7 Surprising Causes of Pain during sex

Pain during sex is the last feeling you should have during an intimate moment. Sex should be a pleasurable and intimate experience, yet for many, it brings discomfort or even pain. If you’ve found yourself hesitant to engage in intimacy due to painful sensations, you’re not alone.

Sexual pain—often misunderstood—can stem from a variety of causes, from physical health issues and hormonal imbalances to psychological and relationship dynamics. In this article, we look at seven surprising causes of sexual pain. We also provide practical tips to help you overcome these issues. This way, you can regain comfort and joy in your intimate life.

What Causes Pain During Sex?

Pain during sex (dyspareunia) can affect people of all genders and may occur before, during, or after intercourse. The discomfort may be mild or severe and can affect the surface of the genitals or deeper within the pelvis.

Pain is typically classified into:

• • Superficial dyspareunia: Pain at the vaginal opening, often linked to dryness or infections.
  • Deep dyspareunia: Pain felt deeper inside, often caused by underlying health issues.

Understanding the type of pain can help identify the cause and guide treatment. And while often discussed in the context of women, men can also experience sexual pain due to infections, prostate issues, or structural problems.

Why Do I Feel Pain During Sex?

1. Physical Health Conditions

Chronic and acute health issues can make sex uncomfortable or even unbearable. Common culprits include:

• • Endometriosis: Uterine tissue grows outside the uterus, leading to inflammation and pelvic pain.
  • Pelvic Inflammatory Disease (PID): An infection of the reproductive organs that can result in scarring and long-term discomfort.
  • Vulvodynia: Chronic pain in the vulva without a clear cause, making any pressure painful.

Inadequate lubrication is another common issue, often caused by hormonal changes, medications, or insufficient arousal. Friction without proper lubrication can cause irritation and pain. Using lubricants or engaging in more foreplay may help, but if dryness persists, a medical check-up is advised.

 2. Psychological Causes

Your mental and emotional well-being has a huge impact on how your body responds to sex. Anxiety, stress, and depression can cause physical tension and reduce arousal, contributing to painful experiences. The cycle of anticipating pain can heighten anxiety and make things worse.

For some, past trauma—especially sexual abuse or assault—can lead to involuntary muscle contractions or fear-based avoidance of sex. Therapy, particularly cognitive behavioural therapy (CBT), can help individuals process trauma and develop coping strategies.

Relationship issues also matter. Lack of trust, poor communication, or unresolved conflicts can create emotional distance and tension during intimacy. Couples therapy or open, empathetic conversations can go a long way toward restoring comfort and closeness.

3. Hormonal Fluctuations

Hormones play a key role in sexual function. During menopause, declining oestrogen levels can cause vaginal dryness, thinning tissues, and decreased elasticity—all of which can lead to painful intercourse. Vaginal oestrogen creams or hormone replacement therapy (HRT) can help.

Pregnancy and postpartum changes can also affect comfort due to hormonal shifts, healing tissues, and emotional adjustments. Patience, open communication, and gradual reintroduction of sex are essential.

Conditions like PCOS (polycystic ovary syndrome) and thyroid disorders can disrupt hormonal balance, contributing to pain and low libido. Medical management of these conditions can improve symptoms and overall sexual well-being.

4. Common Medical Conditions

Some conditions might not seem directly related but can still contirbute to pain during sex:

• • Vaginismus: Involuntary tightening of vaginal muscles that makes penetration painful or impossible. Treatment often includes pelvic floor therapy and relaxation techniques.
  • Interstitial Cystitis: A chronic bladder condition that causes pelvic pressure and pain, often worsened by sex.
  • Irritable Bowel Syndrome (IBS): Abdominal bloating and pain from IBS can radiate to the pelvic area, making sex uncomfortable.

These conditions are manageable with appropriate treatments like dietary changes, medications, physical therapy, and mental health support.

5. Lifestyle Habits

Your everyday choices affect pain during sex more than you think:

• • Diet: Highly processed foods, sugar, and unhealthy fats can lead to inflammation and reduced energy. A balanced diet supports better blood flow, energy, and hormonal health.
  • Exercise: Staying active improves cardiovascular health and reduces stress. But overtraining or intense physical activity can lead to fatigue and muscle tension. Activities like yoga or stretching may help.
  • Substances: Smoking restricts blood flow, affecting arousal. Excessive alcohol or drug use can impair function and reduce sensitivity. Cutting back can boost both sexual performance and comfort.

6. Communication and Intimacy

Shame or embarrassment often prevents people from talking about pain during sex. Yet communication is one of the most powerful tools for resolving the issue.

Create a safe, non-judgmental space with your partner. Use “I” statements to express how you feel—like “I’ve noticed discomfort during sex lately” rather than placing blame. This invites your partner into the conversation rather than making them defensive.

If open conversations are difficult, consider couples therapy or a sex therapist. Professionals can offer communication strategies, exercises to improve intimacy, and a path forward that works for both partners.

7. Treatments and When to Seek Help

Depending on the cause, various remedies can ease or eliminate pain during sex:

• • Medical treatments: For conditions like endometriosis or PID, treatment may include anti-inflammatories, hormonal therapy, or even surgery.
  • Pelvic floor physical therapy: Helps with conditions like vaginismus and vulvodynia. A trained specialist can guide you through exercises to relax or strengthen muscles.
  • Lubricants and moisturisers: Water-based or silicone-based lubricants can ease friction. For hormonal dryness, your doctor may recommend oestrogen creams.
  • Hormone therapy: If hormonal imbalance is the cause, treatments like HRT or thyroid medication may help.
  • Mental health support: Therapy can help manage anxiety, trauma, or relationship issues that may be contributing to the pain.

When to seek help:

If pain persists, affects your emotional well-being, or causes strain in your relationship, don’t ignore it. A healthcare provider, gynaecologist, or sex therapist can guide you toward the right solution.

Dealing with painful sex

Painful sex is more common than you might think, and it’s nothing to be ashamed of. Whether it stems from a medical condition, hormonal imbalance, emotional trauma, or lifestyle habits, the good news is that help is available.

Understanding what’s causing your discomfort is the first step. With open communication, professional support, and the right treatment plan, you can overcome pain and rediscover intimacy, connection, and pleasure.

You deserve a sex life that feels good—physically and emotionally. Don’t settle for less.