Painful sex: What to do when intercourse hurts

Have you ever experienced painful sex? A recent YouGov study shows it’s surprisingly common. In fact, only one in three women say they’ve never experienced sex that was so painful they couldn’t enjoy it – or even had to stop midway through.

So why, if so many women are affected, do we never seem to talk about it?

Painful intercourse – or to give it its medical name, ‘dyspareunia’ – is classified as a persistent pain before, during or after penetrative sex, and can have a huge impact on a woman’s life.

"Unfortunately, there is still a lot of shame and stigma around sex – especially painful sex," says PJ Livett, a relationships and sex educator, who set up rePHRASE: ‘Providing Healthy Relationship And Sex Education (without the awkwardness)’.

"People have this unhelpful belief that if things aren’t functioning perfectly, there’s something wrong with them or they’re even ‘broken’ in some way. But the truth is, problems with our sex lives, including painful sex are very common."

Read more: One in three Brits have suffered a sex injury – which are the most risky positions?

Don’t suffer in silence

The good news is, it is also very treatable.

"It’s important to understand that painful sex is not normal," says Dr Alex Eskander, Consultant Gynaecologist at The Gynae Centre, London. "The sad fact is that many women have resigned themselves to believing that they will not enjoy sex again. But there is no need to suffer in silence.

"Painful sex is often caused by an issue which is easily treated. So, if you are experiencing persistent pain, you should see your GP or gynaecologist as soon as possible to get a diagnosis.”

There are many causes of painful sex, ranging from physical to psychological concerns. Getting a swift diagnosis means treatment can start and you can get back to enjoying your sex life.

Reasons sex could hurt

1. Vaginismus

A condition whereby the vagina experiences contractions or spasms whenever something is inserted into it.

"Vaginismus is a physical and psychological condition which can involve emotional factors," says Livett. "This makes it a complex condition, but the good news is, there are different treatments available."

"Vaginismus can sometimes be treated with pelvic floor exercises and vaginal dilators. These are little silicone, tampon-shaped objects that come in different sizes. Dilators can help restore or stretch the pelvic floor muscles and vaginal tissue, often by starting to insert the smallest until your body is comfortable, then moving on to the next size and so on."

Read more: Exactly why sex is so beneficial to our mental health

Livett explains how Vaginismus can also be psychological – a response to past sexual trauma or abuse. "If this is the case, you may be referred to a counsellor or talking therapy. It’s important to remember there’s nothing wrong with you.

"In fact, our bodies are designed to protect us from danger, and since a past sexual experience has been dangerous for you, it’s a perfectly appropriate response."

2. Thrush

Thrush (also known as ‘candida’) is a vaginal infection which is very common. Caused by an overgrowth of a fungus called candida, it can lead to itching and pain during sex.

"Thrush is characterised by a stinging sensation when peeing, a thick white vaginal discharge and itching/soreness around the labia. Thrush is easily treated with a course of medication and will usually clear up a few days after you start taking medication," advises Dr. Eskander

3. Vaginal dryness

General dryness is a very common cause of painful sex and it has many different possible causing – from medication to hormones (especially, oestrogen levels dropping in menopause, which makes the tissue in the vagina thinner and dryer), some cancer treatments triggering early menopause and even anxiety.

"Lubrication is your best friend if this is the case," says Livett. "There is no shame in going and buying a lubricant. Many women like to use a lubricant even if they don’t suffer from dryness to make sex as comfortable as possible."

4. STIs

Sexually Transmitted Infections can also cause vaginal irritation, for example, sores/blisters from Herpes, or pain from bacterial STIs such as chlamydia and gonorrhoea.

"An imbalance in the pH of your vagina can also increase the risk of infections, including bacterial vaginosis and thrush," says Livett. "It’s so important to visit your GP or sexual health clinic if you think there’s a problem. They are very used to looking at these issues."

5. Penetration that’s too deep

"If intercourse is very deep (‘deep thrusting’) and the penis makes contact with the cervix, it can be very painful," says Livett.

"Some sexual positions make this more likely and can result in sex becoming painful. So, it could simply be a matter of changing positions to something which feels more comfortable.

"Also, remember that we are all unique and so is our anatomy... Some women have shorter vaginas than others and so may be more prone to painful sex (contact with the cervix).

Read more: Sex regrets: Two-thirds of Brits would change first sexual experience if they could

"The position of the cervix also changes during the monthly menstrual cycle (moves up and down), so depending on where you are in your cycle, this could also affect how intercourse feels for you."

Cysts and fibroids, depending on their location, can also make sex painful. Many women suffer painful sex completely unaware they have cysts or fibroids, which can be treated if necessary. Visit your GP or a sexual health clinic for advice, and possible referral for an ultrasound scan.

There are various treatments for fibroids including hysterectomy (surgically removing the womb) to ‘uterine artery embolisation, where by embolic agents are injected into the arteries supplying the uterus, cutting off blood flow to fibroids and causing them to die.’

6. Poor communication

"Presuming that painful sex isn’t a medical issue, foreplay is so important in ensuring sex is enjoyable for those involved. It prepares the body for sex and increases arousal levels, which in turn produces lubrication in and around the vaginal canal," says Livett.

"Also, it’s so important to communicate with your partner about how things feel… what you like, or don’t like etc. Mutually enjoyable sex requires communication, honesty and trust. After all, our brains are our biggest sex organ, so if there’s an unresolved issue that’s not been shared, this can manifest in us physically. We need to talk about sex much more than we do."

7. Pelvic Inflammatory Disease (PID)

PID can be the cause of painful sex – particularly if you are experiencing the pain and discomfort deep inside.

PID is caused by an infection which inflames the organs in the pelvic region. It can be caused as a result of an STI, by infection after birth, and can be caused by an IUD if it was fitted in the presence of existing chlamydia infection.

"PID can lead to long term problems with having children. Most women are absolutely fine however if they get treatment early," says Dr. Eksander. "So don’t let embarrassment stop you from getting checked out."

Enjoyable sex is not only good for your relationship but also good for your mental health, so it’s important to seek help if you’re experiencing any discomfort.