If Sex Is Painful, This Common Condition Could Explain Why

Photographed by Ashley Armitage.
When you're in the middle of penetrative sex and your vagina starts to hurt, you probably go through a silent checklist of what could be causing it: Is it a weird position? Do I need more lube? Do I have an infection? It might feel like a mystery of your vagina that you're doomed to suffer through, but pain during sex is not only pretty common — it's manageable, too. There's even a medical term for it: dyspareunia.
"Dyspareunia refers to pain with intercourse, and it encompasses a wide range of issues," says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology at Yale University School of Medicine. The good news is that once you figure out the cause, there are plenty of ways to treat and manage the symptoms of dyspareunia, Dr. Minkin says.
Unfortunately, many people neglect to mention painful sex to their doctors, because they're self-conscious, ashamed, or flat out don't think there's anything out there to help. Ahead, Dr. Minkin explains how to tell if you have dyspareunia and what you can do to seek relief.
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What does dyspareunia feel like?

According to Dr. Minkin, the first question patients and doctors should consider is: Where is the pain? "Is it vaginal pain with penetration and during intercourse? Or is it deep pelvic pain — for example, with thrusting, in the pelvis," she says. Both of these sensations would fall under the umbrella of dyspareunia, but they require different treatments.

In general, some common symptoms of dyspareunia can include pain with penetration (including penetration with a tampon), pain around the vaginal entry; deep pain during thrusting; burning or aching; or throbbing pain after sex, according to the Mayo Clinic. People may experience pain in the vagina, labia, or clitoris, according to Harvard Health.
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What causes it?

The causes vary depending on the type of pain, Dr. Minkin says. "For vaginal pain, there are many common potential problems," she says. For example, the pain may be related to a vaginal infection like bacterial vaginosis. Or, it's often linked to vaginal dryness, which tends to happen in breastfeeding and menopausal women, she says.

With deep pelvic pain, on the other hand, the causes are more varied, Dr. Minkin says. "Endometriosis is certainly associated with pelvic pain," she says. "Some women have scarring in their pelvis related to previous pelvic infections." See your gynecologist if you do have deep pain, so they can perform a pelvic exam, and rule out these possibilities, Dr. Minkin suggests.

Interestingly, sometimes dyspareunia can be tied to emotional factors, like anxiety or stress, according to the Mayo Clinic. If someone has survived sexual abuse, for example, that can play into associating pain with sex.
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How common is dyspareunia?

Broadly speaking, about 60% of the general population of women have experienced pain with intercourse, according to a study from way back in 1990. In another study, when researchers surveyed women who visited a primary care facility, they found that 46% reported dyspareunia. It's also common after having kids, and according to a small 1999 study, 45% of people reported dyspareunia postpartum.

But it's hard to pinpoint an exact number of people with dyspareunia, because not everyone who experiences the symptoms will report it to their doctor. But if you're experiencing pain with sex, it's definitely worth bringing up at your next checkup.
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How is it treated?

The treatment for dyspareunia also depends on the cause. If the pain is related to a vaginal infection, then it may just be a matter of taking antibiotics to clear up the infection, Dr. Minkin says. Or if dyspareunia is linked to vaginal dryness, using an OTC vaginal moisturizer (like Replens) can help. "The use of a lubricant at the time of intercourse is also very helpful," she says. If the dryness is due to menopause, your doctor may recommend using topical estrogen therapy, according to the Mayo Clinic.

If you're experiencing dyspareunia for months or years, or suspect an emotional component to your symptoms, your doctor may recommend sex therapy or counseling.
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Can dyspareunia be prevented?

There are certainly some easy lifestyle adjustments that can help make sex more enjoyable. For example, using lube during sex can decrease friction. Certain positions may be more comfortable than others, so play around until you find something that works for you. And be sure to communicate with your partner about what you're feeling, so you can troubleshoot together. And don't forget: There are tons of ways to be intimate without penetration.
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