When Sex Hurts

Pain Is Not Normal

Let’s start here: painful sex is common, but it is not normal. It’s not something you should grit your teeth and endure. It’s not a character flaw or a failure of effort. It’s a signal that something needs attention.

Many women have been taught—explicitly or implicitly—to tolerate discomfort during sex. To prioritize their partner’s pleasure over their own pain. To wonder what’s wrong with them rather than what’s wrong with the situation.

Nothing is wrong with you. Pain has a cause, and most causes are addressable.

Types of Pain

Sexual pain presents differently depending on its source:

Pain at entry (superficial dyspareunia):

Stinging or burning at the vaginal opening
Feeling of tearing or rawness
Often related to dryness, skin conditions, or pelvic floor tension

Deep pain (deep dyspareunia):

Aching or cramping deep inside during penetration
Pain with certain positions or depths
May relate to endometriosis, fibroids, ovarian issues, or pelvic conditions

Pain after sex:

Burning or soreness that persists
Cramping or aching afterward
May indicate irritation, inflammation, or pelvic floor involvement

Pain with arousal:

Discomfort even before penetration
May relate to nerve sensitivity or conditions affecting the vulva

Common Causes

Vaginal Dryness and Atrophy

The most common cause of painful sex in perimenopause and menopause. As estrogen declines:

Vaginal walls thin and become less elastic
Natural lubrication decreases
The tissue becomes more fragile and prone to micro-tears
pH changes can make the area more susceptible to irritation

This is addressable with local estrogen, moisturizers, and lubricants. See the entry on Vaginal & Vulvar Dryness.

Pelvic Floor Dysfunction

The pelvic floor muscles can become too tight (hypertonic), causing pain with penetration. This is often related to:

Chronic clenching in response to past painful experiences
Protective guarding after trauma
Habitual tension from stress or anxiety
Physical factors like sitting posture or core imbalances

Pelvic floor physical therapy is highly effective for this.

Vulvar Conditions

Several conditions affect the vulvar skin and can cause pain:

Lichen sclerosus (thinning, whitening of vulvar skin)
Vulvodynia (chronic vulvar pain without identifiable cause)
Contact dermatitis (reaction to products)
Infections (yeast, bacterial vaginosis)

These require proper diagnosis and targeted treatment.

Endometriosis and Pelvic Conditions

Deep pain may indicate:

Endometriosis
Fibroids
Ovarian cysts
Pelvic inflammatory disease
Adenomyosis

If you have deep pain, especially with specific positions, see a gynecologist for evaluation.

Psychological Factors

Pain often has both physical and psychological components:

Anticipating pain creates tension, which creates more pain
Past trauma can cause involuntary clenching
Relationship issues affect arousal, and poor arousal means less lubrication and more friction
Anxiety activates the nervous system in ways that amplify pain signals

This doesn’t mean the pain is “in your head”—it means the mind and body are connected, and both may need attention.

Breaking the Pain Cycle

Pain during sex creates a self-reinforcing cycle:

Pain → Anticipation of pain → Tension and anxiety → Less arousal → Less lubrication → More pain

Breaking this cycle requires addressing it at multiple points.

Physical Interventions

Lubricant: Use more than you think you need, every time. Silicone-based lubricants last longer; water-based need reapplication.

Vaginal moisturizers: Used regularly (not just during sex), these maintain tissue health.

Local estrogen: For vaginal atrophy, this is often the most effective intervention. Low-risk for most women.

Pelvic floor therapy: A specialized physical therapist can assess whether muscles are too tight and teach relaxation techniques.

Medical treatment: For specific conditions like lichen sclerosus or endometriosis, targeted medical treatment is needed.

Psychological Support

Trauma-informed therapy: If past sexual trauma is contributing, working with a therapist who specializes in this area can help.

Sex therapy: A sex therapist can help you and your partner navigate pain, rebuild intimacy, and find what works.

Mindfulness practices: Learning to stay present with sensation rather than tensing against anticipated pain can shift the experience.

Relational Approaches

Communication: Your partner needs to know what’s happening. Pain often creates silence and avoidance, which creates distance.

Expanding the definition of sex: If penetration hurts, it doesn’t have to be the goal. There are many ways to be intimate.

Going slower: Rushing increases the likelihood of pain. More time for arousal means more natural lubrication and relaxation.

Control: You need to feel in control of the pace, depth, and duration. Positions where you control penetration often help.

What Not to Do

Don’t push through: Pain during sex often worsens when you try to ignore it. You teach your body that sex equals pain.

Don’t blame yourself: This isn’t a failure of effort or attraction.

Don’t avoid all intimacy: Pain with penetration doesn’t mean avoiding all physical closeness. Maintain connection while you address the issue.

Don’t assume it’s permanent: Most causes of sexual pain are treatable.

Seeking Help

If sex is painful, see a healthcare provider—ideally one who takes sexual health seriously. Unfortunately, many women have had their pain dismissed. If that happens, seek another opinion.

A good evaluation includes:

Detailed history of the pain
Physical exam
Possibly cultures or tests for infections
Referral to pelvic floor PT or specialist if needed

You deserve sex that feels good. Pain is not your lot in life.

Go Deeper

These are the original writings this entry draws from: