Why Does Sex Hurt All of a Sudden?
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Feeling pain during partnered or solo sex is abnormal. However, it's not uncommon. Painful sex affects nearly 20% of women in their reproductive years and up to 45% of postmenopausal women, though men can experience sexual discomfort too.
It's incredibly frustrating and confusing to feel pain during sex if you haven't had sex in a while or it's a new sensation. A few causes of sudden or recurring pain during solo or partnered sex include endometriosis, vaginismus, vulvodynia, and more.
This article discusses common causes of pain during intercourse and how to get your sex life back on track.
PhotoAlto/Frederic Cirou / Getty Images
How Does Pain During Sex Feel?
Pain during sex is different for everyone. Women can experience discomfort deep in the pelvis, in the vaginal canal, or externally on the vulva. It can feel itchy, throbbing, sore, scratchy, or tight. Men may experience soreness, itching, or pain on or around the penis. Discomfort can last for a moment or last for hours.
Timing and frequency are important too. Some people feel pain before intercourse, only at the beginning, throughout, or after. Sometimes this type of pain is felt sporadically during intercourse or even other times in the absence of a sexual encounter (like when putting in a tampon).
Dyspareunia: Pain From Sex
Dyspareunia is the technical name for genital pain experienced before, during, or after sex. It's a complex disorder often involving psychological, hormonal, physical, and psychosocial etiologies. Therefore, diagnosing dyspareunia is usually different for everyone.
To help diagnose dyspareunia, physical pain symptoms break down into four categories:
Superficial refers to external pain around the vulva or vagina.
Deep describes any discomfort felt inside the vaginal canal or lower pelvis.
Primary describes pain felt when a person started having sex for the first time.
Secondary refers to sudden pain after previously pain-free sex.
Talk to a healthcare provider if you feel sudden pain during sex. Sometimes, dyspareunia is a symptom of underlying disorders, like endometriosis, which can go untreated for years.
Does Sex Hurt the First Time?
Having sex for the first time doesn't always hurt, but everyone's experience differs. You may feel discomfort or bleed a bit the first few times due to the stretching of hymenal tissue, or it may feel pleasurable. Sex can also be uncomfortable initially due to the lack of natural lubrication.
Causes of New Pain During or After Sex
All pain during sex should be a red flag. Sex should be pleasurable before, during, and after the experience. Because dyspareunia is unique for everyone, consider tracking when and how often you feel pain during sex. Write down what the pain feels like and where it is in the body. This information will help you and a healthcare provider get to the root of the diagnosis.
Painful sex for males can happen during erection, ejaculation, or penetration (friction). It's often skin-related and points to infections (thrush) or sexually transmitted infections (STIs) like herpes. Issues with a tight foreskin can also cause it. Other causes of painful sex for men include prostate infections, UTIs, medications, and anatomy.
Menopause
The natural drop in estrogen during menopause can cause the vulva (including the labia, clitoral hood, and opening of the vagina) and the internal walls of the vagina to become thinner. With less elasticity, tissue, and lubrication, sexual play can become uncomfortable or painful.
Endometriosis
Endometriosis is a gynecological disorder in which endometrial cells grow outside the uterus. Two common symptoms of endometriosis are bleeding or pelvic pain after sex. Some cases of endometriosis can cause scarring in the pelvis, for example, the bladder, uterus, and rectum are attached together. Sex in these cases can cause pain due to the scar tissue. Endometriosis is considered the primary cause of pelvic pain in people who menstruate.
Infection
Common bacteria or yeast infections can cause vaginal irritation, itching, inflammation, or discharge, making sex uncomfortable. STIs such as herpes can cause blisters, often leading to painful intercourse.
Vaginismus
Vaginismus is characterized by involuntary spasms and tightening of the vagina whenever penetration is attempted. It's often caused by emotional and physical factors, like expecting sex to hurt or having past painful experiences. Some women only experience vaginismus during intercourse, and others can't insert anything into their vagina (like a tampon) without pain.
Vulvodynia
Vulvodynia is a chronic pain disorder that could contribute to superficial dyspareunia because it deals with the external female genitalia (vulva). The cause of vulvodynia is unknown, but some studies point to nerve dysfunction or psychological factors. It's different from vaginismus anatomically and because the pain it causes can continue outside of sexual activity.
Other Physical Causes of New Pain During or After Sex
Dyspareunia can result from several other factors, like:
Medications that interfere with sexual arousal or lubrication
Injury or trauma (childbirth)
Allergic reactions
Atopic dermatitis (eczema)
Cysts
Beyond Physical Pain: Psychological Pain With Sex
Psychological factors, like sexual abuse, trauma, or relationship issues, can contribute to dyspareunia too. Women are more likely than men to experience sexual assault in their lifetime and develop post-traumatic stress disorder (PTSD). PTSD symptoms include anxiety, preoccupation, fear, and difficulty sleeping.
According to one study, sexual trauma may make it difficult to become excited about having sex. It may bring up distressing physical, emotional, or mental responses that cause symptoms like vaginal tension or fungal infections. Healing from sexual assault takes time and various therapeutic methods, such as talk therapy or pelvic floor therapy.
When to See a Healthcare Provider
Any pain during sex is a reason to speak to a healthcare provider, even if it starts suddenly. They will help you determine the cause of the discomfort.
Be as specific as possible. Some women find it helpful to keep a journal. Record any related symptoms, like strong emotions, discharge, burning, fever, itching, or unexplained bleeding. Include where the pain comes from and when it happens during sex.
It's not always easy to disclose sexual experiences to a stranger. But in this case, it's critical to your physical and mental health. Sometimes painful sex is your body's way of alerting you to a more serious condition.
Some pregnant women experience pelvic discomfort during sex due to normal physical changes to the abdomen and pelvis. But pelvic pain can also indicate early labor, vaginal infection, or ovarian cysts. It's important to see a healthcare provider immediately to treat any underlying causes of painful sex.
What Helps With Painful Sex
Treating dyspareunia will depend on your unique diagnosis. Many treatment options range from products to more comprehensive therapeutic solutions. A healthcare provider can help you put together a comprehensive plan, which may include:
Vaginal lubricants
Pelvic floor therapy
Vaginal dilators (medical devices meant to stretch the vagina to reduce pain)
Cognitive behavioral therapy
Hormonal medications
Antibiotics for STI treatment
How to Talk to Your Partner About Painful Sex
Feeling uncomfortable, shy, or insecure about telling your partner that sex is painful sometimes is normal. If you feel safe disclosing personal information to them, their involvement can help you in your journey toward healing your dyspareunia.
Start slowly and stay honest. Let them know all the things you like about your sex life together. Think about what kind of support you need from them, if any. Remember, dyspareunia can result from a range of underlying conditions that can be serious.
Couples with strong sexual communication are more satisfied with their sex lives. Your partner may have already noticed some apprehension in the bedroom; talking about it can clear up confusion and worry.
Summary
Pain during sex is not normal. Dyspareunia can result from many underlying conditions, such as endometriosis, vulvodynia, ovarian cysts, menopause, STIs, and PTSD. There is no one-size-fits-all diagnosis or treatment solution for dyspareunia, so finding a healthcare provider you feel comfortable working with is important. Admitting things are wrong is the most significant step to finding pleasure in sex again.
