Why Does Sex Hurt? Doctors Break Down Possible Causes and Solutions

Sex should largely be about pleasure, not unwanted pain. It may surprise you then, that approximately 75% of women report pain during intercourse at some point in their lives, according to the American College of Obstetricians and Gynecologists. This pain ranges from mild to severe, and for some, it's a quick phase rather than a long-term problem. But that doesn't make it any less uncomfortable in the moment.

"Sexual pain, known as dyspareunia, is a common problem that is often not talked about or is dismissed," Jodie Horton, MD, tells PS. "There are multiple reasons that sex can hurt, including physical and mental factors, and can occur before, during, or after the actual act of sex."

For those who consistently experience moderate to intense pain during sex, it can be difficult to pinpoint the exact cause, and the topic is sometimes awkward to discuss with a partner or even a healthcare provider. Sometimes it feels like "there must be something inherently wrong with me," when in reality, there's plenty of reasons for painful sex. To get a better idea of why sex hurts, we asked doctors about potential causes, treatment, and expert-approved recommendations to help ease pain.

Jodie Horton, MD, is a board-certified ob-gyn and medical advisor at Love Wellness.

Sandra Hilton, PT, DPT, MS, is on the board of the Abdominal and Pelvic Pain special interest group and co-host of the "Pain Science and Sensibility" podcast.

There's many possible causes for painful sex, and some are more common than others. "Get to know your body and ask yourself questions to understand what may be the cause," Dr. Horton says. Some possible questions include:

"This will also help the physician figure out the cause or causes of painful sex," Dr. Horton says. As a reminder, she says it's always best to consult with your doctor, as a detailed medical history and physical exam are necessary to diagnose and treat dyspareunia (aka painful sex). The physical exam may involve an inspection of the vulva, vagina, cervix, and possibly pelvis in order to check for any pelvic floor dysfunction, fibroids, pelvic masses, or points of pain, Dr. Horton says. Vaginal swabs and urine samples may also be used to help rule out infection. Until then, this list of common causes may give you a better idea of why sex hurts.

Infections like bacterial vaginosis, yeast infections, and STIs such as gonorrhea, chlamydia, and herpes can all cause irritation, which may lead to painful sex, Dr. Horton says.

"A lack of foreplay can contribute to a lack of lubrication and can cause pain," Dr. Horton says. Foreplay is for everyone, but for people with vaginas, longer foreplay can be especially helpful for avoiding painful penetrative sex.

"[Those] who have endometriosis or fibroids may have chronic pelvic pain," Dr. Horton says. Sandra Hilton, PT, DPT, MS, explains that pelvic pain may occur in response to stress or fear. "Imagine if your hand was clenched and you didn't unclench it for days. Moving your hand or having something put in your hand would likely feel stiff and may be painful," she says.

"There can be an emotional aspect that causes pain, too," Dr. Horton says. "Stress, anxiety, depression, previous injury, or trauma can cause fear or anticipation of pain." This anticipation can trigger the pelvic muscles to contract in an effort to guard the pelvis and other internal structures, Dr. Hilton says.

"Hormonal changes that occur during perimenopause, menopause, and breastfeeding can lead to a decline in estrogen," Dr. Horton says. "A decrease in estrogen can cause vaginal dryness, itching, burning, and loss of elasticity of the vaginal tissues." This can result in painful sex. Dr. Hilton also explains that hormonal changes lead to less lubrication. "The skin of the vagina and perineum are less lubricated with changes in the estrogen levels, making the friction and shearing forces of intercourse painful," she says.

"Relationship problems or lack of intimacy with your partner can also lead to stress in the relationship and manifest as painful intercourse," Dr. Horton says.

If sex suddenly starts hurting, there's a chance it could be due to an injury. "Sometimes there is an initial injury like a fall, or rough sex, or trauma, or a muscle spasm that didn't go away," Dr. Hilton says. "This can cause a protective pain response and the nervous system gets overly protective and sensitive to touch, pressure, or movement of the vulva and vagina."

Vaginismus is a condition "which is caused by the fear or anxiety of having sex and causes involuntary contractions or tensing of the vaginal muscles," Dr. Horton says. This could lead to painful sex, but therapy and "vaginal training" (which uses different sized forms to stretch the vaginal tissue) can help.

Painful sex is best addressed on a case-by-case basis by a medical professional. Treatment will depend on what is specifically causing the pain. For instance, painful infections like bacterial vaginosis can usually be resolved with antibiotics, whereas a condition like endometriosis may require a doctor who specializes in pelvic pain and sexual disorders, Dr. Horton says (you may even consider surgery to remove painful fibroids).

For more emotional triggers, Dr. Hilton recommends working with a sexual therapist, a gynecologist, and pelvic health physical therapist, adding that "specific mindfulness techniques such as yoga, Tai Chi, and Qi Gong have been helpful for restoring a sense of control and trust with movement." If a lack of foreplay is contributing to pain, Dr. Horton suggests having an honest talk with your partner. "Open and honest communication about sex can help you and your partner feel more comfortable and satisfied with your sex lives and address any concerns," she says.

"If you have frequent or recurrent pain with intercourse, have unusual discharge, chronic pelvic pain, or vaginal bleeding, you should talk to your doctor," Dr. Horton says. "Many people will delay getting help because they are reluctant to discuss sexual health or problems with their doctor. Do not feel embarrassed or ashamed because your doctor will be able to help you or address your concerns."

If you're unsure where to go for help, an ob-gyn is typically a good starting point. "They may refer you to a doctor who specializes in pelvic pain and sexual disorders, such as a urogynecologist, a urologist, a sexual therapist, or a physical therapist," Dr. Horton says. They may also recommend cognitive behavioral therapy to help properly address the pain.

Caitlin Flynn is a journalist, true crime fanatic, full-time Gemini, former ballerina, and big fan of unlikeable female protagonists.

Chandler Plante is an assistant editor for PS Health & Fitness. Previously, she worked as an editorial assistant for People magazine and contributed to Ladygunn, Millie, and Bustle Digital Group. In her free time, she overshares on the internet, creating content about chronic illness, beauty, and disability.