5 common reasons for pain during sex – and what you can do about it
Sex shouldn’t hurt – but for many people, it does.
Pain just before, during or after sex is actually pretty common. Also known as dyspareunia, it affects people of all genders, orientations and body types.
And we’re not talking just penis-in-vagina penetration either. Pain can show up with anal, oral or digital (with fingers) sex too. And you may feel it around the vulva, pelvis, or anus, inside the vagina or even as an ache or pain in your stomach.
If pain has become an unwelcome part of your sex life, always talk to your GP, particularly if:
the pain is persistent (happens more than once or twice)
you’ve got other symptoms, such as unusual discharge, blood or sores.
you’ve had sexual contact with someone who’s got an STI.
There are also some simple, practical things you can try for yourself to make things better. Here are five common reasons for sexual pain - and what you can do about them
1. You need more lubrication - or more foreplay
When there’s a lack of lubrication, any kind of friction or penetration can hurt. This lack of wetness can be due to:
Hormonal changes, with menopause being one of the main culprits, but breastfeeding is another.
Certain medications, including antidepressants or allergy meds
Not being aroused enough. This may be because you’re not really in the mood, you’re experiencing low desire, or you need more ‘turn ons to get you going.
Having anal sex without enough lube. Unlike the vagina, the anus doesn’t lubricate itself.
What you can do
Take your time. More foreplay helps your body get ready. Dr Karen Gurney talks about the conditions for good sex: three essential criteria you need to meet to feel turned on, or horny. If one of these is missing, natural lubrication might be in short supply.
Use plenty of PH-balanced lube. You can never have too much! For extra slipperiness, try the ‘double glide’ technique: water-based lubricant on top of an oil-based lubricant.
If dryness is a problem every time you have sex, speak to your GP. If it’s menopause-related, ask them or speak to a menopause specialist about topical oestrogen, a low-dose form of HRT that’s available as a cream, gel, vaginal tablet, pessary or ring.
Talking to a Psychosexual therapist like me can help you get to the root cause. And if pain has become a chronic issue, I can also help you create a satisfying sex life that works around the discomfort and stops it being the focal point.
2. You’ve got an infection, irritation or skin condition
Yeast or bacterial infections, STIs (sexually transmitted infections), and skin conditions can all cause pain, itchiness or a burning sensation during or after sex. You might get this around the penis or vulva, or around or inside the vagina and/or anus.
What you can do
If you notice discharge, a strong odour, sores, or lingering discomfort, get yourself down to your GP or find a local sexual health clinic (link for UK readers). They can diagnose and treat the issue.
Talking about this kind of thing can be embarrassing, but I promise you, specialists in this area have heard it all before. Plus, the sooner you get diagnosed, the sooner the problem can be sorted.
It’s also a good idea to avoid sex until you’re symptom-free to avoid making things worse or infecting your partner(s).
3. You’re not in the right head (or heart) space
Anxiety, stress, previous abuse, body image issues, or relationship troubles can cause you to tense up making penetrative sex difficult or even impossible. You may also find it much harder to get aroused.
Past traumas can also cause the body to resist penetration. Vaginismus, for example, a contraction of the vaginal muscles, can sometimes be the body’s way of preventing what it fears may be a painful experience. This can happen even if you want sex and are feeling turned on.
What you can do
Talk openly with your partner(s) about what’s going on so they can support you. Sharing your boundaries, needs and desires together can improve all areas of your sex life and bring you closer. Remember, sex should feel good for everyone involved. If it hurts, it’s okay to pause, talk, and get help.
Develop a mindfulness practice. Dr Lori Brotto, author of ‘Better Sex Through Mindfulness’, has some guided mindfulness recordings on her website that you might find helpful.
Focusing on non-penetrative intimacy can also ease the way. Sex is more than what happens to your genitals. You have plenty of other erogenous zones to play with. Sensual massage can help you find more.
Seeing a psychosexual and relationship therapist can help you navigate difficult emotions around sex and process negative past experiences.
Be kind to yourself. It can be hard if you’re feeling pressure to perform, worried that you’re letting your partner(s) down, or you’re feeling ashamed or embarrassed. A little self-care and compassion can go a long way.
4. You’ve got a medical condition
Conditions like endometriosis, interstitial cystitis (bladder pain syndrome), fibroids, or ovarian cysts, can cause deep or persistent pain during sex.
If you’re bottoming during anal sex, haemorrhoids (piles) or anal fissures can also cause a lot of pain during penetration.
What you can do
This is another one for the professionals. If pain persists or you feel it deep inside, speak to your doctor to get a proper diagnosis, along with help managing the condition. This may involve medication, physical therapy or some other personalised support.
5. You’ve got pelvic floor tension or spasms
Your pelvic floor is the muscular ‘hammock’ that helps keep organs like the bladder, bowel, and uterus in place. If it’s tight or spasms, penetration may be painful or impossible. If you do orgasm, tight muscles can get even tighter, which can cause pain after sex.
This can affect people of any gender, and you may experience it with vaginal, anal or even external stimulation.
What you can do
Mindfulness and breathing exercises can help you relax and help you get better at releasing tension from the body.
Yoga and gentle stretching can also help reduce pelvic pain.
Ask your GP to refer you to a pelvic floor physiotherapist. They can help you regain normal pelvic floor functioning.
Being in control of the pace and type of sex you’re having can also reduce tension. Try different positions or kinds of touch to see what feels good.
Although sexual pain is common, it’s not something you have to put up with.
Be brave and reach out for support. With the right support, information, and care, you can find what works for you - and make sex more of a pleasure; less of an ordeal.