Cedars-Sinai Blog
What Women Need to Know About Pain During Sex
Pain during sex is a common problem for women.
As many as 75% of women will experience pain during sex at some point, according to the American College of Obstetricians and Gynecologists. For many women, the pain is rare or happens only once, but for others it’s persistent.
"Some women may have experienced sexual joy, but then at some point in their life, it becomes painful," says Dr. Karyn Eilber. "They may stop having sex with their partners. Whether your pain is mild or severe, if it bothers you and it’s inhibiting you from having sex, you should definitely talk to you doctor."
Dr. Eilber and Dr. Alexandra Dubinskaya treat women with sexual dysfunction and study its causes. Here’s what they think women should know about painful sex:
"Like mental health, sexual health can carry a stigma. Mental health is slowly losing that stigma, and sexual health needs to follow that trend. We can look at these things as health conditions and normalize having these conversations as part of our regular healthcare."
Sex isn’t supposed to hurt
Just because painful sex is very common, that doesn’t mean you have to accept it as "normal." Occasional minor soreness is likely nothing to worry about, but intense or frequent pain is worth having a conversation with your doctor.
Sex should be a pleasurable experience, and if it’s not, don’t hesitate to speak up to your partner and your doctor.
Sexual health is worth prioritizing
Many women are hesitant to bring up sexual problems with their doctors, Dr. Eilber says.
"It can feel embarrassing," she says. "It’s difficult enough to share with our partners and friends, so telling a doctor—a stranger—can feel intimidating."
She likens it to mental health.
"Like mental health, sexual health can carry a stigma," she says. "Mental health is slowly losing that stigma, and sexual health needs to follow that trend. We can look at these things as health conditions and normalize having these conversations as part of our regular healthcare."
Dryness is a common cause of pain during sex
Dryness is one of the most common causes of painful sex, and it can occur in any woman at any age. While it is more common in peri-menopausal and post-menopausal women, younger women can experience it as well.
In addition to making sex painful, dryness can throw off the vagina’s balance of good bacteria, which can result in infections that contribute to painful sex. Dryness can happen for many reasons including birth control use, breastfeeding and menopause.
"It’s normal to use a personal lubricant," says Dr. Dubinskaya. "There are studies that show women who use their personal lubricant while having intercourse experience more pleasure.
I think it’s important for people and their partners to recognize that just because a woman isn’t lubricating does not mean she isn’t aroused."
Drs. Eilber and Dubinskaya suggest approaching lubricants in the same way many women consider skin care products: Pay attention to the ingredients and test it on a small patch of skin first to make sure it doesn’t cause irritation.
Many conditions may cause pain during sex
Dryness is the most frequent reason, but there are many other reasons sex might become painful. Some conditions that can be at the root of the problem:
- Endometriosis: In people with endometriosis, the tissue that normally lines the uterus grows in other areas of the pelvis, such as the ovaries, fallopian tubes, or intestines. The condition can be painful, including causing pain during sex.
- Interstitial cystitis: Also known as painful bladder syndrome, this condition is often mistaken for a urinary tract infection because it shares many of the same symptoms such as bladder and pelvic pain, pressure, and a frequent urge to urinate. However, the condition is not an infection.
- Pelvic floor dysfunction: The pelvic floor muscles—the ones you tighten when you want to stop passing urine quickly—can become painfully tight. It can cause an achy pelvis and pain with any kind of insertion.
- Pelvic floor injury: An injury to the pelvic floor, which can have many causes from vaginal childbirth to improperly fitted bicycle seats, can cause pain during sex.
- Vaginismus: The muscles at the opening of the vagina become tightly contracted, making penetration impossible.
- Vulvodynia: Chronic pain at the opening of the vagina, including burning, stinging, soreness, itching, rawness and pain during sex.
- Infections: Bacterial, yeast or sexually transmitted infections can cause pain during sex and usually have other symptoms, such as discharge.
- Ovarian cysts: These fluid-filled sacs on the ovaries often have no symptoms. When they rupture, they can cause pain and bleeding.
- Fibroids: These non-cancerous growths on the uterus can cause heavy menstrual bleeding, pelvic pressure, pain, and painful intercourse.
Don’t suffer in silence
Painful sex usually has a cause, and once it’s identified, it’s likely treatable. If you’re avoiding sex, it’s time to see your doctor. Your gynecologist is often the best place to start, as they’re likely to be able to accurately diagnose the cause of the pain.
Many women are reluctant to talk about any issues they're having in the pelvic region, whether it's a prolapse, incontinence or painful sex. Many don't open up to friends or loved ones about these issues, and as a result, these problems seem kind of mysterious to the average person.
"I think as women, we often tend to blame ourselves," Dr. Eilber says. "That can definitely contribute to the pain and to sexual dysfunction. I think the more resources we can make available, and the more we’re able to talk openly about these issues, the more beneficial it will be."
