Why Sex Hurts: 7 Culprits Behind Painful Sex and Fixes for Each

Sex is supposed to feel great, not hurt. Yet plenty of people experience discomfort before, during, or after intercourse. Painful sex is common enough that the 2009 National Survey of Sexual Health and Behavior found roughly 30 percent of women reported pain during a sexual encounter. Several everyday factors can be behind it, and doctors even have a clinical term for it: dyspareunia. Most of the time you can resolve or ease the discomfort yourself. When you can't, it's worth bringing up with your doctor.

Below are some of the more common culprits behind painful sex. The reassuring part is that nearly all of them can be addressed so intercourse feels good again.

1. Losing Your Virginity

The first time you have intercourse, your hymen stretches, and that stretching can hurt. It's also possible you simply weren't aroused enough before penetration began. Arousal causes the vagina to lengthen, creating more room for a penis, and it also triggers natural lubrication. Without enough lubrication, thrusting creates friction, and friction usually means pain.

Next time, build in plenty of foreplay before intercourse and have your partner ease into thrusting slowly. Speak up if something hurts, or coach him through what feels good — tell him to slow down, or let him know when he hits on something that feels great so he keeps it up. As you gain more experience and learn your own body, the pain should fade. If it doesn't, a visit to the gynecologist may be in order.

2. Not Enough Lubrication

Insufficient natural lubrication before sex is a frequent cause of pain. You might genuinely want sex and still not produce enough wetness on your own — even with generous foreplay. A hot bath beforehand can dry you out, and so can allergy medication or birth control pills. Some women's bodies simply never generate enough natural lubrication for comfortable sex, and that's perfectly normal.

The fix is reaching for lube. There are a few varieties, so it may take some trial and error to find your favorite: water-based, silicone-based, or oil-based.

• Water-based: The most widely used lube, and it's compatible with condoms and sex toys. Cleanup is simple too. Its drawback is that it can dry out mid-session, so you may need to reapply water or saliva.
• Silicone-based: Outlasts water-based lube but shouldn't be paired with silicone toys. It works fine with latex condoms, though it's harder to rinse out of sheets.
• Oil-based: Never combine this with latex or rubber. It's thick — picture Vaseline — which makes it messier to clean afterward.

Read up on lube.

3. Being Wound Up and Anxious

Nervousness or tension going into sex tends to translate into pain, since anxiety keeps your body from lubricating properly. The remedy is easing that tension and letting go of sexual anxiety. Sometimes all you need is a relaxing massage first.

That relaxation can then flow naturally into foreplay. When your partner puts in real effort with foreplay, arousal and wetness should follow — but only if the foreplay actually turns you on. If breast play isn't doing much for you, maybe watching porn together or getting him to go down on you will. Once arousal kicks in, the anxiety tends to dissolve, and blood flow to your genitals increases, which is what produces wetness.

4. An Infection

Infections like a yeast infection can make your vagina sore, and it'll stay that way until treated — which naturally makes sex painful too. Yeast infections bring intense itching, burning, and discharge. A sore vagina means sore intercourse. Over-the-counter medication usually clears it up; if it doesn't, you may be dealing with something else, including a bacterial infection. Learn more here.

If yeast infections keep coming back, try to prevent them. Clean the vaginal area thoroughly when you shower or bathe, then dry it completely — some women even use a blow dryer for this. Skip douching, though, since it strips away the vagina's natural defenses and can actually cause yeast infections.

5. Sexually Transmitted Infections (STIs)

STIs — also known as sexually transmitted diseases (STDs) or venereal diseases (VDs) — need medical treatment to clear. Several types exist, and any of them can make sex painful. You really shouldn't have sex at all while dealing with an active STI.

• Chlamydia: Often symptomless, but when symptoms show up they include unusual vaginal discharge and a burning feeling while urinating. Treatment matters because untreated chlamydia can progress to pelvic inflammatory disease (PID), which can affect fertility or pregnancy. A doctor's lab test can confirm it.
• Genital herpes: Causes painful, itchy genital sores. Once contracted, it remains in the body and resurfaces periodically. Sex can hurt during a flare-up. There's no cure, but medication can reduce pain during outbreaks.
• Genital warts (HPV): Shows up as visible warts, along with possible itching, discharge, and bleeding — though many HPV strains cause zero symptoms and only surface on a PAP test. A doctor needs to manage this; it sometimes clears on its own, and your doctor will guide the right approach.
• Gonorrhea: May produce no symptoms, but when it does, expect green or yellow vaginal discharge, pelvic pain, burning urination, bleeding between periods, and spotting after sex. Antibiotics from a doctor will clear it up. Left untreated, it can also lead to PID.
• Syphilis: Produces sores on the vagina or mouth. Untreated, a rash spreads to the hands and feet, and further neglect can seriously damage the heart and brain. Penicillin (or an alternative antibiotic for those allergic) typically resolves it.
• Trichomoniasis: The most common STI among women. It may cause no symptoms, or it may bring frothy, bad-smelling greenish-yellow discharge, painful urination, vaginal itching and irritation, and pain during sex. A doctor-prescribed antibiotic treats it.

6. Vaginismus

Vaginismus is a condition where the vagina tightens involuntarily, making penetration difficult or outright impossible. The vaginal muscles clench on their own, sometimes without the person even realizing it's happening. Attempting intercourse under these conditions causes pain. In some cases the PC muscles clamp down hard enough to form a barrier that blocks penetration entirely; in milder cases, penetration is possible but painful.

Vaginismus is really a mind-body loop. The moment penetration seems imminent, the brain signals the PC muscles to contract, blocking it. Some people have dealt with this from their very first sexual experience — called primary vaginismus — while others develop it later, after previously having pain-free sex, which is called secondary vaginismus.

Left untreated, vaginismus tends to get worse, and the pain persists — but it responds very well to treatment. Each painful attempt at intercourse reinforces the mind's resistance to the idea. The body starts expecting pain, which breeds fear and anxiety, which triggers the involuntary tightening, which then produces pain, which confirms the body's fear — a cycle that, left unchecked, often leads someone to avoid sex entirely.

Treatment focuses on retraining the body — especially the PC muscles — to respond differently when intercourse is anticipated. This typically includes pelvic floor exercises to build muscle control, along with insertion training, techniques to reduce pain, and support for any emotional roots of the problem. Much of this work can be done at home under a doctor's guidance, and the odds of resolving the pain are good.

7. The Penis Reaching the Cervix

Men love to boast about size — bigger supposedly being better. But a penis really can be too large for comfort, to the point that it causes pain during sex. Most vaginas can stretch to accommodate quite a lot, but sometimes it still feels like too much, and that translates into pain. A different position or a tweak in your partner's approach can usually solve this. Ask him to ease off the pace, or take the top position yourself so you're the one controlling depth and rhythm — that alone can eliminate the pain.

Tracking your cycle helps too, since sex is more likely to hurt around and during your period, when the cervix sits lower and firmer.

Pain during sex is your body's way of flagging that something needs to change, and it usually isn't cause for alarm. But if it doesn't let up, talk to your doctor or gynecologist.

January 17, 2021