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8 Reasons Why Sex Hurts

There are lots of reasons to have sex: connection, pleasure, or fun, to name a few. But feeling pain? That’s everything sex isn’t supposed to be. For many women, though, discomfort is a painful reality of getting intimate: As many as one in five young women say that intercourse consistently hurts. And the physical discomfort is only the start of their strife: Women with dyspareunia, the medical term for pain upon penetration, often fear losing their partner, feel sexually inadequate, and experience a dip in desire and satisfaction in the sack, according to the Journal of Sexual Medicine[Tweet this fact!]

Yet many women say nothing—to their doctor, or to their partner. “There is a lot of depression and anxiety associated with this topic,” says Kenneth A. Levey, M.D., M.P.H., a gynecology professor and pelvic pain specialist at NYU. 

But identifying the underlying cause of your pain is the first step to resolving it. To find out what may be making sex more painful than pleasurable, read on. (And to find a gynecologist who specializes in painful intercourse, visit the International Pelvic Pain Society website, where you can search for physicians in your area.)

Endometriosis
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In a 2014 Journal of Sexual Medicine study, 75 percent of women with endometriosis (a condition where endometrial tissue grows outside the uterus) also suffered from sexual pain—often leading them to avoid sex. Deep penetration can put pressure on areas where endometriosis occurs, such as the ligaments attaching your uterus to your pelvis or the lining of your pelvis. “Anything that touches those areas—a penis, a tampon—can be extremely painful,” says Levey.

Overactive Pelvic Floor Muscles
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Your pelvic floor (a group of sling-like muscles that support your uterus) is supposed to relax during sex. But in some women, these muscles constrict, often as a result of difficult childbirth, sitting too much of the day, or past sexual abuse, according to Virginia Tech researchers. “Pelvic floor muscle spasm is far and away the number one most under-recognized cause of painful intercourse,” Levey says. “Not a lot of doctors are looking for this cause—sometimes they just tell a woman she has a tight vagina, which is ridiculous.” Signs to look for: a burning, throbbing sensation at the entrance of your vagina, which can last for hours or days after sex.

A History of Urinary Tract Infections
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If your medicine cabinet is regularly stocked with antibiotics, you may be predisposed to penetration pain. In a 2013 study, Italian researchers found that women with “provoked vestibulodynia”—a type of discomfort triggered by pressure around the vaginal opening—had a higher number of UTI’s than pain-free ladies. [Tweet this fact!] “Infection leads to nerve hypersensitivity,” says Levey. “Normally, nerves calm down over time. But if you get another infection within a couple weeks or months, those nerves never have time to relax.” That means the entrance to your vagina is incredibly sensitive, so much so that even attempting penetration can be intolerable. (Excessive use of antibiotics may lead to recurrent infections too, triggering severe inflammation and a greater risk of pain around your vulva, the study authors say.)

You’re Not Lubing Up
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If you’re not sufficiently wet, your partner’s penis may feel far from pleasurable. An estrogen drop (a common side effect of menopause, childbirth, or breastfeeding) could be to blame for a lack of lubrication, according to Mayo Clinic experts, or you just may not be aroused enough. In this case, the fix is simple: silicone-based lubricants, says Levey, which tend to be slicker than water-based varieties. Try Wet Platinum Lubricant.

Fibroids
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Fibroids (a type of rubbery growth in your uterus) may set your sex life on fire—and not in a good way. “Pain with fibroids tends to be a quick, fast, sharp pain,” says Levey. In a recent Journal of Sexual Medicine study, women with fibroids were three times more likely to report severe pain during sex than those without the growths. “Fibroids can indent into the vagina, and the act of hitting them can be incredibly uncomfortable,” Levey explains. Another cause of discomfort: As fibroids increase in size, they may die off, leaving your uterus inflamed and primed for pain, he says.

A Tilted Uterus
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Women with a tilted uterus have a higher risk of endometriosis (a common cause of sexual pain), says Levey. An off-kilter uterus may also be directly linked to discomfort: “When the top of the uterus is tilted back, the penis can hit that,” Levey explains. That can lead the supporting tissues to stretch, ultimately causing pressure and pain. Other signs of a tilted uterus: menstrual pain, back pain during sex, UTI’s, and trouble using tampons, according to the American Pregnancy Association.

A New Baby
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Nearly half of nursing women reported pain six months after childbirth, compared to 30 percent of new moms who weren’t breastfeeding, a 2014 study in the International Urogynecology Journal found. Vaginal delivery can also cause tearing and nerve damage (ouch!) and breastfeeding may temporarily affect your body’s ability to lube up during sex, says Levey.

Stress!
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Anxiety alone probably won’t make sex a pain—but it can set you up for a number of conditions that trigger tension below the belt. “Stress often causes changes in the pH of the vagina, which can lead to bacterial infections,” says Levey. A bad case of the nerves may also cause pelvic floor muscle spasms, while reducing your overall tolerance for pain, too, he says.