Pain During Sex: Causes, Assessment and Treatment

Pain is not something to put up with

Pain during sex (dyspareunia) is common and not something women should simply endure. Causes include dryness, skin conditions, infection, pelvic-floor tension and pelvic disease.^[1]

Many people stay silent out of embarrassment or because they think it is normal, but most causes are treatable.

Why not push through it

Pain is a signal to pause and look for the cause; nobody needs to endure pain for a partner.^[1] Pushing through pain teaches the body to expect pain, so muscles tighten more and pain becomes worse, a cycle that gets harder to break.

How common is it?

Estimates vary widely with age, pain location and how pain is measured; occasional pain is not the same as a persistent pain condition.^[1] ACOG notes that many women experience pain during sex at some point in their lives.

Common causes

Causes can be roughly grouped by where the pain is felt^[1],[2]:

• Pain at the entrance or superficially: too little lubrication, hormonal dryness, vulval skin conditions, thrush, or pelvic-floor muscle tension.
• Deep pelvic pain: endometriosis, pelvic inflammatory disease, ovarian cysts or adhesions.
• Psychological and relationship factors, such as anxiety, previous painful experiences or not feeling safe, which often occur alongside physical causes.

Assessment

A doctor will ask where it hurts, whether it is superficial or deep, when it started, whether it happens every time, and about other symptoms such as discharge, itching, period changes or pelvic pain.^[1],[2]

An internal examination is done only with consent, you can ask to stop at any time, and the doctor may start with an external examination. Further tests, such as swabs or ultrasound, are done as indicated.

Treating the cause

In the meantime, stop activities that hurt and choose other comfortable forms of intimacy. A suitable lubricant may help.^[1]

Treatment depends on the cause and may include^[1],[2]:

• Skin care and treatment of vulval skin conditions.
• Treating infection once confirmed.
• Local hormones for dryness due to low oestrogen, when appropriate.
• Pelvic-floor physiotherapy to release muscle tension.
• Sex or couples counselling to reduce anxiety and break the pain cycle.

Avoid repeatedly self-treating with antibiotics or numbing products, which may not match the cause and can increase irritation.^[1]

How we care for you at Dr. Kris Clinic

We listen carefully and without judgement, examine you only when you are ready and consent, and you can stop at any time, in English or Thai. We look for treatable causes, such as infection or dryness, and plan treatment with you.

If you wish, we refer you for pelvic-floor physiotherapy, or sex and couples counselling at Kris Care Space, and to a gynaecologist if pelvic disease is suspected.

Frequently asked questions

Dr. Krida Uakridathikarn (Dr. Kris)

Board-certified family physician with certificate training in clinical sexology and sexual medicine. He works at Suratthani Hospital and provides sexual health, hormone and LGBTQ+ inclusive care at Dr. Kris Clinic. Profile and CV

References

1. ACOG: When Sex Is Painful
2. NHS: Vaginismus
3. NICE NG23: Menopause—identification and management; recommendations

Keep reading

Main guide: Women's sexual health

Low Sexual Desire in Women: When to Seek Help and What HelpsVaginismus and Fear of Penetration: Understood and TreatableVaginal Dryness and Menopause (GSM): Symptoms and Treatment Options

This article is general education, not personal medical advice or a promise of results. Diagnosis and treatment require assessment by a doctor. Content reflects the cited sources as of the update date.