Pain During Sex (Dyspareunia): Causes & Treatment

Painful sex can be caused by a range of physical, psychological, and situational causes. For example, dyspareunia can be a result of an infection, anxiety, or even your sexual position. Identifying the cause is crucial for effective management or treatment.

Physical causes

Here, we look at some of the physical causes of pain during sex and why they may cause it.

Vaginal dryness

Without enough lubrication, sex can become painful because of increased friction. Common causes of vaginal dryness, medically known as vaginal atrophy, include:

• hormonal changes during menopause, childbirth, or breastfeeding
• not enough foreplay
• low arousal
• certain medications, including antidepressants, antihistamines, and sometimes contraceptives

Infections

Several infections can cause painful sex, including:

• yeast infections (female thrush) – these can cause inflammation and pain, and can affect men too
• urinary tract infections (UTIs) – including cystitis, which can result in pain during and after sex
• sexually transmitted infections (STIs) – chlamydia, gonorrhoea, or genital herpes can contribute to painful sex

In the UK, 7.5% of people who have a womb report experiencing painful intercourse. However, men can also experience painful sex, with around 5% reporting painful intercourse. Understanding the gender-specific causes can help you get closer to a reason and solution.

Painful sex in women

Some of the specific causes of dyspareunia in women include:

• vaginismus – a condition that causes involuntary tightening of the vaginal muscles, making penetration during sex painful or impossible
• menopause – declining oestrogen levels during menopause can lead to vaginal dryness, thinning tissues (vaginal atrophy), and a reduced elasticity, all of which can cause vaginal pain during sex
• pelvic floor dysfunction – tight or weakened pelvic floor muscles can cause pain during sex

Painful sex in men

Some of the gender-specific causes include:

• tight foreskin – also known as phimosis, when the foreskin cannot retract properly, can cause discomfort during sex
• prostatitis – an inflamed prostate gland can lead to pain during ejaculation or after sex
• genital irritation or infections – infections such as male thrush or STIs can cause itching, burning, or soreness during or after sex
• Peyronie’s disease – affecting up to 13.1% of the world’s population, Peyronie’s disease causes the penis to curve when it is erect, which can be painful

Here are some of the most commonly reported dyspareunia symptoms:

• pain on sexual entry, known as penetration
• discomfort during every type of penetration, including inserting a tampon
• burning, itching, or aching sensations
• throbbing pain lasting for hours after sex
• deep pelvic pain during thrusting
• discomfort after pain-free sex
• pain with specific partners, positions, or circumstances
• a stabbing sensation, similar to menstrual cramps
• bladder pain
• muscle tightness or spasms

The most common symptom of dyspareunia occurs at the vaginal opening or deep in the pelvis, which affects a specific area or the entire region. Some people describe it as burning or piercing pain.

The symptoms of pain during sex can vary between individuals. Some may only experience discomfort during deep penetration, while others may find specific sexual positions uncomfortable.

Treatment options for dyspareunia depend on the underlying cause and who is affected. A doctor will usually ask you about your medical history, carry out tests, or perform a physical examination to identify the cause and provide the most appropriate treatment.

Medications

If you have pain during sex, treatment is sometimes needed to treat the underlying cause and provide sex pain relief.

Antibiotics

Antibiotics may be given if the cause of pain is a bacterial infection. For example:

• to treat cystitis and other UTIs
• for some sexually transmitted diseases, such as chlamydia

You may need to do a UTI test or an STI test to identify what infection may be causing pain during sex, especially if you have other symptoms.

Antifungal medication

Yeast infections, such as thrush, can cause painful sex and may require antifungal treatments. For example, if pain during sex is caused by vaginal or female thrush, treatments such as Canesten Cream can be effective, while clotrimazole 1% cream can relieve painful sex caused by male thrush.

Antiviral medication

Viral infections, such as herpes simplex virus, can cause conditions like genital herpes which can make sex uncomfortable. Getting effective treatment can reduce the length of time you have a genital herpes outbreak, reducing pain faster than without treatment.

Hormone replacement therapy (HRT)

If sex is uncomfortable because of declining oestrogen levels during menopause, you might consider oestrogen-containing HRT to help relieve your symptoms.

We also prescribe a range of vaginal dryness treatments that increase oestrogen levels directly in the vagina. Our service includes expert doctor advice and the choice of creams or tablets.

Topical corticosteroids

Topical corticosteroids, like hydrocortisone, can be used when painful sex is caused by inflammation, related to skin conditions or vulvovaginal issues.

Home remedies

Sometimes dyspareunia does not require medical intervention and can be managed at home naturally. Some of the common home remedies include:

• using water-based lubricant to reduce friction and discomfort during sex
• taking warm baths or applying warm compresses to help relax muscles and reduce cramping
• performing pelvic floor exercises to strengthen or relax pelvic muscles to reduce pain
• avoiding perfumed soaps, toilet papers, and sanitary products, which can worsen symptoms and cause infections like thrush
• applying cold compresses or ice packs to your vulva after sex
• practicing relaxation techniques to de-stress before having sex

Some of the things you can try to prevent pain during sex include:

• building foreplay into your routine to increase arousal and allow natural lubrication to happen
• using lubricants, particularly if you are experiencing hormonal changes or using medications that can reduce moisture
• communicating with your partner to let them know how you are feeling and what you need to feel comfortable and safe
• exploring different sexual positions until you find one that is comfortable
• staying hydrated and follow a balanced diet
• managing stress with breathing exercises, yoga, or other forms of mindfulness
• considering therapy if trauma or psychological factors have contributed to discomfort

Some of the causes of dyspareunia may be out of your control, but there are some things you can do, particularly when it comes to practising safe sex, that may help prevent pain and discomfort.