If you’re experiencing pain during sex, you are not alone, around 20% of women say they have experienced pain and discomfort when getting it on. But just because painful sex (also known as dyspareunia) is fairly common, it’s not something we should ignore.
As always, pain is your body telling you something isn’t right - so it’s important to listen. Here are some of the most common causes of painful sex plus our advice on how to manage it and when to seek help.
Causes Of Painful Sex
Whilst 20% of the population report having painful sex, this number rises to up to 60% for people with endometriosis!
This is likely because with a condition like endometriosis, cells similar to the lining of your womb grow outside of your uterus, causing painful scar tissue and adhesions. Although this growth can technically happen anywhere in the body, for the majority of endo patients, it happens around the pelvis.
If you have endometrial tissue growing in or around your vagina, cervix or lower part of the uterus, this tissue can pull during penetrative sex. This can cause pain during sex but can also last for hours after.
Another condition that can cause painful sex is fibroids. Fibroids are benign growths that occur in and around the womb and research indicates that women with the condition are more likely to experience painful sex than those who don't have it.
Similarly to endometriosis, it seems like the location of the fibroids can determine how intense the pain is during intercourse. If you have a large fibroid or one that’s located near your cervix, the pressure from penetrative sex can make it extremely painful.
There are a few different intimate infections that can make sex less pleasurable and more painful.
Thrush is a hugely common infection - around 75% of women will have it in their lifetime! It’s caused by a fungus called candida, something we all have in our bodies which is normally harmless. But when it becomes overgrown it can trigger thrush - which comes with lots of itchiness and irritation. Once you have thrush, your skin can become particularly sensitive and this can make sex far from fun!
Another infection that can cause havoc in your sex life is cystitis. Cystitis can impact people of all genders but is particularly prevalent in women, with 60% suffering at some point. Whilst the infection is technically to do with the urinary tract, it can cause pain and inflammation in the whole genital/pelvic area, which can lead to painful sex.
Often sexually transmitted infections have no symptoms at all, but when they do come, they can be pretty rough! STIs like chlamydia or gonorrhoea can cause symptoms such as painful sex, bleeding after sex, vaginal or penile discharge and pain when going to the toilet. If you are experiencing painful sex and think you could have been at risk of catching an STI, get yourself tested ASAP.
Vaginismus is a pretty complex condition, It’s thought to be a psychosexual condition that triggers involuntary tightening of the vaginal muscles. Experts believe it is often linked to sexual trauma or fear of penetration. For some women, it means they have never been able to have penetrative sex, and for others, it means that they can but it is extremely uncomfortable - and far from enjoyable.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) is an infection of the female reproductive system. It can be caused by things like STIs or procedures such as having an IUD fitted. However, in some cases, it’s simply a case of bacteria in the vagina making its way into other areas of the reproductive system, where it can trigger infection. Painful sex is a common symptom of PID, but the condition can usually be cleared up with a course of antibiotics.
Your Menstrual Cycle
The hormonal fluctuations of your menstrual cycle shouldn’t really cause painful sex, but there are some bodily changes that happen that could potentially make it more or less comfortable. For example, during your fertile window (around the time of ovulation) your cervical mucus will be thinner and wetter - whereas in other phases of your cycle, you might find you need lube to make sex more pleasurable. Likewise, our cervix changes position throughout your cycle, so you might find certain positions feel good at some times in the month and not at others!
Painful sex is sadly a really common issue during perimenopause and into menopause - with up to 45% of women at this life stage saying they struggle with it. As we move towards menopause, our oestrogen levels fall and this means we naturally produce less cervical mucus and arousal fluids, which can lead to vaginal dryness and vaginal atrophy (the thinning and inflammation of the vaginal walls) - which can understandably contribute to painful sex.
How To Manage Painful Sex
If you are regularly experiencing painful sex, it’s important to raise it with your doctor. As you can see, it could be a symptom of many health issues, some of which can be serious if left untreated.
However, whilst you wait for treatment or support there are also a few things you can do to make your sex life more pleasurable and less painful!
- Talk to your partner - Communicate with them about what positions feel comfortable and which cause some pain. Remember this might change from week to week throughout your cycle, so don’t be afraid to mix things up and share how you’re feeling.
- Lube up - Lubricant can make a huge difference to your sex life - especially if you struggle with vaginal dryness, Make sure to choose something natural and water-based to ensure it doesn’t trigger further irritation.
Pass on penetrative - If penetrative sex is hard for you, experiment with other ways to have fun with your partner! You can try keeping things vulva-focused with oral sex or gentle touch and if things are super sensitive for you right now, remember you can always maintain intimacy without anything sexual going on.
- Support your vaginal health - Of course, if your vagina is happy, you’re more likely to have a happy sex life. Avoid products with soaps and fragrances that can mess with the vagina’s natural PH balance and cause irritation and also remember to support your vagina’s good bacteria. When our vaginal microbiome is imbalanced it can make us more vulnerable to infections like thrush and STIs.