March 17, 2026
Painful sex is common — three out of four women experience pain associated with intercourse at some point in their lives. But just because it's common does not mean it's normal.
"So many people feel like it's okay for intercourse to be painful, because nobody has told them any different," says Kelsey Day, FNP, an MU Health Care family nurse practitioner who specializes in dyspareunia — the medical term for pain related to intercourse. "But the truth is that sex should not be painful. Ever. If it is, then there's likely an underlying cause that needs to be addressed."
The problem is that dyspareunia can be caused by many things, ranging from infections and inflammation to poor tissue health and weak muscles. Add in the anxiety and tension that can set in when sex is painful, and it becomes very challenging to know the root cause of the pain.
Having some information about the things that can cause and help dyspareunia is an important first step in alleviating that pain. Day shares seven things you need to know about pain during sex:
1. Dyspareunia Includes More Than Pain From Penetration
Dyspareunia can refer to pain from or during penetration. But the condition also applies to:
- Burning pain on your vulva or inside your vagina after intercourse
- Muscle spasms or discomfort after sex ends
- Pain during initial penetration as your vaginal canal stretches
- Vulva pain that makes it sensitive to the touch
"You really should not experience any pain before, during or right after intercourse," Day says. "Any discomfort inside or outside the genitals counts."
2. There May Be More Than One Thing Causing Your Pain
Where and when your pain happens can help uncover the cause. But it's common to have multifactorial causes — it's not always just one thing.
Possible underlying causes of dyspareunia include:
- Chronic urinary tract infections (UTIs) can lead to pain after sex.
- Endometriosis can cause pain in the pelvic floor and lower abdomen that worsens with intercourse.
- Fibroids and ovarian cysts can make penetration painful.
- Interstitial cystitis (bladder inflammation) can be painful after sex.
- Pelvic floor dysfunction that involves weak or tense muscles can cause pain during and after intercourse.
- Poor tissue health, common in postmenopausal women, can cause vulva pain and vaginal pain during penetration.
- Vaginal infections, such as vulvovaginitis, can cause burning pain on the vulva and inside the vagina.
- Inflammatory conditions, such as lichen sclerosus, can lead to painful tissue changes.
"Painful sex when you are young is often a muscular issue or an infection," says Day. "Once you reach middle age, you're also adding stress, hormonal shifts, pelvic floor problems and tissue health issues. These factors add up and can contribute to the pain you feel."
3. New Pain Is More Concerning Than Chronic Pain
Do not wait to discuss any new or sudden pain associated with intercourse with your doctor.
"If sex suddenly becomes painful or uncomfortable, that warrants investigation," Day says. "It's important to rule out infections and conditions that need to be treated as soon as possible."
If you've been experiencing chronic pain with intercourse, you should still discuss it with a provider but it may not require the same urgency. "Even if your pain doesn't require acute care, it's good to get ahead of it," Day says. "Otherwise, it can become a lifelong problem that can affect intimate relationships."
4. Painful Intercourse Is Often Related to Hormonal Changes
Your hormones fluctuate monthly during your menstrual cycle and with significant life events. Day says the role of hormonal changes depends on what's causing them:
- Monthly menstruation: At the beginning of each menstrual cycle, the skin around your vagina, including the vulva and vaginal tissue, can become sensitive and tender, causing pain with friction.
- Pregnancy: Your hormones shift drastically during pregnancy and can affect tissue health and lubrication. After childbirth, there is a natural drop in estrogen — especially if you are breastfeeding. Vaginal births can also cause trauma to your vaginal tissue, resulting in new scar tissue that can make sex painful.
- Menopause: Your estrogen levels naturally decrease in perimenopause and reach a low once you go through menopause. The changes leave your tissue less supple and more sensitive.
5. Your Products and Behaviors May Be Contributing to Your Pain
Small behaviors are likely not causing severe pain, but they can contribute to it. Vaginal and vulvar tissue is extremely sensitive. Some products, such as soaps, wipes or lotions can irritate that skin and increase sensitivity and cause pain. Choose products for "down there" that are gentle and fragrance-free.
Take a closer look at your physical activity and exercise habits, too. You may avoid painful sex by supporting your pelvic floor with a strong core. On the other hand, high-intensity exercise can stress pelvic muscles and lead to increased pelvic pain.
"Low activity can decrease your ability to contract pelvic floor muscles, but high activity can lead to an overuse injury in those muscles," says Day. "The goal is to find a healthy exercise balance."
6. There Is Treatment for Dyspareunia
The best way to address painful intercourse is to identify the underlying cause and treat it. Dyspareunia treatment may include:
- Physical therapy, which may include electric stimulation therapy or pelvic floor therapy, to help you strengthen or relax pelvic floor muscles
- Medication therapy with intra-vaginal medicines to help relax the muscles if pain is the result of surgical trauma or neuropathic issues
- Antibiotics to treat infections
- Dilator therapy or wand therapy that helps desensitize your tissue or muscles
- Sexual adjustments to position, foreplay or lubrication
- Scar tissue manipulation and surgical interventions to remove or reduce obstructions in painful sex
It can also be helpful to address underlying mental health issues, such as anxiety and trauma. While your mental health may be a secondary issue, it can have a direct effect on how you experience sex.
"Anxiety and fear can cause you to be more receptive to pain," says Day. "If your brain isn't in the right place, you may be tensing your pelvic floor muscles, which can make sexual intercourse painful."
7. Keeping a Log Can Make it Easier to Communicate With Your Doctor
Talking to your provider about sex can feel uncomfortable. But the sooner you address the issue, the less damage it will do to your physical and mental health.
Day recommends keeping a log of the pain you experience with intercourse. Ask yourself these questions:
- Are there certain sexual positions that trigger the pain?
- Is the pain new or chronic?
- Is the pain internal or external and is it always in the same spot?
- Does the pain happen before, during or after sex?
- Is the pain sharp and shooting, dull and radiating, or burning?
- Does the pain feel muscular?
- What makes the pain worse and what makes it better?
The more information you can give to your doctor, the more they'll understand what you're experiencing. Your provider may ask about your relationship and general mental health. They will also consider your physical health and existing medical issues.
"Partner with your provider," says Day. "That's the best way to learn what's causing the pain, what you can be doing at home and what can be done medically to make sex pain-free.
Next Steps and Useful Resources
- Want to discuss more with a doctor? Find one today.
