The 7 Real Reasons Why You’re Having Painful Sex

Painful sex is something that a lot of women deal with and but not many of us feel comfortable talking about it or bringing it up to our doctors.

Let’s set things straight at the beginning, sex should not be painful! If there is pain during sex, then something is not right. Whether you have a medical problem, or you have a psychological problem or there just isn’t enough foreplay. Usually something can be done about it. Sometimes painful sex can be the first sign of a more serious medical condition so it’s definitely worth getting it checked out!

Common Reasons Why Sex May Be Painful

1. Infections

Infections of any part of the female reproductive system can cause painful sex. This includes infections or inflammation of the bladder or urethra (called cystitis or interstitial cystitis).

Infections of the vulva, vagina and cervix can cause pain due to the inflammation of that area. Friction against this “raw” area can cause pain with any repetitive movement.

Infections with STIs (sexually transmitted infections) can spread up through the uterus and involve the Fallopian tubes and ovaries. Sometimes they can cause abscesses to form which can be extremely painful, especially if they burst!

2. Endometriosis

Endometriosis is when the normal menstrual lining of the uterus starts to implant itself on other organs in the pelvis. It can grow on the outside of the uterus, the ovaries, or even the bowel or bladder.

This condition can lead to heavy or irregular periods which can be really painful.

The medical term for painful menstruation is “dysmenorrhoea” – the more you know!

With endometriosis, the pain during sex usually occurs with deep penetration, and it may be worse just before the start of menstruation. Some people report that the pain is positional so trying a different sexual position may help lessen the pain with penetration.

Unfortunately endometriosis is very difficult to diagnose because of how vague the symptoms can be. Usually the best way to diagnose it is to go for diagnostic laparoscopy, which is a surgical procedure where they can put small cameras into the abdomen and look for the endometriosis growing on other organs. Other less accurate options includes going for an ultrasound or an MRI – unfortunately what these imaging tests can see is limited.

Treatment can be with different types of medication, sometimes including the contraceptive pill, and if that fails then there are a few surgical options as well.

3. After Surgery or Episiotomy

Sex after surgery is a common reason for pain. Whether this surgery was a major operation performed on the organs in the pelvis or a simple episiotomy during vaginal childbirth, the body may still need some more time to heal.

Pain during sex after an episiotomy may last a few months but it should improve with time. If you find that you are still having pain 4-6 months after childbirth, it may be worthwhile to see your healthcare provider to make sure everything is okay.

4. Skin Conditions

Any skin condition that can occur on the rest of your body can occur on your vulva. This includes allergic reactions, psoriasis, chronic yeast infections and lichen sclerosus. All of these can cause itchiness which can lead to scratching and sore, raw skin.

Certain sexually transmitted infections like herpes simplex and HPV can cause ulcers or warts on the vulva which can be very painful.

Ingrown hairs are an often forgotten culprit. So many women are removing their pubic hair using all sorts of methods – from shaving to waxing to epilating and more.

When the pubic hair grows back, the hair follicle can get stuck under the skin and become “ingrown”. This ingrown hair can get infected and develop into an angry bump that causes pain when there is any movement of that area.

5. Not Enough Lubrication

I don’t think it can be said better than that!

Trying to have sex without adequate lubrication of the vagina is just asking for all kinds of trouble. Not only will it not be as pleasurable, but it can be painful and sometimes physically impossible to penetrate the vagina.

The causes of inadequate lubrication can range from not enough foreplay to your mental state and hydration level, to certain medications and medical conditions. The list is endless! I will definitely be diving into that list with you soon.

On the PLUS SIDE, there are tons of different lubricants on the market! I have created a handy Lubricant Guide to help you find a lubricant that suits your needs. Feel free to check it out, screenshot it, and take it with you to your local supermarket or pharmacy to find one that will work for you.

6. Vaginismus

Vaginismus is the big word we use to describe involuntary muscle spasms of the opening of the vagina. The pelvic floor muscles tighten and it can make sex extremely painful or physically impossible.

Because these muscle spasms are involuntary, it can make pelvic exams or Pap smears almost impossible.

Currently, vaginismus is considered to be largely a psychological condition but there may be some physical contributors as well. We still need to do much more research in this area.

7. Vulvodynia

Vulvodynia is another big word we use to describe persistent pain of the vulva. This is a diagnosis that we give only after we have ruled out any other identifiable cause.

The pain involve the whole vulva or be restricted to a certain area, happen spontaneously or be provoked (by touch or trying to insert something into the vagina).

Did you find this helpful?

Let me know in the comments. I want to hear from you!

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Much love,

References
  • Medscape. [Online]. Available from: https://www.medscape.com/viewarticle/493989_1 [Accessed 30 December 2018].
  • Kruger, T.F, Botha, M.H. Clinical Gynaecology. (4th ed.). South Africa: Formeset Print; 2014.
  • Torjesen, I. Vulvar diseases are skin diseases. Dermatology Times. 2018;39(10): U017.
  • Lahaie, M.A, Boyer, S.C, Amsel, R. Vaginismus: A Review of the Literature on the Classification/Diagnosis, Etiology and Treatment. Women’s Health. 2010;6(5): 705-719.
  • Bornstein, J. Medscape. [Online]. Available from: https://www.medscape.org/viewarticle/877370 [Accessed 25 January 2019].


Dr Megan Martin

Medical Doctor with an Interest in Sexual Health. Aspiring Sexual Health Physician and Sexologist with a Specific Interest in Women’s Sexual Well-being

2 comments to “The 7 Real Reasons Why You’re Having Painful Sex”

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  1. Nicole - 9th Feb 2019 Reply

    Such an important post. As someone with diagnosed vaginismus it took me forever to feel like it was actually worth going to the doctor for. Physio and lots of understanding later, I can deal with it pretty well.

    • Dr Megan Martin - 9th Feb 2019 Reply

      Hi Nicole, it sounds like you have had a tough time but have managed to make great strides forward. I’m so happy to hear that you managed to get a diagnosis and the help that you need. May I ask, what made you eventually decide to go see a doctor?

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