What causes pain during sex?

Bottom linePain during sex (dyspareunia) is most often caused by vaginal dryness or low estrogen, but also by infections, insufficient arousal, vaginismus, endometriosis, pelvic conditions, skin problems, or emotional factors. It is treatable with lubricants, vaginal estrogen, treating infections, more arousal, pelvic floor therapy, and addressing underlying conditions; see a doctor if pain is new, severe, persistent, deep, or comes with abnormal discharge or bleeding.

Pain during sex (called dyspareunia) is common and almost always has an identifiable, treatable cause. It's not something to push through or feel embarrassed about.

Physical causes

• Vaginal dryness or low estrogen - the most common cause, especially in perimenopause, menopause, after childbirth, or while breastfeeding
• Infections - yeast, BV, or STIs cause inflammation and soreness
• Not enough arousal before penetration
• Vaginismus - involuntary tightening of the pelvic floor muscles
• Endometriosis - often causes deep pain during or after sex
• Pelvic inflammatory disease or ovarian cysts
• Skin conditions of the vulva, or scarring after childbirth or surgery

Emotional and relational factors

Stress, anxiety, past trauma, and relationship strain can all contribute, and they often interact with the physical causes.

What helps

• Lubricant for dryness, and vaginal estrogen if it's hormonal
• Treating any infection first
• More foreplay and arousal
• Pelvic floor physical therapy for muscle-related pain
• Treating underlying conditions like endometriosis

When to see a doctor

• Pain that is new, severe, or persistent
• Pain with abnormal discharge, odor, or bleeding
• Deep pain during sex, which can point to endometriosis
• Pain that's affecting your relationship or wellbeing

Persistent pain during sex deserves evaluation. If you also have painful periods, read period pain vs endometriosis pain.

Log pain during sex with your cycle in Femora so you can show a clinician whether it tracks with hormones, your period, or infections.