Why Does Sex Hurt?: A Guide for Figuring Out What Might Be Causing Painful Sex

Painful intercourse, or dyspareunia, can be a frustrating, sometimes alienating problem. Many people consider sex to be a private matter and may be reluctant to talk about sexual pain or dysfunction with their health care providers. Nevertheless, because dyspareunia can be caused by injury, an underlying medical condition, or psychological reasons, it is a good idea to consult a health care professional if you experience frequent or long-term pain during intercourse. In the meantime, the following guide may provide a good starting point for determining why sex hurts.*

Painful Sex for Men

1. If you experience…

• Discharge from the penis not related to sexual activity
• Painful red bumps or white blisters around the genitals
• Non-painful ulcers of the genitals

…you may have a sexually transmitted infection (STI) like gonorrhea, herpes, syphilis, or another type of STI. If you believe you may have an STI, it is important to get tested as soon as possible to treat the infection and take steps to avoid infecting others.

2. If you have…

• Difficulty getting or maintaining an erection (erectile dysfunction)
• Penile pain, with or without an erection
• A hardened area (plaque) under the skin on the shaft of the penis
• Shortening of the penis
• A curve or “hourglass” shape to the penis

…you might have Peyronie’s disease, a condition in which scar tissue develops on the penis, causing penile curvature or deformity and often resulting in painful erections.

3. If you notice…

• Swelling of the penis or the foreskin
• The inability to pull back the foreskin
• A white ring at the opening of the foreskin
• Difficulty urinating

…your foreskin may be too tight, a condition called phimosis. If the foreskin becomes so tight that it cannot be retracted at all, this is called paraphimosis. 

Painful Sex for Women

1. If you have…

• Itching or burning in the vaginal area
• Abnormal vaginal discharge color/texture (whether greyish-white, yellow, greenish-yellow, or white, thick, and clumpy)
• A change in the vaginal odor (such as a “fishy” odor)
• Vaginal bleeding or spotting

…you may have a vaginal infection like a yeast infection or bacterial vaginosis. Alternatively, such symptoms may point to an STI such as trichomoniasis, gonorrhea, chlamydia, genital warts, or herpes, especially if you have additional symptoms such as small red bumps, blisters, or sores (in the case of herpes). Your health care provider can help you determine the proper diagnosis.

2. If you experience…

• Difficult or impossible penetration, with pain upon entry
• Pain during a gynecological exam
• Pain when putting in a tampon
• Muscle tightness or spasms, particularly during intercourse

…you could have vaginismus, a condition in which the pelvic floor muscles spasm involuntarily, making penetration difficult, painful, or even impossible.

3. If you find…

• Deep pain during deep penetration
• Worse pain in certain sexual positions
• Pain in the lower abdomen or back
• Dull aching
• Pressure or heaviness in the pelvis

…you might have a chronic pelvic pain condition such as endometriosis, pelvic inflammatory disease, uterine fibroids, interstitial cystitis, pelvic organ prolapse, irritable bowel syndrome, or pelvic floor dysfunction. Read more about these and other chronic pelvic pain conditions here.

4. If you feel…

• Pain in the vulvar region (the external sexual organs including the clitoris, vaginal lips, and vaginal opening)
• Burning, soreness, or rawness in genital area
• Constant pain or pain when this area is touched, whether during sex, a gynecological exam, or tampon insertion

…you may have a chronic pain condition that affects the vulva called vulvodynia. One type of vulvodynia is vestibulodynia, which refers to pain in the vestibule of the vulva.

*Although this guide may provide a starting point for determining the cause of sexual pain, it is not all-inclusive. This content is not intended to be a substitute for expert medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Resources:

Kennard, J. Medically reviewed by Chris Vincent, MD. (2020, May 10). Reasons Men Have Pain During Sexual Intercourse. VerywellHealth. https://www.verywellhealth.com/pain-during-intercourse-2329078.

Mayo Clinic. (2019, May 14). Chronic pelvic pain in women. https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/symptoms-causes/syc-20354368.

Mayo Clinic. (2020, February 7). Painful intercourse (dyspareunia). https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967.

Mayo Clinic. (2020, April 30). Sexually transmitted disease (STD) symptoms. https://www.mayoclinic.org/diseases-conditions/sexually-transmitted-diseases-stds/in-depth/std-symptoms/art-20047081.

Smith, L. Medically reviewed by Janet Brito, Ph.D., LCSW, CST. (2018, February 13). What you need to know about vaginismus. Medical News Today. https://www.medicalnewstoday.com/articles/175261.

WebMD. Medically reviewed by Nazia Q. Bandukwala, DO. (2019, October 22). 2 Penis Disorders: Phimosis and Paraphimosis. https://www.webmd.com/men/phimosis-paraphimosis.

WebMD. Medically reviewed by Traci C. Johnson, MD. (2020, August 28). Painful Sex in Women (Dyspareunia). https://www.webmd.com/sexual-conditions/guide/female-pain-during-sex.