Sex can feel stupendous. But it can also feel excruciating. If sex hurts, there’s usually a medical reason for it, whether it feels like a pinch, a cramp, or like your vagina has been thrown from a car and is skidding down the pavement at lighting speed with every thrust. And whether that pain feels like it’s originating near your vulva, cervix, or even in your stomach, it’s worth figuring out what’s going on.
Dr. Karen Duncan, MD, assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health, explains that painful sex “doesn’t mean something’s wrong with you, but it’s worth paying attention to and looking into, especially if it’s getting worse.” There’s no need to suffer in silence, and you’re not alone. You should see an OB/GYN about your symptoms, and potentially another specialist based on their recommendations.
Your partner thrusting deeply inside of you may be part of the problem, especially if you’re not wet enough or you’re dealing with an especially large penis or sex toy.
Duncan explains that sometimes different organs like your bladder can be — for lack of a better word — poked during penetration causing people with vaginas to feel discomfort internally. “Deep thrust pain is something a lot of women experience more internally,” she explains. “The pain is felt more in relation to the cervix, uterus, bladder, or bowels… The first thing I’d suggest for this is switching sexual positions, which is often a successful solution for women,” she explains. However, pain with deeper penetration can also be a sign of a different underlying issue going on in the body. So if you’ve tried a few different positions and you’re still suffering, it might be time to consider other factors.
“If a woman has a UTI, that could cause discomfort with intercourse,” Duncan says. Although the typical sign of a UTI is pain when you’re urinating or having to pee all the time, tenderness with sex can happen too.
This condition can occur for reasons other than UTIs, and one of its symptoms is painful intercourse, including tightness and a burning or stinging feeling. The American College of Obstetricians and Gynecologists says this can also make penetration difficult, as well as the insertion of tampons.
There are various triggers for this, which can be either emotional or physical. Duncan says emotional triggers might include incidences such as sexual assault, unhealthy relationships, anxiety, or other traumatic life events.
Physical triggers can also include menopause, childbirth, pelvic surgery, or other health conditions. Treatment can involve things such as counseling and pelvic floor physical therapy.
Duncan notes that some STIs can cause inflammation inside your vagina, which can cause pain during sex. “It can make the tissue irritated, especially in the vagina and around the cervix,” she says. There can also be open blisters, and having intercourse across one of those would certainly be uncomfortable. That’s one reason I always tell patients to get a mirror and look down there if they’re having pain... Feel in there with your fingers and explore the area that’s hurting. This can help you figure out what’s going on.”
Duncan explains that menopause can cause hormonal changes, particularly in estrogen and progesterone, that can make the vagina less equipped to self-lubricate. If this is happening to you, one of the best things you can do is buy a lubricant — no need to use it judiciously. A lot of foreplay can also be helpful, as well as a vaginal hormone cream. In some cases, your doctor might suggest hormone replacement therapy, Duncan says.
Similarly to menopause, breastfeeding can suppress hormones and might make you drier than usual. You can ask your doctor about this, and many of the solutions Duncan mentioned for those going through menopause will work here too.
Allergies to lube or condoms
If you think the condom is the problem, there’s a chance you have a latex allergy. Luckily, some brands don’t use that material. Similarly, many condom brands put lube or spermicide on the condoms, and some people might have a sensitivity to ingredients in those.
Duncan says that if this is the case, you might typically feel burning or itching soon after exposure. She suggests keeping a diary of what you think is happening, and writing down the symptoms you're having. You might try different brands and try to figure out what it is that’s affecting you. Your doctor can help you figure this out.
If you’re crazy constipated, Duncan says it might cause increased inflation and make it more uncomfortable to have something inside of you.
Irritable Bowel Syndrome
Similarly, IBS causes people to have sensitive bowels, and having something thrusting into your lower extremities in certain positions could hit you the wrong way and cause pain.
This condition causes inflammation in the vagina, and is often caused by a yeast or bacterial infection, as ACOG notes. Luckily, it can be treated with medication.
These are benign tumors might grow near your cervix or vagina. These are the most common solid pelvic tumor in women, and they cause symptoms — including pain with sex — in about 25% of women in their reproductive years, according to the Center for Uterine Fibroids.
Duncan says they’re very common, and doctors usually won’t recommend removing them unless they’re causing discomfort. Sometimes they can be surgically removed or will shrink with medication.
ACOG notes that some over-the-counter or prescription drugs — specifically pain meds and some forms of birth control — can reduce your sexual desires, which can make it harder for you to get wet.
If you’ve been diagnosed with this condition, you might experience pain during both sex and mensuration. Endometriosis occurs when the tissue that usually lines the uterus is growing elsewhere in the body. You might feel cringey during sex because deeper penetration is causing the endometrial growths to bleed or swell.
Dr. MacKoul says this condition should be looked at by a doctor immediately. “One problem with endometriosis is that you can’t identify it well with ultrasounds,” he says. “Most patients will need a laparoscopy.” He recommends seeing a specialist who can help you treat the condition.
Other gynecological conditions
There are various kinds of other gynecological conditions that might be causing you to have pain. You might want to talk these over with your doctor, as you can’t really diagnose them on your own. Things to talk about with your doctor include pelvic floor disfunction, skin disorders that might cause ulcers or cracks in the skin of your vulva, or other conditions.
Other medical conditions
ACOG notes that some medical conditions can “indirectly affect sexual response.” If you’ve been diagnosed with something like cancer, diabetes, arthritis, or have a thyroid condition, ask your doctor if you experience discomfort or you have less desire for sex.
“We shouldn’t limit the cause of pain with intercourse to only physical,” Duncan says. “I think discomfort with intercourse can certainly be multifactorial.” She says it might have to do with either emotional or physical things, or a combination of the two.
“Sex can be an incredibly intimate personal thing,” she says. “There’s more pain in women who are survivors of sexual trauma, intimate partner violence, molestation, and rape.” she says. “That can translate to the clinching and tightening of pelvic floor muscles, and that increase in pain with intercourse is real.”
If this is the case, she recommends first talking to your OB/GYN, who may refer you to a psychologist or counselor who can help. She says that talk therapy, and possibly pelvic floor physical therapy.
The bottom line:
If you’re in agony every time you have sex, it doesn’t have to stay that way. With the help of a hand mirror and your doctor, you can figure out what’s going on and look for a solution.
“What happens for many women is these things aren’t talked about with their OB/GYN or primary care doctor,” MacKoul says. “They also don’t talk with their partner, and they just endure the pain. That's not the way to live your life. If you seek out the help of a specialist, you can go through [all of the possible causes] and rule a lot of them out. Don’t give up and keep suffering.”