What is painful sex?

Painful sex includes discomfort before, during or after sex. It can have a physical or emotional cause. Around 1 in every 10 females experience painful sex.

You might have pain during sex which is deep inside your pelvis. Pelvic pain before, during or after vaginal intercourse is called ‘dyspareunia’.

You might have pain around the opening of your vagina before or during penetration.

This article relates to people who were assigned female at birth.

What are the symptoms of painful sex for females?

Painful sex falls in to 2 categories:

1. deep pain
2. superficial pain

Deep pain

Deep pain is when you feel pain deep inside your pelvis. This might happen when your partner thrusts, or when their penis, fingers, or a sex aid is fully inside you. The pain can be a burning, tearing or aching feeling.

Superficial or entry pain

Superficial pain is when you feel pain at the entrance of your vagina rather than deep inside. This can also be called entry pain. Symptoms include a burning, stabbing or itchy feeling.

What causes painful sex for females?

Deep pain

Some causes of deep pain during sex include conditions of the uterus (womb) or ovaries such as:

• endometriosis
• adenomyosis
• prolapsed uterus
• fibroids
• ovarian cysts
• pelvic inflammatory disease (PID)
• ectopic pregnancy

Other possible causes of deep pain are:

• bladder infections
• urinary tract infections
• sexually transmitted infections (STIs) — such as chlamydia or gonorrhoea
• irritable bowel syndrome
• recent childbirth
• previous surgery or radiation treatment to the pelvis

Superficial or entry pain

Some causes of superficial pain are:

• lack of sexual arousal (not being turned on)
• skin irritation or a condition like eczema
• vaginismus
• injury to part of your vagina
• having something inside your vagina
• vaginal dryness — this often happens around the time of menopause or after childbirth
• STIs — such as genital herpes or trichomoniasis
• having a partner with a large penis
• having an intact or thickened hymen

Vaginismus

Vaginismus is a condition that causes the muscles around your vagina to spasm and tighten by themselves. This can happen even if you want to have sex.

It usually occurs when your genital area is touched. This can be before or during sexual intercourse, when attempting to insert a tampon, or during a pelvic examination.

How is the cause of painful sex diagnosed?

Your doctor will ask about your symptoms and how long you have had them. They may ask what triggers the pain. They may ask about your other medical conditions and any other symptoms you have had.

Your doctor will probably do a physical examination and may suggest some tests. Ask your doctor to explain how they will examine you.

They may refer you to a specialist doctor or a pelvic floor physiotherapist for further tests and .

When should I see my doctor about painful sex?

You do not have to have sex if it’s painful. Go to a doctor you can talk to openly. Often it can take a while for the problems that cause painful sex to go away. Still having sex while it’s painful might make things worse.

If you have painful sex, it’s important to see your doctor to check what the cause is.

How is painful sex in females treated?

The right treatment depends on the cause of your pain. If you have pain during sex and don’t know why, continuing to have penetrative sex can make things worse. Often it can take a while for the problems that cause painful sex to go away.

What self-care can I try at home?

You can make some simple changes during sex like:

• longer foreplay
• using a lubricant
• trying a new sexual technique

How can I talk to my partner about painful sex?

You might find it awkward, but it’s important to talk to your partner if sex is painful. Explain that you find it hard to be enthusiastic about having sex because it hurts. It doesn’t mean that you don’t care about them. Discuss other ways to relax and learn to enjoy each other’s body. Ask your partner to go slowly and wait until you are ready.

Are there any medicines for painful sex in females?

Your doctor will recommend treatment of any underlying condition that may be causing painful sex.

Your doctor may prescribe a hormonal cream or gel. They may also recommend a change in contraception.

Talk to your doctor about the most appropriate treatment for you.

What other treatment options are there?

Depending on the cause of your pain, you may be referred to a specialist pelvic floor physiotherapist, sex therapist, relationship counsellor or psychologist.

A psychologist can talk to you about any problems, fears about sex or relationship issues that may be contributing to the problem.

Can painful sex be prevented?

Remember, sex doesn’t always need to include intercourse. There are many ways to have sexual pleasure with or without a partner. Using sex toys or masturbating can be fun.

Are there any complications of painful sex for females?

Painful sex or vaginismus can lead to fear and avoidance of sex.

If deep pain doesn’t go away, you should see a specialist in case you have a gynaecological problem such as an ovarian cyst.

Resources and Support

Read more about causes of pelvic pain at the Pelvic Pain Foundation of Australia website.

Jean Hailes for Women’s Health provides fact sheets in several languages to help you learn about sexual health.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.