Pain During Sex: Common Causes, Red Flags, And First Steps
Pain during sex (often called dyspareunia) is more common than most people realize. And while it can feel awkward to bring up, it’s also one of those symptoms your body uses to say, “Hey, something needs attention.” The good news: many causes are treatable, and you don’t have to just “power through it.”
This post walks through the most common reasons sex can hurt, what counts as a red flag, and the first practical steps to take. I’m going to keep this straightforward and friend-to-friend.
First, A Quick Reality Check
Pain is not a normal price of admission for sex. Mild discomfort can happen sometimes (especially with new positions, postpartum changes, stress, or not enough arousal), but persistent or sharp pain deserves a closer look.
Also, “pain during sex” isn’t one single thing. It can show up as:
Pain at the vaginal opening with penetration
Deep pelvic pain with thrusting
Burning, stinging, or rawness
Pain with tampon use, pelvic exams, or even tight clothing
Pain plus other symptoms (bleeding, discharge, urinary symptoms, fever, etc.)
Where it hurts, when it hurts, and what else is going on can point toward the cause.
Common Causes Of Pain During Sex
Not Enough Lubrication (Often From Arousal Mismatch Or Dryness)
This is one of the most common and most fixable reasons. If tissues are dry, friction can cause burning, stinging, or tearing sensations.
Common contributors include:
Rushing, stress, anxiety, or feeling pressured
Hormonal shifts (postpartum, breastfeeding, perimenopause/menopause)
Some medications (especially SSRIs, antihistamines, and certain birth control methods)
Dehydration or low estrogen
What it feels like: burning or “sandpaper” friction at the opening or inside, especially early in penetration.
Vaginal Or Vulvar Irritation (Contact Dermatitis And Sensitivities)
The vulvar skin is sensitive. Products that are “normal” elsewhere can cause irritation here.
Common culprits:
Scented soaps, bubble baths, bath bombs
Douches (these can disrupt healthy vaginal balance)
Certain lubricants (especially those with fragrance, flavors, warming/cooling agents)
Laundry detergents, fabric softeners, and tight synthetic underwear
Hair removal irritation
What it feels like: burning, itching, rawness, and pain with touch.
Infections (Yeast, Bacterial Vaginosis, STIs, UTIs)
Infections can inflame tissues and make sex painful.
Clues can include:
New or unusual discharge or odor
Itching or burning
Pain with urination or frequent urination
Pelvic discomfort
New partner or STI risk
What it feels like: burning, tenderness, or a deeper ache. Some STIs can be silent and still cause inflammation, which is why testing matters if risk is present.
Pelvic Floor Muscle Tension (Sometimes Called Pelvic Floor Dysfunction)
Your pelvic floor muscles support the bladder, bowel, and reproductive organs. When they’re too tight or don’t relax well, penetration can hurt.
Triggers can include:
Chronic stress, trauma history, or anxiety
Pain conditions that cause “guarding”
Postpartum changes, scars, or past injuries
Longstanding constipation or certain exercise patterns
What it feels like: tightness, sharp pain at the opening, difficulty “letting anything in,” or pain that improves when you pause and breathe.
Vaginismus (Involuntary Tightening With Penetration)
Vaginismus is a pattern where pelvic muscles involuntarily tighten when penetration is attempted, often linked with anxiety, fear of pain, past painful experiences, or trauma. It’s not “all in your head,” and it’s treatable.
What it feels like: hitting a “wall,” burning, sharp pain, or an inability to tolerate penetration.
Vulvodynia Or Vestibulodynia (Chronic Vulvar Pain Conditions)
These are pain syndromes involving the vulva or the vestibule (the area around the vaginal opening). The pain can be provoked (touch/sex) or unprovoked.
What it feels like: burning, stinging, or cutting pain at the opening, often with no obvious infection on testing.
Low Estrogen Changes (Postpartum, Breastfeeding, Menopause, Some Birth Control)
Lower estrogen can make vaginal tissue thinner and drier, which increases friction and micro-tears.
What it feels like: dryness, burning, and pain with penetration, sometimes with light bleeding after.
Endometriosis, Adenomyosis, Or Fibroids (Deep Pelvic Causes)
These conditions can cause deep pain with sex, especially with certain angles or deeper penetration.
Clues can include:
Painful periods or heavy bleeding
Pain with bowel movements (especially during periods)
Chronic pelvic pain
Pain that lingers after sex
What it feels like: deep aching, cramping, or stabbing pain with deep penetration.
Ovarian Cysts Or Pelvic Inflammation
Cysts can be asymptomatic or painful. Pelvic inflammatory disease (PID) is an infection-related inflammation that needs medical care.
What it feels like: deeper pain, sometimes one-sided, and possibly worse with movement.
Structural Or Skin Conditions (Lichen Sclerosus, Eczema, Tears, Scarring)
Some skin conditions cause thinning, cracking, and pain, and can be missed without a careful exam. Post-birth tears, episiotomy scars, or surgery scars can also contribute.
What it feels like: burning, tearing, sharp pain at the opening, itching, white patches, or skin changes.
Red Flags That Should Prompt Medical Care Soon
If any of these apply, it’s worth contacting a clinician promptly (urgent care or emergency care if severe):
Sudden severe pelvic or abdominal pain, especially with nausea, vomiting, fainting, or shoulder pain
Fever, chills, or feeling very unwell with pelvic pain
New heavy bleeding, bleeding after sex that is more than light spotting, or bleeding after menopause
Foul-smelling discharge, pus-like discharge, or significant pelvic tenderness
Pain with sex plus burning urination, back pain, or blood in urine
Pain after a sexual assault or any situation where you did not consent
A new painful bump, blister, ulcer, or rash on the vulva
Known pregnancy with pelvic pain or bleeding
Any pain that is steadily worsening, persistent, or interfering with daily life
If you’re thinking, “This seems like me, but I’m not sure it’s serious,” that’s still a good enough reason to reach out. You don’t need to be 100% certain to deserve care.
First Steps You Can Take Right Now
These are practical, low-risk steps that can help you learn what’s going on and reduce pain while you figure out your next moves.
Pause Penetration And Reset The Goal
If penetration hurts, stop and switch to other forms of intimacy. This isn’t “giving up,” it’s protecting your body from a pain cycle. Repeated painful attempts can teach your muscles to brace automatically.
Track The Pattern For One To Two Weeks
A simple notes app log can be surprisingly helpful. Include:
Where the pain is (opening vs. deep)
What it feels like (burning, sharp, pressure, cramping)
When it happens (start of penetration, deep thrusting, after sex)
Cycle timing (before your period, during, after)
Lubrication level, stress level, and any new products
Other symptoms (itching, discharge, urinary symptoms, bleeding)
This can speed up diagnosis at a visit.
Use A Plain, Body-Safe Lubricant
If dryness or friction might be part of it:
Use a generous amount, and reapply as needed
Consider avoiding fragranced, flavored, warming, or “tingly” products
If using condoms, check compatibility (some oils can degrade latex)
If you’re prone to irritation, choose the simplest ingredient list you can find.
Check For Irritants And Simplify Your Routine
For a couple of weeks, try:
No douching (ever)
No scented soaps on the vulva; use warm water or a gentle, fragrance-free cleanser externally only
Skip scented pads, sprays, wipes, and bath additives
Switch to breathable cotton underwear
Avoid tight leggings for long stretches if you’re irritated
Try More Warm-Up And Slower Pacing
Arousal changes blood flow, lubrication, and tissue stretch. Helpful ideas:
Longer foreplay (and no rushing)
More communication during sex (“slower,” “shallower,” “pause”)
Positions that allow control over depth and angle (often being on top or side-lying)
Experiment With Depth And Angle
If pain is deep:
Try shallower penetration
Use positions that limit depth
Use pillows for support
Consider whether certain times in your cycle worsen it (some people notice more sensitivity around ovulation or before their period)
If You Suspect Pelvic Floor Tightness, Use Down-Training Techniques
A few gentle options:
Diaphragmatic breathing (slow belly breathing) before and during intimacy
Relaxation-focused stretching (no pushing into pain)
A warm bath or heating pad on low for pelvic muscle relaxation (external)
If you notice a pattern of “my muscles clamp down,” a pelvic floor physical therapist can be game-changing.
Do Not Self-Treat Repeatedly With Over-The-Counter Yeast Meds Without Testing
It’s easy to assume “yeast,” but irritation, BV, dermatitis, and vulvodynia can feel similar. If symptoms keep returning or don’t improve quickly, it’s time for an exam and appropriate testing.
What To Expect At A Medical Visit
If you decide to get checked (and if the pain is persistent, that’s a smart move), here’s what typically helps:
A detailed symptom history (your notes are useful here)
A gentle pelvic exam focused on pain mapping (you can ask them to go slowly, stop, or explain each step)
Testing for infections or STIs if relevant
Discussion of hormones, postpartum/menopause changes, medications, and contraception
If deep pelvic pain is suspected: ultrasound, referral to gynecology, or evaluation for endometriosis and related conditions
If pelvic floor involvement is likely: referral to pelvic floor physical therapy
A good clinician should take pain seriously and avoid minimizing it.
How To Talk To A Partner About It
If you’re in a relationship, this conversation can actually reduce pain by lowering pressure.
A simple script:
“I’ve been having pain with penetration lately. I want to figure out what’s going on, and I need us to go slower and keep things comfortable. We can still be intimate, just without pushing through pain.”
If you feel pressured to continue despite pain, that’s an important signal. Your comfort matters.
Takeaway
Pain during sex is common, but it’s not something you should accept as “just how it is.” Many causes are treatable, and even when the solution takes time, the right next step is usually the same: pause what hurts, note the pattern, reduce irritation, and get a targeted evaluation if it’s persistent or comes with red flags.
If you want one simple rule: pain that repeats deserves attention.
