finally receive this diagnosis and treatment. This data comes from a scientific studyWomen’s Sexual Pain and Its Management that describes how women endure these nine plus years:

“Anyone who constantly deals with complaints of dyspareunia knows that women tend to continue sexual contact, if necessary, just gritting their teeth”.

Endometriosis occurs when the tissue that makes up the uterus grows on other organs, and pain during sex due to endometriosis is one of the most intense.

Endometriosis cannot be cured, but hormonal therapy or surgical intervention may be used to improve the condition.

In addition to endometriosis, chronic pain in the pelvic area can be caused by scarring of tissues due to infections, uterine prolapse, pelvic inflammatory disease, fibroids, ovarian cysts, and so on. Dr. Minkin believes that deep pelvic pain is definitely a reason to see a doctor, as you may need to remove fibroids or cysts.

10. Uncomfortable positions during sex and a large partner’s penis

It is possible that you are comfortable and well in some positions, but others cause pain during penetration, especially deep penetration.

In this case, it is necessary to communicate this to your partner to search together for new positions that are comfortable for both of you.

A large penis or phallus imitator can also cause discomfort and pain. However, Dr. Minkin states that it is unlikely the penis is "too large" for the vagina or that it will damage the cervix. After all, the vagina can accommodate the head of a baby with a diameter of 10 centimeters.

In this case, using more lubrication and avoiding positions where penetration is too deep and causes pain can help.

11. Psychological issues

Fear and anxiety related to penetration can create a mental barrier. This, in turn, can lead to unconscious tension of the pelvic floor muscles during sex, creating a physical barrier to penetration.

You may have had negative sexual experiences, experienced sexual violence, harassment, or boundary violations. In such a case, the body expects pain and discomfort from sex, and the brain goes into combat mode.

According to Dr. Chavez, low self-esteem and body acceptance issues can also reduce arousal and cause tension or a nervous reaction during sex.

In this case, overcoming these psychological barriers will entirely depend on your readiness for this, as it will require work from you. Only you decide whether you are ready to seek specialists and undergo what will likely be a lengthy therapy.

Why it is advisable to consult a doctor for any discomfort

In Russia, according to gynecologist Tatiana Rumyantseva, in the overwhelming majority of cases of dyspareunia, the cause is inflammation of the vaginal mucosa, diseases of the pelvic organs and adjacent organs, atrophic changes in the mucosa. Vaginismus and vestibulodynia (a variety of vulvodynia) are rare but require special attention due to difficulties in diagnosis and treatment stages.

According to Rumyantseva, there is no need to delay visiting a gynecologist:

“Any pain during sexual contact that prevents pleasure (especially if such sensations were not previously experienced) is a reason to consult a doctor”.

A reason to make an appointment is also bleeding or atypical discharge after sexual intercourse. The main cause can be identified by a gynecologist, but later you may need the help of a psychiatrist, psychologist, or urologist — depending on the primary cause of your condition.

Usually, pain during penetration does not require emergency assistance, but it is advisable to seek it if the following symptoms occur:

  • a new attack of pain or sensations sharper than before, lasting longer than a few minutes;
  • bleeding in conjunction with pain;
  • nausea, vomiting, or rectal pain;
  • changed discharge.

It is also important to mention that advice to use anesthetics is often given on the internet in such cases to continue sexual intercourse.

Tatiana Rumyantseva commented on such recommendations: “Since there are a huge number of causes of dyspareunia (and most of them require treatment), prolonged self-use of anesthetics is not recommended, as it may lead to the progression of the underlying disease (such as endometriosis, vaginitis, and others), where pain during sex is one of the symptoms.

Anesthetics can long mask a serious problem, thus their temporary use is only possible until the cause of the pain sensations is identified.

If “true” dyspareunia is diagnosed, then anesthesia is not included in the treatment standards and is not an effective remedy.”