When sex hurts: reasons you’re experiencing pain during intercourse

It can be a tough conversation to start.  Often when patients raise the issue, “it” has been going on for a while.  I’m talking about painful sex.  It’s likely more common than you’d think, with estimates saying that nearly three out of four women experience painful intercourse at some point in their lives. 

If you’re lucky, pain during sex is a temporary problem — for example, experienced right after childbirth. But for others, the pain is long-term. Painful intercourse may be a sign of a gynaecological problem, such as ovarian cysts or endometriosis; but problems with sexual response, such as a lack of desire or a lack of sexual arousal, may also be the cause.  

Whatever the case, I am always relieved when patients bring up their problems with painful intercourse, so that we can address the cause and get started on treatment.

What causes painful sex for women?

There are several causes for pain during sex. Some are a result of gynaecological conditions, but there are many others that aren’t. Some reasons you may be experiencing pain during sex could include:

Non-gynaecological conditions

• Medications: Several medications can impact your sexual response.  Pain medication and even certain types of birth control have been linked with decreased desire for sex.
• Your emotions: Relaxing is key to sexual arousal.  Feelings of awkwardness, fear, shame or guilt about having sex can make it difficult to relax.  When you’re not relaxed, arousal is difficult and this can cause pain during sex.  If you’re stressed or tired, this can also impact your desire to have sex.
• Your relationship: Having a partner that is experiencing a sexual problem can also impact your sexual response and make you anxious.  If your partner has erectile dysfunction and is taking a drug for the condition, it may take him a long time to orgasm (meaning long, and sometimes painful, intercourse).
• Certain conditions: Maybe you have arthritis and certain movements hurt, or you’re recovering from cancer.  There are many medical conditions that can have an affect on your sexual response and body image.

Gynaecological conditions

As a gynaecologist, these are my top five gynaecological causes for pain during sex:

• Hormonal changes: During perimenopause, which often stretches from 45 to 55 years, and menopause, a woman’s estrogen drops and can cause vaginal dryness.  In addition to hormone therapy, a lubricant during sex or vaginal moisturizer, can really help.
• The V-series: There are three: vulvodynia (pain disorder affecting the external female genitals), vaginitis (inflammation of the vagina caused by a yeast or bacterial infection) and vaginismus (a tightening of the muscles at the opening of your vagina).  Your gynaecologist can help diagnose these and determine the best care for you.
• Irritated skin: Cracks in the skin of the vulva, the external genital area, can be caused by certain skin conditions like contact dermatitis.  Contact dermatitis causes burning, itching and pain and is a reaction to an irritating substance like perfumed soaps, douches or lubricants.  Treatment depends on the type of skin disorder.
• Having a baby: If you’ve had an episiotomy, tears in the perineum during childbirth, or are breastfeeding, there’s a chance that you will have pain during sex.  The good news is that time often helps, and there are good treatments, including physical therapy, medication and surgery.
• The gynaecological heavy-hitters: In no particular order, endometriosis, uterine prolapse, pelvic inflammatory disease, fibroids, cystitis, ovarian cysts.  Speak with your family physician about a referral to a gynaecologist.

Please don’t ignore issues with painful sex, there is help available.  Talk to your doctor and your partner.  Tell your partner what is uncomfortable, and explore sexual activities that aren’t painful.  Massage can be relaxing and sensual.  If you have sex, empty your bladder before sex, take a warm bath or an over-the-counter pain reliever to reduce discomfort.  Water-based lubricants are good too, they won’t irritate sensitive skin.

Sex and intimacy are important in a relationship.  Speak up and get the help you need.