Painful Sex (Dyspareunia): Why Does Sex Hurt?
Pain during or after sex is common, but it isn't something you should simply have to tolerate.
Dyspareunia is the medical term for persistent or recurrent pain associated with sexual intercourse or penetration. Pain may occur around the vaginal opening, deeper within the pelvis, during penetration or after sexual activity.
There are many possible causes of painful sex, including pelvic floor muscle dysfunction, hormonal changes, vulval conditions, endometriosis and other pelvic health concerns.
Understanding where your pain occurs, what it feels like and when it happens can provide important clues about what may be contributing.
What Does Dyspareunia Feel Like?
Painful sex can feel very different from person to person.
You may experience:
Burning or stinging around the vaginal opening
Pain when penetration first begins
A feeling of tightness or resistance
Deep pelvic pain during penetration
Pain with certain sexual positions
Aching or cramping during sex
Pelvic pain after sex
Vulval sensitivity after penetration
Pain that continues for hours after sexual activity
Fear or anticipation of pain before penetration
Some people experience pain every time, while for others it only occurs in certain situations or at particular times.
Pain around the vaginal opening is sometimes referred to as superficial or entry dyspareunia.
Possible contributors can include:
Pelvic floor muscle overactivity or guarding
Vulvodynia or vestibulodynia
Vaginal dryness
Hormonal changes
Skin conditions affecting the vulva
Infection or irritation
Scar tissue following childbirth or surgery
Previous painful experiences
Inadequate arousal or lubrication
Because several different conditions can cause similar symptoms, persistent pain around the vaginal opening should be appropriately assessed.
Why Does Sex Hurt at the Vaginal Entrance?
Pain experienced deeper within the pelvis is sometimes described as deep dyspareunia.
Deep pain can have several possible contributors, including:
Endometriosis
Adenomyosis
Pelvic floor muscle dysfunction
Pelvic inflammatory disease
Ovarian or other gynaecological conditions
Pelvic surgery or scar tissue
Bladder or bowel conditions
Musculoskeletal factors
The location and behaviour of your symptoms can help guide what type of assessment may be appropriate.
Deep pelvic pain shouldn't automatically be assumed to be caused by the pelvic floor. Depending on your symptoms, medical or gynaecological investigation may also be important.
Why Do I Get Deep Pain During Sex?
Can a Tight Pelvic Floor Make Sex Painful?
Pelvic floor muscle overactivity can contribute to painful penetration for some people.
For comfortable penetration, the pelvic floor needs to be able to appropriately relax and lengthen.
If the muscles are guarding, sensitive or having difficulty relaxing, penetration may feel tight, painful or uncomfortable.
Importantly, this means someone experiencing painful sex doesn't necessarily need more pelvic floor strengthening.
If muscle overactivity is present, management may instead focus on relaxation, coordination and gradually improving the pelvic floor's ability to respond comfortably to penetration.
Why Does Sex Hurt Afterwards?
Pain doesn't always occur during penetration itself.
Some people notice pelvic aching, cramping, burning or muscle soreness after sex.
This may be influenced by pelvic floor muscle activity, irritation of sensitive tissues, depth or duration of penetration, other pelvic pain conditions or a combination of factors.
If pain after sex happens regularly, lasts for a significant period or is worsening, it's worth discussing with a healthcare professional.
Can Endometriosis Cause Painful Sex?
Yes. Pain during or after sex can occur in people with endometriosis, particularly when pain is experienced deeper within the pelvis.
However, not everyone with painful sex has endometriosis, and not everyone with endometriosis experiences dyspareunia.
Pelvic floor muscle tension can also occur alongside persistent pelvic pain conditions such as endometriosis, meaning there may be more than one contributor to someone's symptoms.
Where endometriosis or another gynaecological condition is suspected, medical assessment should form part of your care.
Some people experience changes in comfort with sexual activity during pregnancy or after having a baby.
Postpartum contributors may include:
Perineal tears or episiotomy scars
Pelvic floor muscle changes
Vaginal dryness
Hormonal changes, particularly while breastfeeding
Pain or sensitivity around healing tissues
Changes in body confidence
Fatigue
Previous painful experiences
Changes in desire or arousal
There is no universal timeframe in which you should feel ready to return to penetrative sex after having a baby.
If you experience pain when you do return, you don't need to simply push through it.
Can Pregnancy or Childbirth Cause Painful Sex?
Can Perimenopause or Menopause Make Sex Painful?
Hormonal changes during perimenopause and menopause can affect the vulval, vaginal and urinary tissues.
Some people experience vaginal dryness, burning, irritation or discomfort with penetration as part of genitourinary syndrome of menopause (GSM).
Pelvic floor muscle tension may also coexist with these symptoms.
Management may therefore involve pelvic health care alongside discussion with your GP or other medical practitioner about hormonal and other treatment options where appropriate.
Pain can occasionally occur for many reasons, but recurrent or persistent pain during sex shouldn't simply be dismissed as normal.
This is particularly important if pain is causing you to avoid sexual activity you would otherwise like to participate in, affecting your relationships or creating fear around penetration.
Pain is a symptom worth understanding.
Is Painful Sex Normal?
You don't need to repeatedly push through painful penetration in an attempt to make your body “get used to it”.
Repeatedly experiencing pain can sometimes increase anticipation, guarding and sensitivity around sexual activity.
This doesn't mean you need to avoid all intimacy. Instead, it may be useful to temporarily modify or avoid activities that are consistently painful while you investigate what is contributing.
Sexual activity doesn't have to involve penetration, and your comfort and consent matter throughout.
Should I Keep Having Sex if It Hurts?
The two conditions can overlap, but they don't mean exactly the same thing.
Dyspareunia describes recurrent or persistent pain associated with sexual intercourse or penetration.
Vaginismus involves involuntary tightening or guarding around the vaginal opening when penetration is attempted or anticipated, which may make penetration painful, difficult or impossible.
Someone can experience one or both.
What's the Difference Between Dyspareunia and Vaginismus?
Not necessarily.
A pelvic health appointment can begin with discussing your symptoms, medical history, sexual health and what you would like help with.
An internal pelvic floor examination may provide useful information for some presentations, but it should only be performed when clinically appropriate and with your informed consent.
You can decline an internal examination, ask questions, request modifications or stop the examination at any time.
Do I Need an Internal Pelvic Floor Examination?
The first step is understanding what may be contributing to your pain.
Depending on your individual presentation and preferences, pelvic health management may include:
Pelvic floor assessment
Pelvic floor relaxation and coordination
Education about pelvic anatomy and pain
Breathing strategies
Movement and exercise
Scar assessment where relevant
Vaginal trainer/dilator guidance where appropriate
Strategies for comfortable penetration
Self-management techniques
Collaboration with psychology, sex therapy, gynaecology or other healthcare professionals
Where another medical condition is suspected, appropriate referral or investigation is an important part of management.
How Can Pelvic Health Care Support Painful Sex?
When Should I Seek Medical Advice About Painful Sex?
Seek assessment if pain during or after sex is persistent, worsening, newly developed or affecting your wellbeing.
Medical assessment is particularly important if pain occurs alongside symptoms such as:
Unexplained vaginal bleeding
Bleeding after sex
Unusual discharge
New vulval skin changes
Fever
Significant or worsening pelvic pain
New menstrual changes
Other concerning symptoms
You don't need to wait until pain becomes severe before asking for help.
Painful Sex & Pelvic Health Care in Healesville
At Yarra Valley Women's Health, our pelvic health osteopaths provide individualised assessment and management for painful sex, dyspareunia, pelvic floor muscle dysfunction and associated pelvic health concerns.
Our aim is to help you understand what may be contributing to your symptoms, provide appropriate management options and give you the knowledge to make informed decisions about your pelvic and sexual health.