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Here Are 11 Causes of Painful Sex (and What to Do About Them)

Nearly three out of four women have pain during sex at some time during their lives—and one of these culprits may be the reason sex hurts.

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Surprising reasons for painful sex

Pain during sex is unfortunately a common problem. According to the American College of Obstetricians and Gynecologists (ACOG), nearly 3 out of 4 women experience painful sex at some time during their lives. But just because it's common, doesn't mean it's easy to talk about.  All too often women aren't sure exactly why they are having pain, or how to fix it, and hesitate to talk to their doctor about it.

It’s important to talk to a physician or gynecologist to get to the root of your problem so you can have a pain-free, satisfying sex life with your partner. There are a diverse set of reasons why some women experience sexual pain with their partners, but there are ways to fix them.

We asked Raquel Dardik, MD, clinical associate professor, department of obstetrics and gynecology at the NYU Langone Joan H. Tisch Center for Women’s Health, about the reasons—some surprising, others not—why sex may hurt.

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You’re not having enough sex

If you haven’t had sex for two years, it’s going to hurt, Dr. Darkdik. "It's like saying, 'I’m going to run three miles,' when you haven't done more than 10 steps in three years." Just like any muscle, regular activity can keep your vagina healthy and strong. “If you have regular intercourse, the vaginal walls stay stretched and the vaginal muscles stay flexible,” she adds. (Here are other health secrets your vagina wants to tell you.)

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You’re stressed out

Stress alone won't result in painful sex, but it does impact arousal. “If you’re thinking about moving in two weeks or you and your partner were just in a fight—whatever the stressor—it can decrease the amount of lubrication and muscle relaxation,” Dr. Dardik says. A bad case of the nerves has also been linked with pelvic floor muscle spasms and bacterial infections—both common causes of painful sex.

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You’re going through menopause

Perimenopause and menopause top the list when it comes to issues that can affect sex drive. Atrophic vaginitis—also known as vaginal atrophy, or thinning, drying, and inflammation of the vaginal walls—is one of the most common culprits during this time of life. “Atrophic vaginitis essentially means the vaginal area doesn’t have enough estrogen—so the vaginal skin is not as stretchy and there’s not as much lubrication,” Dr. Dardik explains. (This is what happens to your body when you stop having sex.)

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You’re not using enough lubricant

Though menopause is generally blamed for vaginal dryness, many other factors can play a role. “If you’re not as aroused or are taking some medication, you can have less lubrication than you normally have,” Dr. Dardik says. The result: Increased friction and pain during or after sex, she explains. If you’re dry down there, a little lube can go a long way. Avoid oil-based lubes like petroleum jelly, however, as they can lead to bacterial infection and can't be used in combination with condoms because they damage latex. (Here are 10 signs you could be headed for early menopause.)

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You have a bacterial or yeast infection

Once again you can blame those fluctuating hormones. During menopausal years, bacterial or yeast infections are more common. “Often times women don’t know they have an infection,” says Dr. Dardik, “but they know that it feels very uncomfortable and irritated when they do have intercourse.” (Find out the 13 ways sex changes in your 40s.)

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You have pelvic floor dysfunction

Pelvic floor dysfunction (PFD) is hard to diagnose, yet surprisingly common. A 2014 study published in Obstetrics and Gynecology suggests it affects one in four women in the U.S. During intercourse, the pelvic floor—the melon-size web of muscles, ligaments, and nerves that support the uterus, vagina, and area around the rectum—can spasm and cause searing pain. Hormonal declines in menopause and loss of muscle mass with age are common culprits. Here are 10 silent signs you have a pelvic floor disorder.

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You have digestive problems

For women who have irritable bowel syndrome (IBS) or Crohn’s disease, the bowel is right next to the uterus so any type of movement of the uterus can trigger inflammation and irritation of the bowel. “People may say, 'It hurts when I have sex' and point to their abdomen rather than their external organs or their vagina,” says Dr. Dardik. (These are the 8 sex myths to stop believing.)

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You have endometriosis

A 2018 study published in the journal Sexual Medicine found that endometriosis—the common gynecologic condition in which tissue similar to the type that lines the uterus grows outside the uterus—is among the main causes of painful sex. The condition affects 10 percent of reproductive-age women. (Here are 15 things no one tells you about endometriosis.)

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You’re in a bad state of mind

It’s not too surprising that your emotions play a role—fear, guilt, shame, embarrassment, or awkwardness about having sex can make it hard to relax, notes the ACOG. And when you can’t relax, arousal becomes difficult, and pain may result. (Here is the surprisingly simple secret to a sizzling sex life, according to a sex expert.)

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Your partner has erectile dysfunction

Erectile dysfunction (ED) can play a role in why some women feel pain during sex. According to a 2016 article published in the Journal of the American Medical Association, half of men over age 40 experience ED. ED treatments, like Viagra, Levitra, or Cialis, can prolong erections and delay orgasm, which may cause long, painful intercourse for some women, according to ACOG. (See how ED could be a red flag for a much more serious disease.)

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You’ve ignored the pain

If painful sex becomes a chronic problem you can start having a physical reaction every time you have intercourse. This is because you’re anticipating that it’s going to hurt, says Dr. Dardik. And now you’re dealing with the psychological component of pain in addition to the initial cause. “Don’t pretend it’s going to go away,” she advises. See your gynecologist and find out how to make sex enjoyable once again. (Here are 19 other topics patients are too embarrassed to ask their ob-gyn.)

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Medically reviewed by Tia Jackson-Bey, MD, on April 16, 2020