Sexual Health Women’s Health

Painful sex treatment available online

In order to treat your painful intercourse (dyspareunia) symptoms, consult with one of our board-certified primary care doctors online today to find out what might be causing you to have painful symptoms during sex. Get a new prescription or refill to treat painful sex and find relief.*

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Learn about painful sex

Pain during sex, or dyspareunia, is persistent or recurring pain just before, during, or after sex. The pain is felt in the genital region. Women can have pain externally in the vulvar region to the labia (lips of the vagina) or at the opening to the vagina. Some feel the pain internally in the cervix, uterus, or lower abdomen.

It's a common condition that can have negative emotional and psychological effects. In addition to the physical pain, couples may suffer from loss of intimacy or experience strain in their relationship.

Painful sex causes

The following conditions may contribute to painful intercourse:

Vaginal atrophy

The vaginal lining can lose its normal moisture and thickness and become dry, thin, and inflamed. This can be caused by medication, menopause, or other hormonal changes.

Vaginismus

The fear of being hurt or prior trauma can cause a spasm of the vaginal muscles.

Vaginal infections

These conditions are common and include yeast infections and bacterial vaginosis.

Problems with the cervix (opening to the uterus)

The penis can reach the cervix at maximum penetration. Therefore, problems with the cervix (such as infections) can cause pain during deep penetration.

Problems with the uterus

These may include fibroids, which can cause deep intercourse pain.

Endometriosis

This refers to a condition in which the endometrium (tissue lining the uterus) grows outside the uterus.

Problems with the ovaries

Such conditions may include ovarian cysts.

Pelvic inflammatory disease

This refers to a condition where the tissues deep inside the pelvic region become severely inflamed, and the pressure of intercourse causes deep pain.

Ectopic pregnancy

This refers to a pregnancy in which a fertilized egg develops outside of the uterus.

Sexually transmitted infections (STIs)

These may include genital warts, herpes, or other STIs.

Vulvodynia

This condition causes chronic pain in the vulvar area.

Injury to the vulva or vagina

These injuries may include a tear from childbirth or from a cut (episiotomy) in the perineum (area of skin between the vagina and the anus) that is made during labor.

Psychological issues

Anxiety, depression, and low self-esteem can prevent sexual arousal. If you have been a victim of sexual abuse, it can also contribute to your pain during sex.

Skin disorders affecting the genitalia

In some cases, women can experience pain during sex if there is not sufficient vaginal lubrication. In these cases, the pain may be resolved by using a sexual lubricant.

Like women, men can also feel pain if there is not enough vaginal lubrication during sex. In other instances, painful sex in men can be caused by certain penile disorders:

Foreskin damage: Damage to the foreskin (skin that covers the head of the penis) caused by rubbing or tearing can lead to pain.
Sexually transmitted infections (STIs): Yeast infections or infections under the foreskin, as well as common STIs like genital herpes or gonorrhea, can make sex painful.
Penis deformities: Peyronie’s disease or other deformities of the penis can cause painful intercourse.

Painful sex symptoms

The most common symptom is pain with intercourse that occurs at the vaginal opening or deep in the pelvis. It can be a distinct pain in one area, or it may affect the entire genital region. There can be feelings of discomfort, burning, or throbbing. If you have pain during sex, you may feel:

Sharp pain during penetration or at entry
Deep pain during thrusting
Throbbing or aching after intercourse
Burning pains
Pelvic cramping
Muscle tightness or spasms

How to treat painful sex

Some treatments for sexual pain do not require medical intervention. For example, in the case of painful intercourse after pregnancy, waiting at least six weeks after childbirth before attempting intercourse can help prevent painful intercourse. In cases in which there is vaginal dryness or a lack of lubrication, water-based lubricants can help.

Some treatments for sexual pain do require prescription medication and other therapies. If vaginal dryness is due to menopause, ask our board-certified doctors about estrogen creams, tablets, rings, or other medications. Other underlying conditions that cause painful sex may be resolved with prescription medications as well. Our doctors can help determine the cause of your painful intercourse through an online evaluation and order further testing to your nearest lab, if necessary.

For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve guilt, inner conflicts regarding sex or feelings regarding past abuse. Book an online therapy appointment with one of our licensed therapists to discuss options for sexual therapy.

Medications for painful sex

There are medications available to treat pain during sex. If vaginal dryness due to low estrogen is the cause of your painful sex, topical estrogens can be applied to the vagina. Medication can also be prescribed to treat pain due to infection or underlying medical conditions.

Painful sex after menopause

Ospemifene

Intrarosa (prasterone)

Dehydroepiandrosterone (DHEA)

Bacterial vaginosis

Flagyl (metronidazole) Cleocin (clindamycin)

Yeast infections

Diflucan (fluconazole) Terazol (terconazole)

When to see a doctor for painful sex

Book an appointment with one of our trusted doctors online if there are symptoms such as new or worsening pain during sex, bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions. For pain with no underlying medical cause, our doctors can refer you to one of our licensed therapists for counseling.

Talk openly with our clinical team about any pain during sexual intercourse. Some questions you may want to discuss include:

Where is the pain occurring?
How often does the pain occur?
How long have you been having painful intercourse?
What does the pain feel like?
What medications are you taking?
Have you had any prior surgeries in the area?
Have you been treated for any conditions of the vagina?

Painful sex treatment FAQs

What does it mean if intercourse is painful?

Painful intercourse can be caused by various factors, such as infections in the genital area or urinary tract, skin problems in the genital area, involuntary spasms of the vaginal wall muscles (vaginismus), vaginal atrophy, sexually transmitted infections such as gonorrhea or chlamydia, and genital herpes. If you are experiencing painful intercourse, it is important to consult with a doctor to determine the underlying cause and receive appropriate treatment. Our board-certified doctors can evaluate your symptoms online and help determine an appropriate treatment plan, depending on the cause of your painful intercourse.

What is the most common cause of pain during intercourse?

There is no one most common cause of pain during intercourse, as it can have a variety of causes. Some reasons for painful intercourse include vaginal dryness, extreme fatigue, problems within an intimate relationship, and uncertain feelings toward sex that might stem from psychological factors. Pelvic inflammatory disease (PID), an infection of the reproductive organs, can also cause pain during intercourse, as can sexually transmitted infections (STIs) like gonorrhea and chlamydia, which can cause vaginal irritation. Additionally, low estrogen levels resulting from menopause, childbirth, or breastfeeding may lead to less lubrication and painful intercourse.

Can hormone imbalance cause painful intercourse?

Yes, a hormone imbalance can cause painful intercourse. Hormonal changes can lead to a decrease in estrogen levels, which can result in vaginal dryness and thinning of the vaginal walls. This can make sexual activity uncomfortable or painful. In addition, vaginal atrophy, which is the deterioration of vaginal tissue caused by estrogen loss, is a major source of painful intercourse for women around menopausal age.

What causes painful intercourse after menopause?

Vaginal dryness and painful sex are common for postmenopausal women. They can occur in conjunction with vaginal itching related to the dryness caused by the changing hormones in your body.

Is it normal for sex to be very painful?

Pain during sex can be a common issue and can have several different causes, however, severe pain is not normal. It is important to speak with a doctor to determine the cause of the pain and to discuss possible treatments. This can be a sensitive topic, but it is important to seek medical advice to address any underlying issues or concerns.

Does painful sex during menopause go away?

Painful sex during menopause may not go away on its own, but there are treatments available to help alleviate the symptoms. One of the main reasons for painful sex during menopause is a decrease in estrogen levels, which can cause vaginal dryness and thinning of the vaginal walls. Treatment options may include hormone replacement therapy, vaginal moisturizers or lubricants, and medication to increase blood flow to the pelvic area. It is important to consult with a doctor to determine the best course of treatment for each case.

Does dyspareunia cause bleeding?

Dyspareunia does not necessarily cause bleeding. Any bleeding that occurs during sexual intercourse is likely caused by the underlying medical issue. The bleeding could be caused by the same issue that is causing the painful sex.

Therefore, dyspareunia does not directly cause bleeding during sexual intercourse, but underlying medical issues that cause dyspareunia may lead to bleeding.

What tests are done to diagnose dyspareunia?

To diagnose dyspareunia, healthcare providers may perform a physical exam, which could include a pelvic exam, rectal exam, and Pap test. In addition to a physical exam, doctors may also take a complete medical and sexual history to help identify potential causes of the pain. A single-digit vaginal examination may identify tender pelvic floor muscles, and a bimanual examination can assess for uterine issues and pelvic masses.

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