Dyspareunia refers to the feeling of pain whenever a woman has sexual intercourse. While this condition can affect both men and women, this condition is more commonly seen in women.

Pain or discomfort during sexual intercourse is not commonly spoken about as there it is still considered a “taboo” subject that has stigma surrounding it. As such, many women going through this problem may also feel that they are alone in this due to the lack of awareness around this topic.

Dyspareunia is actually more common than we realize, and it can affect women of various ages from younger girls to older women who have gone through menopause.

It is important for women to understand why they are experiencing pain whenever they have sex, as many of these causes can actually be successfully treated.

Other than not being able to enjoy intimacy with your partner, leaving this problem untreated can actually lead to long term implications on your emotional and psychological health and lead to a strain in your relationship.

So what are the top 11 most common causes for painful sex? 

Painful sex or Dyspareunia can be broadly classified into 2 categories – Superficial and Deep. The causes also vary depending on the type of dyspareunia you experience as well.

Superficial pain or dyspareunia:

picture of vulva

Women experiencing superficial dyspareunia usually feel the pain on the outer part or just at the entrance of the vagina.

This can include feeling a tearing or burning sensation, which can also sometimes be localized to one particular spot.

Common causes include:

  1. Lack of or reduced vaginal lubrication

This is one of the most common causes of dyspareunia which affects a significant number of women. A lack of vaginal lubrication during sexual intercourse is usually due to psychological factors in younger women, or reduced estrogen and dryness especially in menopausal women.

Some common factors that cause reduced vaginal lubrication include:

  • Fear and nervousness during sexual intercourse
  • Tension and failure to relax
  • Not having enough foreplay prior to penetration
  • Unsatisfactory foreplay performed by the male partner

The good news is that painful sexual intercourse due to a lack of lubrication can easily be treated by simple methods such as increased duration of foreplay, relaxation techniques or by using some water-based lubricant during sex.

  1. Vaginismus

Vaginismus is a condition that is caused by involuntary clenching or contracting of the vaginal walls and muscles, hence making penetration or any attempt at penetration painful or difficult.

Some common symptoms that a patient may experience will include:

  • difficult or impossible penetration, entry pain or uncomfortable insertion
  • burning or stinging pain during sex
  • vaginal tightness during sex
  • partner feels like he is “hitting a wall”
  • difficulty with inserting tampons or with a medical vaginal examination 
  • avoidance of sexual intercourse due to fear, pain or failure

Fear and psychological avoidance forms a huge contributing factor to vaginismus and other causes can also be attributed to a history of restrictive upbringing, previous history of sexual assault or non consensual penetration or previous painful vaginal infections such as genital herpes.

  1. Vaginal Atrophy

Vaginal atrophy refers to the drying up of the tissues around the vagina due to ageing and menopause

When a woman undergoes menopause, her ovaries stop producing hormones such as estrogen. This leads to drying and shrinking of the skin and tissues around the vaginal region.

As a result, many menopausal women may experience extreme vaginal dryness or painful sexual intercourse.

The can be treated by using water based vaginal lubricants to reduce the pain that comes from friction and dryness. Another useful treatment method available can be with topical vaginal hormonal therapy to improve hydration and rejuvenate the tissues around the vagina.

Another useful non hormonal treatment method can also include laser vaginal rejuvenation.

  1. Vaginal infection or inflammation
picture of orange to represent inflamed vagina

Vaginal infection is another very common cause of painful or uncomfortable sexual intercourse.

Common infections can include yeast infections, bacterial vaginosis or sexually transmitted infections such as chlamydia, gonorrhea, genital herpes or trichomonas

Other symptoms that may be associated with infection can also include:

  • abnormal vaginal discomfort
  • burning sensation or pain around the vagina
  • vaginal itching
  • abnormal bleeding
  • painful blisters

Your doctor may perform vaginal swabs to screen for infections, which if correctly treated, can help to resolve the dyspareunia.

  1. Inflammation of the Vulva

The vulva is the outer part of the female genitals, which includes the 2 folds of skin around your vaginal region.

Inflammation or irritation of the vulva can lead to abrasions, broken skin or cracks in the skin. This can lead to pain and discomfort, especially with any further abrasion or contact such as during sexual intercourse.

Inflammation of the vulva is commonly caused by external skin irritation due to bad habits or direct exposure to strong soaps or vaginal douches.

  1. Injury
picture to represent vaginal injury

While this may not happen commonly on a regular day to day basis, it is an important factor to consider, especially for women who have just given birth.

Injury or trauma to the vaginal opening is unavoidable during child birth, and an episiotomy cut or tears can occur during labour. Sometimes if the tears are more serious, or if the stitches do not heal well, it may lead to pain during sex for an extended period of time.

Deep pain of dyspareunia

picture of uterus and ovaries

Women experiencing deep dyspareunia usually have no issues with the initial attempt of penetration, but usually feel the pain or discomfort after full penetration is achieved.

The pain is often felt deep in the vagina or may sometimes even present as a deep discomfort in the pelvic region.

Common causes can include:

  1. Endometriosis

Endometriosis is a condition whereby the endometrium (inner lining of the uterus) grows outside of the uterus. This results in inflammation of the surrounding tissues, which can lead to pain during sexual intercourse.

  1. Cervicitis (Inflammation of the cervix)

Inflammation of the cervix is most commonly associated with infections, especially sexually transmitted infections such as chlamydia, gonorrhea or trichomonas.

As the penis comes into contact with the cervix during sexual intercourse, any contact with an inflamed cervix can cause pain. Bleeding after sex may also be observed.

  1. Uterus (womb) or Ovarian problems

Abnormal growths in the womb or ovaries may also contribute to pain. Hence it is important to rule out problems such as fibroids or ovarian cysts.

Women with a retroverted uterus (womb direction pointed backwards) may also be more predisposed to deep dyspareunia. This is an anatomical variation of a woman’s uterus that is commonly found.

4. Pelvic Adhesions

picture of adhesions on uterus and ovaries

Pelvis adhesions are scar tissues that form as a result of a previous abdominal or pelvic surgery, or from previous  radiation treatment or from PID.

These adhesions cause the pelvic organs to be stuck together and as a result lead to pain during sex.

  1. Pelvic inflammatory disease (PID) 

PID is a result of undiagnosed and untreated inflammation of the womb or pelvis organs. This is often the result of undiagnosed sexually transmitted infections such as chlamydia.