Painful sex is common, and it is real
Many people who have pain during sex assume they are unusual, or that they should be able to relax their way through it. Neither is true. The American College of Obstetricians and Gynecologists (ACOG) notes that nearly 3 out of 4 women have pain during intercourse at some time in their lives. For some it is a temporary problem; for others it lasts much longer.
The medical term is dyspareunia: persistent or recurring pain just before, during or after sex. Cleveland Clinic notes that it is more common in women but that anyone can experience it. People with a penis can feel pain in the penis, the testicles or the pelvis. Pain is a signal worth listening to in any body.
See a clinician first
Because pain can come from a physical cause that needs treatment, a medical evaluation is the right starting point. ACOG notes that pain during sex may be a sign of a gynecologic problem such as ovarian cysts or endometriosis, and advises seeing an ob-gyn or other health care professional if pain is frequent or severe. Cleveland Clinic suggests contacting your provider about new or worsening pain, bleeding, genital sores or unusual discharge.
Depending on where the pain is and who you are, that may mean a gynecologist, a urologist or your primary care clinician. ACOG describes what the visit usually involves: questions about your medical and sexual history, a physical exam and sometimes tests. You may also be asked about past experiences that affect how you feel about sex. You can share as much or as little as feels manageable.
Terms you may hear
- Dyspareunia: the general term for painful sex, which can have many causes.
- Vaginismus: the NHS describes this as the vagina tightening automatically when something is inserted. It is not under the person's control, and it can be treated.
- Vulvodynia: the National Institute of Child Health and Human Development (NICHD) describes chronic vulvar pain lasting at least 3 months without a clear cause, usually diagnosed after infection and skin conditions are ruled out.
- Genito-pelvic pain/penetration disorder (GPPPD): the International Society for Sexual Medicine (ISSM) explains that this diagnostic umbrella covers dyspareunia and vaginismus when significant pain or difficulty with penetration lasts at least six months.
A name can be a relief, but it is a starting point, not the whole story. Only a clinician who has examined you can say which, if any, applies.
How fear of pain can feed the pain
Pain changes how the next sexual encounter feels before it even begins. The ISSM describes how the anticipation of pain can bring fear and anxiety, and how pelvic floor muscles may then contract involuntarily, which adds to the pain. Over time, desire can fade and some people start avoiding sexual situations altogether.
ACOG makes a related point about the mind's role: emotions such as fear, guilt, shame or embarrassment can make it hard to relax, and when you cannot relax, arousal is difficult and pain may result. This is not the same as saying the pain is imagined. It means body and mind are working on each other, so care that addresses only one side may leave the other untouched.
The relationship can get caught in the same loop. The ISSM notes that partners may not understand why sex is so difficult, and that some people worry about disappointing a partner or being left. Silence on both sides can then turn a physical problem into emotional distance. Is It Physical or Emotional? looks at how the two usually overlap.
What pelvic floor physical therapy is
The pelvic floor is a group of muscles that supports the pelvic organs and, as the ISSM notes, contributes to arousal and orgasm. Muscles that are too tight can be part of painful sex. Pelvic floor physical therapy is a specialized treatment for those muscles. According to the ISSM, people may be referred for painful intercourse, vaginismus or chronic pelvic pain, and men may be referred for painful ejaculation.
The ISSM describes several things a pelvic floor physical therapist may use: education about pelvic anatomy, exercises to contract and relax the muscles, hands-on manual therapy, biofeedback, and, for some women, vaginal dilators. It also notes that this therapy may be one part of a team that includes physicians, sex therapists and mental health professionals. Ask the clinician who evaluates you whether a referral makes sense. Who to See for a Sexual Problem explains how these roles fit together.
Where emotional support fits
Cleveland Clinic notes that painful sex can have negative emotional and psychological effects, and that couples may lose intimacy or feel strain. A psychologist does not diagnose or treat the physical cause. Therapy can help with what often comes with it: dread before sex, shame, frustration, grief over what has changed, and conversations with a partner that keep going wrong.
For some people, pain is also tied to past experiences. The NHS lists anxiety about sex, a painful earlier experience, sexual assault or abuse, and a belief that sex is shameful among the things thought to contribute to vaginismus. If that is part of your story, How Past Sexual Trauma Can Affect Intimacy may be useful.
Dr. Lehmann offers psychotherapy for intimacy and sexual concerns, which can be part of individual therapy or couples therapy. Ask which format fits your situation when you call. If a specific kind of sex therapy matters to you, ask any therapist about their training.
In the meantime
ACOG suggests some steps people can try while they get evaluated:
- Tell your partner where and when you feel pain, and what you enjoy.
- Choose sexual activities that do not cause pain, or nonsexual touch such as massage.
- Set aside time when neither of you is tired or anxious.
- Use a lubricant if dryness or irritation is part of the problem.
It is also fine to pause or stop whenever something hurts. Closeness does not have to depend on penetration, and saying no to pain is not a failure.