Pain during sex can be discomforting and can cause major relationship problems. It leads to major emotional issues. Prompt care and management is very important. Many will be eager to know the causes of painful sex in women.

Painful sex also referred to as dyspareunia affects about 1 in 10 sexually active women. It has also been found out that women in their late 50’s and early 60’s are most likely to experience pain during sex followed by women aged 16 to 24 years.

The major problem is that most women find it embarrassing to discuss their sexual issues with their doctors and they suffer in silence. Many of these conditions can be managed.


Pain during sex can be during superficial or deep penetration

The cause of pain during sex can be due to a physical structural abnormalities such as lack of lubrication, urinary tract infection or psychological such as in fear of pain or injury, feelings of guilt or shame, ignorance of sexual anatomy and physiology and fear of pregnancy.


The causes of superficial pain which results when the man is about to penetrate or is at the tip of the vagina includes;

  1. Lichen sclerosis; a condition that causes thin white patches of the skin usually around the genital region. It causes easy bruising if the area. It is however a rare disease.
  2. Infections affecting the labia, vagina or lower urinary tract such as candida infection, herpes can lead to pain during sex.
  3. Vaginal dryness; can be due to insufficient foreplay and stimulation or due to sjogren’s syndrome
  4. Muscular dysfunction of the pelvic floor such as levator ani myalgia.
  5. Psychologic; vaginismus which is an involuntary spasm in the vaginal sometimes caused by fear of being hurt
  6. Female circumcision; refers to the cutting of any part of the female genitalia for cultural, religious or non-medical reason.


The common causes of deep pain which results from deep penetration includes;

  1. Urinary tract infection: This commonly results from chronic bladder infection {interstitial cystitis}.
  2. Pelvic inflammatory disease; infections of the cervix, uterus and the fallopian tubes.
  3. Injury to surrounding tissue; such as after childbirth, after trauma
  4. Anatomical variation from normal can lead to pain. Examples of such variation are
  • Retroverted uterus; this is a uterus that is tilted posteriorly instead of anteriorly as in most women. About 20-30% of women have retroverted uterus.
  • Uterine prolapse; this results when there is laxity in the ligaments holding the uterus {womb} in place. This leads to the uterus caving in and coming out from the cervix.

    Urinary Tract: Drinking plenty of water may reduce urinary tract infections in women

    5.Hormonal causes such as

  • Endometriosis; this is a condition in which the tissue that lines the uterus grows outside the uterus
  • Estrogen deficiency as seen in menopause

Causes may also include;

6. Ovarian cysts; which is a build-up of fluid within an ovary.

7. Uterine fibroid and polyps; Non-cancerous tumours that grow on the wall of the uterus

8. Cancer of the female reproductive system; vagina, cervix, uterus, ovaries

9. Stress can trigger a tightening of the pelvic floor muscles, resulting in pain.



The treatment of pain during intercourse depends on the cause.

  • If an infection is discovered it should be treated; mycotin cream and pessaries for candida infection while the patient can use antibiotics for bacterial infection of the female genital tract and urinary system.
  • Patients with endometriosis can seek surgical and medical care.
  • Water-based lubricants can be prescribed for vaginal dryness which is common in post-menopausal women to help aid penetration and reduce pain. You can apply a lubricant liberally to the penis and vaginal orifice. A folded towel under the woman’s hip can help prevent spillage of lubricant.
  • Topical estrogen may help women who experience vaginal dryness due to low estrogen levels.
  • It is important you study about your body and learn how you like to be caressed.
  • You should also engage in longer foreplay to encourage secretion of the body’s natural lubricant.
  • Sexual partners should discuss and decide in choosing comfortable sexual positions to minimize deep pain.
  • It is important the woman learns techniques that can help relax vaginal muscles and reduce pain.
  • Practicing good genital hygiene and safe sex, and attending regular medical check-ups will help to prevent genital and urinary infections that can contribute to painful intercourse.
  • Kegel exercise can also help women with vaginismus and weak pelvic floor muscles to strengthen the pelvic floor muscles.

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