Painful sex reasons: why it hurts and what can help

In short: Painful sex is common and almost always has a cause that can be helped. The usual reasons are vaginal dryness, not enough time to feel aroused, an infection, tight pelvic muscles (vaginismus), healing after birth, menopause changes or conditions like endometriosis. Sex should not hurt, so do not just put up with it. See a gynaecologist if pain keeps coming back, if you bleed after sex, or if you have fever or unusual discharge.

If sex hurts, you may feel embarrassed, worried something is wrong with you, or guilty about not enjoying it. Please know this: you are not alone, and you are not "too tight" or "broken". Many women, married or not, feel pain during sex at some point.

Pain is your body's way of saying something needs attention. Once you know the reason, there is almost always a way to make things comfortable again.

Is painful sex normal?

Mild discomfort the first few times, or after a long gap, can happen. But sex that hurts again and again is not something you should simply accept. Doctors call it dyspareunia, which just means pain during or after sex.

The pain can be at the opening of the vagina, deep inside the tummy or pelvis, or a burning or sore feeling afterwards. Noticing where and when it hurts helps a doctor find the cause.

Painful sex reasons: the common causes

Pain at the opening:

• Dryness. Not enough natural wetness makes the skin rub and sting.
• Not enough arousal. Rushing, without enough foreplay or time to relax, means the vagina is not ready.
• Infection. Yeast infections, bacterial infections, UTIs and some sexually transmitted infections can cause burning, itching and soreness. Read more about vaginal itching causes.
• Vaginismus. The muscles around the vagina tighten on their own, often from fear of pain. It is real, common and very treatable.
• Skin irritation from scented soaps, washes or a new condom.

Deep pain inside:

• Endometriosis. Tissue like the womb lining grows outside the womb and can make deep sex very painful. Learn about endometriosis symptoms.
• Pelvic infection (PID). Often comes with fever, discharge or tummy pain.
• Ovarian cysts or fibroids.
• Constipation or bladder problems.

Painful sex after birth

Many women feel pain when they start having sex again after a baby. Stitches or a tear may still be healing, and breastfeeding lowers oestrogen, which leaves the vagina drier and thinner. After a C-section, your tummy may also feel tender.

There is no fixed date to restart. Wait until bleeding has stopped, you have had your check-up and you feel ready. Go slowly, use a lubricant, and tell your doctor if it still hurts after a few months. See our guide to postpartum care for more on healing.

Painful sex and dryness

Dryness is one of the most common reasons sex hurts. It can come from not enough foreplay, stress, breastfeeding, the time of your cycle, menopause, or harsh soaps.

A plain water-based lubricant from a pharmacy is safe and can make a big difference. Avoid oils with condoms, as they can make condoms break. If dryness happens every time, or comes with itching or burning, see a doctor to check for infection or hormone changes.

Painful sex and bleeding

A little spotting the very first time can happen. But bleeding after sex at other times always needs a check, even if it is light. It can be caused by dryness, infection, a polyp on the cervix, or changes on the cervix that need early care.

Your doctor may examine you and do a Pap smear or HPV test. If you are pregnant and bleed after sex, call your doctor straight away.

What helps at home

• Slow down. Give yourself time to feel relaxed and aroused before penetration.
• Use a water-based lubricant.
• Talk to your partner. Say what hurts and what feels good. A kind partner wants you to enjoy it too.
• Try a different position where you control the depth and pace.
• Empty your bladder before sex and pass urine afterwards.
• Wash with plain water only. Skip scented washes, douches and powders.
• Stop if it hurts. Pushing through pain can make the body tense up more next time.

When to see a gynaecologist

Book a visit if sex hurts more than once or twice, if you have pain deep inside, if you bleed after sex, or if you notice itching, burning or unusual discharge. A gynaecologist will listen, may examine you gently, and may suggest tests like a swab, a Pap smear or an ultrasound. They can find the cause and suggest the right treatment.

Go to a doctor the same day if:

• You have fever with pelvic pain
• You have foul-smelling discharge with fever
• You are pregnant and bleed after sex

Go to hospital straight away if:

• You have sudden, severe or one-sided tummy pain
• You are bleeding heavily, soaking a pad every hour
• You faint or feel very dizzy
• You have a positive pregnancy test with severe or one-sided pain, or heavy bleeding

Questions women ask

What are the most common reasons for painful sex in women?

The most common reasons are dryness, not enough arousal, infections, vaginismus and healing after childbirth. Deep pain can come from endometriosis, pelvic infection, cysts or fibroids. A gynaecologist can work out which applies to you.

Why does sex hurt right after my period?

Right after your period the vagina can feel drier, as oestrogen is lower at that point in the cycle. Leftover blood can also irritate. Infections sometimes flare around periods. If pain after your period keeps happening, or comes with deep pain, see a doctor to rule out endometriosis.

Is it normal to bleed after painful sex?

A small amount the first time can happen, but bleeding after sex at other times is not normal and should always be checked. It may be simple dryness or infection, but your doctor will want to look at your cervix to be sure.

How long does sex hurt after giving birth?

It varies. Many women feel some discomfort for the first few weeks or months after restarting, especially while breastfeeding. Go slowly and use a lubricant. If it still hurts after a few months, or is getting worse, talk to your gynaecologist.

Can painful sex be treated?

Yes. Once the cause is found, most women feel much better. Treatment depends on the reason: clearing an infection, help for dryness, pelvic floor physiotherapy and relaxation exercises for vaginismus, or treating endometriosis. You do not have to live with it.