Mountain depths illustrating clenching
Illustration by Marta Pucci

Pain during sex - what causes it and how to overcome it

Photo of Dr Katherine Hertlein
Reviewed by Dr Katherine Hertlein,
created by Blueheart
created by Josh Green
created by Sophie Browness
Photo of Dr Katherine Hertlein
Reviewed by Dr Laura Vowels,
created by Blueheart
created by Josh Green
created by Sophie Browness

TLDR:

  • Pain during sex may be common but it should not be thought of as normal
  • Reasons for sexual pain can be both physical and psychological, any worrying symptoms should always be checked with your GP or other health care professional
  • The expectation of intercourse pain may cause anxiety, making the sufferer less inclined to initiate or participate in sex
  • There are effective treatments or solutions for most causes of sexual pain
  • Sensate Focus can help by offering touch exercises and mindfulness techniques to help reduce any anxieties you may feel around sex.

If you experience pain during sex, you may find yourself becoming anxious about intercourse and less inclined to initiate any form of sexual activity with your partner. This may lead to feelings of guilt as well as, in the long term, a very real impact on feelings of intimacy and relationship security for both of you.

Sexual pain can be caused by many things, both emotional and physical, but be reassured there are lots of effective ways to overcome discomfort and resume a healthy, happy sex life. It’s important you address the problem, however difficult you may find it to talk about sex.

Is it common to have pain during sex?

Pain during sex is common but not normal. Around 25% of our users report some pain or discomfort present during sex, and this is more common in women than men. But once you have experienced painful intercourse, it’s difficult to contemplate sex without a degree of anxiety or an expectation of discomfort. This can make your body tense, creating a vicious cycle leading to more pain.

What causes painful sex?

Painful intercourse can be caused by several factors including both the physical and psychological, with one of the most common being low arousal leading to vaginal dryness - something that can lead to pain for either or both partners. Here we’ll look at some of the physical causes of painful sex, and what you can do to help reduce discomfort.

While sexual pain is usually not an indicator of anything serious it is important to visit your health care professional if the pain persists or you become concerned.

Lack of vaginal lubrication

The walls of the vagina produce a natural lubricant (Mucosa) to help keep hydrated, but this process can be impacted by a number of things. Changing levels of the hormone estrogen will alter the amount and texture of this Mucosa, and it’s for this reason that women will notice changes in the amount of discharge they have throughout their ovarian cycle. Lower estrogen levels can also explain why postmenopausal women often struggle with vaginal dryness, sometimes leading to a condition called vaginal atrophy.

Certain medications such as chemotherapy drugs or antidepressants can have an impact on how wet or dry the vagina is, but often it is lack of arousal that can result in inadequate lubrication for penetration purposes.

What can you do?

Relaxation and mindfulness techniques can play a big part in reducing pain due to lack of lubrication, helping to reduce anxiety and tension. Try increasing the amount of foreplay you engage in to aid arousal and increase lubrication before penetration. You may also find that a sexual lubricant can help.

Endometriosis

Endometriosis is a condition experienced by women where endometrial tissue, similar to the lining of the uterus, grows outside of the uterus. Symptoms can include stomach, back, or pelvic pain as well as menstrual cramps and heavy periods. But for women with endometriosis, one of the key issues reported is the negative impact it can have on their sex life, with deep penetration often causing severe pain during sexual intercourse.

What can you do?

There are ways to reduce painful intercourse, despite your endometriosis. These range from experimenting with sexual positions that allow for shallower penetration, to having sex at different times during your monthly cycle to see whether some feel more comfortable than others.

Mindfulness can also be useful to help you to relax and encourage you to focus on being present in the moment.

Uterine fibroids

Fibroids are benign tumors that can grow on the walls of your uterus. They are extremely common and can run in families. Fibroids in themselves are not harmful, in fact, they can often be symptomless. However, depending on the number, location, and size of the growths, they can leave sufferers with heavy periods, abdominal bloating, incontinence, constipation, and deep pain during sex. What’s more, they can lead to hormonal changes which can result in loss of libido or sexual desire. So even if sex is not painful, you may find you just don't fancy it anymore.

What can you do?

If fibroids are impacting your everyday life or sex life, there is a quick, non-surgical procedure called uterine fibroid embolization (UFE) that can successfully treat the condition. This should not be something to be afraid of. Always contact your GP if you notice changes within your body and are concerned.

Vaginismus or vaginal spasm

Vaginismus is a common medical condition in which there is an involuntary tensing of, or spasm, in the vaginal muscles. It may happen during penetration, but also while inserting a tampon or during a pelvic exam. Vaginal spasms can range from mildly uncomfortable to very painful and can often be caused by the fear of being hurt if you have experienced painful intercourse before, or been impacted by a prior trauma such as sexual abuse.

What can you do?

Unfortunately, the cause of Vaginismus is unknown and there are no medical treatments available, however, vaginal Kegel exercises or vaginal dilators can help. As anxiety and negative emotions around sex can play a large part in this condition, Cognitive Behavioural Therapy (CBT), Sensate Focus, and mindfulness techniques may also be helpful to relax muscles and stop spasms.

If you are concerned, talk to your GP. They will be able to conduct a pelvic exam to rule out any other problems and confirm the presence of vaginal muscle spasms.

Fear-based vaginal clenching

In the case of vaginismus (above), there is no obvious cause for the woman’s vaginal muscles to clench. However, there are times when clenching can happen for clear psychological reasons. 

If sex has been unpleasant, painful, or abusive in the past, women may consciously or unconsciously flinch and tighten their vaginal muscles due to tension or fear. This can cause intercourse to be more painful for her and for her partner.

What can you do?

As with many of the more psychological causes of pain during sex, it is important to create a relaxed, low-pressure environment to reduce fear and anxiety. CBT, Sensate Focus and mindfulness techniques can all help, as can the support of a caring partner. 

STIs

Sexually transmitted infections (STIs), such as chlamydia and gonorrhea, can be caused by viral or bacterial infection and may lead to discomfort due to genital irritation, pelvic pain, or even testicular swelling in men. Genital herpes can cause a painful blistering rash around the genitals, also leading to irritation and pain during intercourse.

What can you do?

If you are worried you may have an STI, it is important you see your GP or local genitourinary medicine (GUM) clinic as soon as possible. Most STIs can be treated quickly and easily, but it’s important to get symptoms checked to avoid long-term impacts such as Pelvic Inflammatory Disease. It’s also important you explain the situation to any recent sexual partners so that they can get checked out too, and be sure to abstain from unprotected sex until you are sure that you are clear.

Yeast infection

Yeast infections occur because of an overgrowth of a type of fungus called Candida that naturally grows in the body. It can cause itching and inflammation around the vagina which may lead to pain during sexual intercourse. Yeast infections are a common condition, in fact, researchers at the University of Manchester found that 138 million women are affected by fungal infections worldwide.

What can you do?

If you believe you may have some of the signs of infection, there are over-the-counter remedies available from your local pharmacy. If it’s the first time you’ve had the condition or you are worried about any of your symptoms it is always best to ask your GP to check you over. They may wish to take a vaginal swab to confirm the diagnosis.  

Prostatitis

When a man’s prostate gland gets swollen it can cause a range of issues including pain when ejaculating, pelvic pain after having sex, and also erectile dysfunction. Prostatitis can be acute (sudden and short-lived) or chronic (longer-term). Acute prostatitis is rare but can be life-threatening so always seek medical attention if you’re concerned.

What can you do?

If you’re experiencing symptoms of prostatitis, be sure to see your doctor, especially if symptoms come on suddenly. Depending on whether it’s acute or chronic, you may be given antibiotics, or support to manage symptoms, such as painkillers.

Tight foreskin

If a man’s foreskin is too tight to be pulled back over the head of the penis (a condition known as phimosis), penetration can be painful as it is pushed back. There are several causes of phimosis, from STIs to skin conditions such as eczema, psoriasis, and lichen planus.

What can you do?

Speak to your doctor to see if there is a medical reason that your foreskin can’t be pulled back as it should. They might provide treatment such as a topical steroid, which can soften the skin so that it moves more easily. Lubrication can help too, as can using a condom.

Relaxation techniques to reduce pain

Pain during sex can create real anxiety about participating in a sexual relationship, making it important that you take notice of symptoms and follow up.

In almost all cases, no matter the cause, helping your body to relax can reduce the amount of pain you experience. And that is where Sensate Focus can help by using touch exercises to bring you closer to your partner and reduce sexual anxiety, making way for intimacy without pressure.

With our Blueheart app, you'll receive a plan tailored just for you. If you are suffering from endometriosis, fibroids, or another condition that results in physical pain during intercourse, you may find you need to follow the Sensate Focus plan slowly.

Ultimately, if you focus on reducing your anxiety throughout your body as well as practicing the solo exercises provided, you'll soon find you're making progress.

Find out more about how Sensate Focus therapy could help you find relief from pain during sex.

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