Understanding the causes of painful sex and finding real relief

Sex shouldn’t hurt. Period.

Yet so many women endure pain during intercourse, thinking it’s normal, thinking it will eventually pass, or worse, thinking they just need to “relax more.” If you’ve been told to have a glass of wine and take a bath, what your doctor is really saying is that there’s nothing medically wrong with you, so just relax. But when sex hurts consistently, something IS wrong. Pain during sex is a real medical issue that deserves proper diagnosis and care, not dismissal.

When sex consistently hurts, it affects everything – your desire, your relationship, your sense of self. And perhaps most frustratingly, the pain often feels invisible to others, making it harder to explain why intimacy has become something to avoid rather than enjoy.

What Causes Pain During Sex? Understanding the Two Main Patterns

Figuring out where your pain comes from is the first step toward fixing it. While doctors now recognize that these conditions often overlap, it helps to understand the two main patterns of sexual pain:

Dyspareunia: When Penetration Is Painful

Dyspareunia (painful intercourse) refers to genital pain during or after sex. The pain can happen in different places – at the entrance of the vagina, deep inside, or throughout your pelvis. The main thing is that penetration is physically possible but causes pain or discomfort.

Vaginismus: When Your Muscles Won’t Let You

Vaginismus describes an involuntary spasm of your pelvic floor muscles that makes vaginal penetration extremely difficult or impossible. Think of it as your body creating a protective wall at the vaginal opening – muscles contract and close off entry, whether you’re attempting to insert a tampon, undergo a gynecological exam, or have intercourse. This response happens automatically.Vaginismus is typically your body’s response to something else: past trauma, chronic pain, or another underlying condition that taught your nervous system to guard against penetration.

Where Does the Pain Happen? External vs. Internal

Pinpointing where your pain happens matters tremendously for getting the right help. Sexual pain generally comes from either external or internal sources.

External Pain

External pain happens on the vulva – the visible parts of your genitalia including the vaginal lips and the area around the vaginal opening. This includes:

• Nerve-related pain like vulvodynia or vestibulodynia, where concentrated nerve endings in the vulva or around the vaginal entrance create pain that isn’t visible to the eye. These conditions can make even light touch feel burning or stinging.
• Skin conditions that create an extra layer of rough tissue around the vulva, causing irritation and pain. Unlike nerve pain, these conditions can often be seen or felt as a change in the skin texture.

Internal Pain

Internal pain starts deeper – in the vaginal canal itself or the pelvic region. This type often gets described as “deep pain” that happens with penetration. Common sources include:

• Pelvic floor muscle tension, where the muscles supporting your pelvic organs stay chronically tight rather than moving through their natural cycle of tension and release. These muscles should work like any other muscle group in your body, but stress, trauma, or other factors can keep them constantly contracted.
• Endometriosis, where tissue similar to the uterine lining grows outside the uterus, causing deep pelvic pain especially during intercourse.
• Lack of arousal and lubrication – a crucial point that often gets minimized. If your body isn’t sufficiently aroused, your vagina won’t be adequately lubricated or physically ready for penetration. Continuing anyway causes friction and tearing of delicate vaginal tissue. This isn’t about “relaxing more” – it’s about understanding that arousal is a physiological process that prepares your body for comfortable sex.
• Menopausal changes including vaginal atrophy, where hormonal shifts cause the vaginal walls to thin and produce less natural lubrication. These are real physical changes, not merely psychological concerns.

 

Past sexual trauma or difficult birth experiences can also contribute to painful intercourse, creating both physical tension and emotional barriers to comfortable intimacy.

Why You Should Stop Having Painful Sex Immediately

This needs to be said clearly: stop having painful sex.

No more enduring it to please your partner. No more telling yourself “it will be over soon.” No more hoping the pain might mysteriously disappear if you just keep trying. Continuing to have sex when it hurts trains your nervous system to associate intimacy with pain, potentially creating or worsening conditions like vaginismus. Your body learns to protect itself by tensing up, creating a cycle that becomes increasingly difficult to break.

Beyond the physical consequences, continuing painful sex damages your relationship with your own body and your desire for intimacy. Why would you want sex if it hurts? This response is logical, not broken.

Getting Real Help for Painful Sex – Your Action Plan

Addressing painful sex requires a methodical approach with the right professionals. Wishing the problem away or trying random solutions rarely works. Here’s what actually works:

See a Sexual Health-Informed Gynecologist

Start with a knowledgeable gynecologist. Not just any doctor – find someone who is sex-positive and informed about sexual health concerns. Prepare for your appointment by getting specific about your pain: Is it external or internal? When exactly does it occur: during initial penetration, with deep thrusting, or afterward? Does it feel like burning, tearing, aching, or sharp stabbing? Being able to articulate these details helps your doctor make an accurate diagnosis.

Reading resources like “When Sex Hurts” by Dr. Andrew Goldstein and colleagues or “Healing Painful Sex” by Dr. Deborah Coady and Nancy Fish before your appointment can help you identify and describe your symptoms more precisely. This preparation matters – the more accurately you can communicate your experience, the better your doctor can help.

Work with a Pelvic Floor Physical Therapist

Find a pelvic floor physical therapist. These specialized physical therapists work specifically with pelvic floor muscles and related pain conditions. Through targeted exercises, manual therapy, and sometimes biofeedback techniques, they can address pelvic floor muscle tension, vaginismus, and chronic pelvic pain. Many people don’t realize that pelvic floor physical therapy exists, but it’s often the missing piece in resolving painful sex.

Get Support from a Sex Coach or Therapist

Work with a sex coach or therapist. The emotional dimensions of painful sex require dedicated attention. How do you communicate with your partner about avoiding penetration? What forms of intimacy can you enjoy while healing? How do you rebuild desire after taking a necessary break from sex? What relationship dynamics might be contributing to tension or lack of arousal? These questions deserve professional support, whether through sex coaching or therapy. As a sex and relationship coach, I help couples navigate exactly these challenges – the practical, emotional, and relational aspects of painful sex.

How to Talk to Your Partner About Pain During Sex

Your partner cannot see your pain. This invisibility can make it harder for them to fully grasp what you’re experiencing, especially if you’ve been hiding the extent of your discomfort or “getting through it” without speaking up.

Start by clearly communicating that sex has been painful. This isn’t your fault, and it isn’t your partner’s fault – it’s a medical issue that you’re going to address together as a team.

Then explore other forms of touch that feel good: affectionate touch like cuddling, sensual touch like massage, playful touch, and erotic touch that doesn’t involve penetration. Sexual intimacy extends far beyond intercourse, and discovering what feels pleasurable without pain can maintain your connection while you work toward resolving the underlying issues.

Key Takeaways About Painful Sex

• Painful sex is a legitimate medical issue requiring proper diagnosis and care
• Pain during intercourse can be external (vulva/vaginal opening) or internal (vaginal canal/pelvic region)
• Dyspareunia (painful intercourse) and vaginismus (involuntary muscle spasms) are two main patterns of sexual pain
• Stop having painful sex immediately – continuing it worsens the problem
• Prepare for doctor appointments by identifying your pain type and location
• Build your support team: specialized gynecologist, pelvic floor physical therapist, and sex coach or therapist
• Communicate openly with your partner and explore non-penetrative forms of intimacy

Get Help for Pain During Sex

Painful sex doesn’t have to be your reality. If you’re dealing with pain during intimacy and feeling overwhelmed by where to start, or if you need support navigating these issues with your partner, I can help. Book a free discovery call with me, and together we can figure out what you need – whether that’s help communicating with your partner, finding the right professionals, or rebuilding intimacy while you heal.