If you found yourself Googling, 'why does sex hurt?', these are some common reasons that could get you one step closer to help.

By By Laura Tedesco
Updated: March 05, 2019
Photo: Eclipse_images/Getty Images

There are lots of reasons to have sex: connection, pleasure, or fun, to name a few. (That's before you even factor all these health benefits of sex.) But feeling pain? That's everything sex isn't supposed to be.

For many women, though, painful sex is the 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 sexual desire and satisfaction, according to the Journal of Sexual Medicine.

Yet many women say nothing about their painful sex-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.

Identifying the underlying reason why it hurts when you have sex is the first step to resolving it. While you should definitely speak with your doctor about it, the reasons below may help you figure out why you're having painful sex. (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

You've probably heard celebs like Lena Dunham, Julianne Hough, and Sarah Hyland speaking out about their struggle with endometriosis, a condition where endometrial tissue grows outside of the uterus. In a 2014 Journal of Sexual Medicine study, 75 percent of women with endometriosis also suffered from pain during 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, and make intercourse painful. "Anything that touches those areas-a penis, a tampon-can be extremely painful," says Levey.

Overactive Pelvic Floor Muscles

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. (Related: Here's what every woman should know about pelvic floor dysfunction.)

"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

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 pain triggered by pressure around the vaginal opening-had a higher number of UTI's than pain-free ladies.

"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.) Try following these tips for preventing UTIs, and reconsider having sex when you have a UTI.

You're Not Lubing Up

If you're not sufficiently wet, you'll likely feel pain during penetrative sex of any kind. A drop in estrogen (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: first, take your time with foreplay. Second, try silicone-based lubricants, says Levey, which tend to be slicker than water-based varieties. (FYI: Everyone can benefit from lube. Here's your full guide on the different types of lube and how to use them.)

Uterine Fibroids

Uterine 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

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 pain during sex: "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

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 which can definitely cause pain, says Levey.

Stress

Anxiety alone probably won't make sex painful-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.

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