By understanding what causes this pain, how to manage it, and when to seek professional advice, you’re better placed to take control and get back to pleasure instead of pain.
Pain during or after sex is clinically known as dyspareunia. It can affect women of all ages and can cause significant discomfort and distress. Pain can be experienced from the vulva to deep in the vagina, at the beginning of penetration, during or after. It can be experienced differently from burning to itching to aching, cramping or sharp pain.
Understanding its causes and knowing when to see a healthcare professional can help you achieve better sexual health and overall wellbeing.
According to the British Medical Journal, dyspareunia is a common but poorly understood problem affecting around 7.5% of sexually active women aged 16-74 years. It is most common in women aged 55-64 (10.4%) and those aged 16-24 (9.5%). It is an important and neglected area of female health.
Causes of painful sex
Post-coital pain can be attributed to a variety of factors, each requiring different treatment approaches. Here are some of the main causes:
Infections
Sexually transmitted infections (STIs)
Conditions like chlamydia, gonorrhoea and herpes can cause pain during and after intercourse.
Urinary tract infections (UTIs)
A UTI can lead to pain during urination and sex due to inflammation and irritation of the urinary tract.
Pelvic inflammatory disease (PID)
An infection of the female reproductive organs, often but not exclusively caused by untreated STIs, PID can result in significant pain during and after intercourse.
“Other factors that affect our emotions can also contribute to a low level of arousal and resulting discomfort or pain. These include your mental load, general life anxiety, fear of intimacy or relationship problems.”
Hormonal changes
Postpartum period
Hormonal fluctuations after childbirth and during breastfeeding can also result in vaginal dryness and sensitivity.
Conditions like PCOS can also affect vaginal lubrication and elasticity.
Menopause
Reduced oestrogen levels can cause vaginal dryness and thinning of the vaginal walls, leading to discomfort during and after sex.
Vaginal dryness can also arise from insufficient lubrication which could be from lack of arousal or medication.
There are also some types of medications that can affect sexual desire and decrease lubrication which make sex painful. These include certain types of antidepressants, high blood pressure medicines, sedatives, antihistamines and birth control pills.
Physical conditions
Endometriosis
This condition, where tissue similar to the uterine lining grows outside the uterus, can cause deep pelvic pain during and after sex.
Vaginismus
Involuntary muscle spasms in the vaginal walls can make penetration painful and result in lingering discomfort.
Other physical conditions include uterine prolapse, retroverted (tilted) uterus, uterine fibroids, irritable bowel syndrome, pelvic floor conditions, adenomyosis, haemorrhoids and ovarian cysts.
You may also experience physical conditions from trauma or scarring from medical treatment. Scarring could include that from pelvic surgery, such as hysterectomy. It can also develop after cancer treatments, like radiation and chemotherapy, causing changes that make sex painful.
Psychological factors
Besides physical causes of dyspareunia, there can also be psychological causes.
Stress and anxiety
Emotional factors can contribute to physical tension and pain during sex. Our pelvic floor muscles tend to tighten in response to stress in our lives, which can contribute to pain during intercourse.
Other factors that affect our emotions can also contribute to a low level of arousal and resulting discomfort or pain. These include your mental load, general life anxiety, fear of intimacy or relationship problems.
Past trauma
A history of sexual abuse or trauma can result in chronic pain issues related to intercourse.
Allergic reactions
Latex allergies
Allergic reactions to condoms or lubricants can cause irritation and pain.
Product sensitivities
Reactions to soaps, lotions or spermicides can also lead to discomfort.
Managing pain during or after sex
Managing pain at this time involves a combination of medical treatments and home remedies depending on the cause of your discomfort.
Medical treatments
Antibiotics
These may be prescribed by your healthcare professional for bacterial infections such as UTIs or STIs following an appointment to discuss your symptoms.
Hormonal therapy
Oestrogen creams or hormone replacement therapy may be prescribed for menopausal related symptoms.
Pain management
Over-the-counter pain relievers like ibuprofen may help you manage acute pain.
Home remedies
If you’ve spoken to a healthcare practitioner and they have not diagnosed you with a treatable condition, or you would like to use home remedies alongside any prescribed treatments, the following may help:
- Lubrication. Using water-based lubricants to reduce friction during intercourse.
- Warm baths. Soaking in a warm bath can soothe muscle tension and pain.
- Pelvic floor exercises. Strengthening pelvic floor muscles can help alleviate pain from conditions like vaginismus.
- Hydration. Staying well-hydrated can help prevent UTIs and promote overall vaginal health.
Lifestyle adjustments
If your pain is affected by stressors or more psychological causes, try the following lifestyle adjustments:
- Open communication. Discuss any pain or discomfort with your partner to find mutually comfortable solutions.
- Relaxation techniques. Practices like yoga or meditation may reduce stress and muscle tension.
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When to seek help
It’s crucial to know when to manage your pain at home or seek professional help. Seek help if you experience:
- Persistent pain. Pain that continues or worsens after several instances of intercourse.
- Severe discomfort. Intense pain that interferes with daily activities or quality of life.
- Associated symptoms. Additional symptoms such as unusual discharge, bleeding, fever or an unpleasant odour.
- Emotional distress. Pain impacting your mental health or causing significant anxiety.
Over-the-counter treatments and home remedies do not provide relief. Seeing a healthcare professional sooner rather than later can lead to better outcomes and prevent complications from untreated conditions.
Frequently asked questions
It’s natural to have questions about pain during or after sex, here are some of the most common ones.
How do I know what’s normal discomfort and when I should see a doctor?
Occasional mild discomfort might be normal, but persistent, severe or worsening pain, especially with other symptoms, indicates a need for medical evaluation.
Can post-coital pain affect my fertility?
Some underlying causes, like untreated STIs or endometriosis, can impact fertility. It’s important to address and treat these conditions promptly.
Is there anything I can do to prevent pain?
Yes. Regular STI screenings, using lubricants, maintaining good hygiene, staying hydrated and having open communication with your partner can help prevent pain.
Can post-coital pain be a sign of a serious condition?
Yes, it can indicate conditions like infections, endometriosis or even early signs of cancer. It’s important to seek medical advice for a thorough evaluation.
Is it normal to feel pain after sex occasionally?
Occasional mild discomfort might not be unusual, especially if related to temporary issues like rough intercourse or lack of lubrication. However, recurrent or severe pain should be evaluated by a doctor.
Can emotional factors really cause physical painful sex?
Absolutely. Stress, anxiety and relationship issues can contribute to physical symptoms by causing muscle tension and reducing arousal, which can lead to pain.
How can I talk to my partner about this issue?
Open communication is important. Explain want you are experiencing and why, if you know. Reassure them that the pain is not related to their actions, it’s a medical issue that needs addressing. Encourage mutual support in seeking solutions together.
Are there specific tests I should ask my doctor about?
Your doctor might recommend pelvic exams, ultrasounds or tests for infections and hormonal levels to determine the underlying cause of the pain.
Take control
Painful sex can have a real impact on your life but understanding more about the condition and recognising when to seek medical help is a crucial step in maintaining your sexual and overall health.
This article was originally published on AskAwayHealth.
ADDITIONAL INFORMATION
Dyspareunia (pain when having sex) – Royal Berkshire NHS Foundation Trust
