Let’s Talk About Sex (The Painful Kind)
Why Does Sex Hurt? Let’s Talk About It.
Sex is supposed to feel good — not leave you wincing, bracing, or wondering “Is it just me?”
For many people with vaginas, painful sex (aka dyspareunia) is way more common than anyone’s talking about. And it doesn’t just stay in the bedroom. It can impact your mental health, your relationships, your sense of self, and your willingness to be intimate at all. That’s heavy.
What makes it even harder? Sometimes there’s no clear answer. The pain is real, but the diagnosis? Not so much.
This guide breaks down possible causes of painful sex, what might be going on in your body, and how to start getting care that actually helps — not just another “try to relax” dismissal.
What Is Female Sexual Pain? Let’s Break It Down.
Female sexual pain — sometimes called dyspareunia — is pain felt in or around the vagina or pelvis during any kind of sexual activity. That includes penetration, pressure, or even light touch. And yes, it’s a real medical issue (not just “in your head” or “a mental block”).
The pain can show up in a bunch of different ways:
Sharp or burning pain during penetration
A dull ache after sex
Discomfort that’s localized or radiates through your pelvis
Pain that’s constant, or only shows up in certain positions or moments
No matter how it feels, it matters. And if you’ve been brushing it off or feeling brushed off by providers — this is your sign to dig deeper.
Here are some of the most common symptoms people report:
Pain when something goes inside your vagina, like during sex
Stinging or burning in your vulva when it’s touched — even with something like a tampon
Feeling anxious or scared about sex because you’re expecting pain
Pelvic muscles that feel tight or tense, even when you’re not being touched
If you keep feeling pain during sex, don’t let embarrassment hold you back from talking to your doctor. You’re far from alone — millions of people face this challenge and are working through it just like you.
When Sex Isn’t Sexy — Real Reasons It Might Hurt
If sex hurts, you’re not being dramatic — there are a lot of reasons sex might be painful, and figuring out the cause can feel like a never-ending game of “Is it this? Or this? Or all of the above?”
Sometimes there’s a clear medical explanation. Other times? It’s more layered, involving hormones, trauma, pelvic floor tension, or no obvious cause at all (which, by the way, doesn’t make it any less real).
Here are some of the most common causes of painful sex worth knowing — and bringing up with your provider:
1. Vaginal and Vulvar Conditions
Issues with pelvic muscles, organ positioning, or congenital conditions (like a misshaped uterus) can trigger pain. The outer vaginal area (vestibule) and clitoris are particularly sensitive because they have more nerve endings than deeper areas of the vagina. Things like vulvar pain syndromes or skin conditions (like eczema or lichen sclerosus) can make any kind of touch painful.
2. Hormonal Shifts
Hormones play a big role in vaginal health. Low estrogen (which can happen during breastfeeding, menopause, at certain times in your menstrual cycle, or with certain birth controls) can cause dryness, tightness, or irritation. That combo is not fun during sex.
3. Infections
Yeast infections, UTIs, STIs (like herpes or chlamydia), bacterial vaginosis, or pelvic inflammatory disease can all cause pain. If something feels off, get it checked—these are often treatable.
4. Endometriosis or Other Gynecological Conditions
Conditions like endometriosis, fibroids, pelvic congestion syndrome, or interstitial cystitis (aka painful bladder syndrome) can cause deep, aching pain during penetration. They’re often underdiagnosed but worth bringing up with your provider if sex has always been uncomfortable.
5. Past Trauma or Mental Health
Even if there’s no physical issue, emotional stress or past trauma can cause muscles to tense up—sometimes without you even realizing it. Anxiety, depression, or PTSD can all play a role in how your body responds to intimacy.
6. Relationship Stuff
Yep, emotional connection matters too. Conflict, miscommunication, or not feeling safe with a partner can all contribute to discomfort. Painful sex isn’t always just physical—it can be relational too.
7. Unknown Pain
Sometimes doctors can’t find a cause, and that can be super frustrating. But just because there’s no clear answer doesn’t mean the pain isn’t real. Chronic pain can be a complex mix of nerve pathways, body responses, and brain chemistry.
What Can You Actually Do About Painful Sex?
You don’t need to settle for “this is just how it is.” There are ways to treat painful sex — and the right approach starts with understanding what’s causing it in your body.
From pelvic floor therapy to hormonal support to nervous system regulation, effective care looks different for everyone. The goal? Less pain. More connection. Real answers.
Work with a provider who listens, takes your symptoms seriously, and helps create a plan that aligns with your needs — physically and emotionally. Because your care should be just as personal as your pain has been.
Let’s Talk Meds
The right medication depends on the underlying cause of the painful sex (remember the long list of all the possible causes!) and what medications are safe for you, but a few common options include:
NSAIDs like ibuprofen and naproxen can be helpful to take before sex, especially if you have pain that lasts for hours after sex.
Antibiotics if there is an infection that is causing the pain.
Changing medications that interfere with natural lubrication (like certain antidepressants or allergy meds).
Vaginal estrogen creams can help restore moisture and reduce pain, dryness, irritation, or burning—especially after childbirth, during breastfeeding, or post-menopause.
Prescription medications like ospemifene or prasterone which are designed specifically for painful sex can also relieve dryness and discomfort. These may come with side effects, so talk to your doctor to see if there are right for you.
Muscle Relaxants can help relax tight muscles for sex and manage spasms. These can also be taken as vaginal suppositories, if you doctor works with a compounding pharmacy.
Krista knows this story well:
“I’ve been there too — tight pelvic floor, painful sex, and a body that felt stuck in fight-or-flight mode 24/7. While most people go to PT to strengthen things down there, I had the opposite issue. My muscles were clenched from stress, not weakness. Cue pelvic floor therapy, a pelvic wand (yep, that kind), and meds to calm the spasms. Spoiler: it hurt like hell, but it helped. The biggest game-changer? Learning that managing this pain is less about a quick fix and more about consistent care — at home, in my routine, and with support that actually gets it.”
Support for the Body and Brain
Pelvic floor therapy from a specialized physical therapist can help release tension, improve muscle coordination, and reduce pain through internal and external techniques.
Vaginal relaxation & desensitization exercises help retrain your muscles to relax during intimacy. They’re often part of pelvic floor therapy or can be done at home with guidance. This might include a pelvic wand or vaginal dilators.
Sex therapy or counseling helps to relieve anxiety, fear, or emotional distance due to painful sex. Talking with a trained therapist can help you and your partner reconnect, rebuild trust, and explore intimacy without pressure.
Pelvic floor injections: Deliver medication directly into tight or painful pelvic muscles to relax tight pelvic muscles and calm irritated nerves when other treatments haven’t provided enough relief.
Margaret shares what that looked like for her:
“For my overactive pelvic floor, treatments like vaginal suppositories, trigger point injections, and pelvic Botox—especially paired with pelvic floor PT—made a real difference. They didn’t fix everything, but they helped release muscles that had been stuck for years and gave me a path forward.”
At Home Tips
While you’re figuring things out, there are a few changes you can try right now:
Take an over-the-counter pain medication before sex.
Switch up the positions.
Communicate with your partner.
Take your time. More foreplay = more arousal = more natural lubrication.
Add more lubricant!
Talking to Your Doctor About Painful Sex: What to Expect
Bringing up painful sex with your healthcare provider might feel awkward — but it’s one of the most important steps toward getting real answers and relief. Whether you speak with a gynecologist, pelvic floor therapist, or sex therapist, the right care team can help you get to the root of what’s going on.
Pelvic pain is complex, and every detail helps. You might be asked questions like:
When did the pain start?
Where exactly does it hurt?
Does it happen every time, in specific positions, or with certain partners?
Be as specific as you can — the more context you give, the better they can help.
What Might Happen During the Visit:
A Pelvic Exam:
This part can feel vulnerable, especially if touch or penetration has already been painful. During the exam, your provider may gently press on different areas to locate the pain. A speculum might be used to examine the vaginal walls and cervix. Remember: you’re in control. You can pause or stop the exam at any time if it becomes uncomfortable.
Possibly, a Pelvic Ultrasound:
If your provider suspects something deeper — like endometriosis, fibroids, or ovarian cysts — they may recommend an internal or external ultrasound. It’s a safe, noninvasive way to get a clearer look at your internal organs.
Moving Forward: Let’s Redefine What Normal Feels Like
Sex shouldn’t be something you brace yourself for. If pain has been part of your experience, that’s valid — but it doesn’t have to be your forever.
Whether it’s tight pelvic muscles, hormonal shifts, past trauma, or something no one’s quite named yet, there are ways to better understand what your body’s trying to tell you. Healing takes time (and usually some trial and error), but progress starts with curiosity, not shame.
This isn’t about “fixing” you — it’s about reconnecting with your body on your terms, with care that meets you where you are.
So if you're ready to stop guessing and start tracking what matters, we're here for that.
Resources & Support
Lasa Health is dedicated to supporting people suffering with endometriosis through personalized care, education, and a community.
Here's how we help:
Our mobile Lasa Health app creates individualized plans to help manage endometriosis, offering insights into symptoms, treatment options, and at-home flare-up strategies.
Our 24/7 chatbot, provides instant answers to questions, suggests coping strategies, and assists with pain management techniques like pelvic floor and breathing exercises.
An AI-powered online Endometriosis Assessment Tool helps users understand their symptoms and receive guidance on next steps toward diagnosis.
Online support groups provide a platform for people to share patient stories and foster a sense shared experience among those affected by endometriosis.
References
https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
Burri, A., Hilpert, P., & Williams, F. (2019). Pain Catastrophizing, Fear of Pain, and Depression and Their Association with Female Sexual Pain.. The journal of sexual medicine. https://doi.org/10.1016/j.jsxm.2019.10.017.
Al-Abbadey, M., Liossi, C., Curran, N., Schoth, D. E., & Graham, C. A. (2015). Treatment of Female Sexual Pain Disorders: A Systematic Review. Journal of Sex & Marital Therapy, 42(2), 99–142. https://doi.org/10.1080/0092623X.2015.1053023
Ali, M., Fraker, J., Sobel, T., & Vegunta, S. (2024). Beyond the discomfort: understanding and managing sexual pain in women, a comprehensive case-based discussion.. Sexual medicine reviews. https://doi.org/10.1093/sxmrev/qeae040.
