Sex is meant to be pleasurable, fun and something you want to return to without anxiety or fear of pain. But for a lot of women, sex is sadly accompanied by pain, discomfort and even distress.
The worst part is that, despite being remarkably common amongst those with a vulva or vagina, painful sex remains one of the most under-discussed, isolating and shame-filled topics in sexual health. In fact, many women suffer in silence for years, assuming their experience is a normal part of sex, unavoidable or somehow their fault, and that their body must be “broken”. It is none of these things.
So why do women push through and suffer? Because asking for something else feels awkward. Because we have been taught to perform pleasure rather than experience it. Because we do not want to disappoint a partner. Because we worry we will be labelled difficult, frigid or broken.
This article will help you explore the different ways that painful sex is described, what might cause it and the possible paths forward. You deserve support, and with the right investigation and care, there may be ways to make sex more comfortable and fulfilling.
How common is painful sex?
The honest answer is: far more common than most people realise.
According to the American College of Obstetricians and Gynecologists, nearly three in four women experience pain during intercourse at some point in their lives. For some, it is temporary. For others, it becomes a longer-term problem (American College of Obstetricians and Gynecologists, 2020).
The numbers only tell part of the story. What they cannot capture are the women who never seek help, the relationships strained by unspoken discomfort or the countless times someone has gritted their teeth and waited for sex to be over.
Pain during sex is common, but that does not mean it should be accepted as normal.
Understanding the terminology
The language surrounding painful sex can feel confusing. Different terms describe different patterns of pain, and some overlap significantly.
Dyspareunia
Dyspareunia is the medical term for persistent or recurrent genital pain that occurs before, during or after sexual intercourse. It can describe pain at the vaginal opening, pain felt deeper in the pelvis or a combination of both.
Dyspareunia is not a diagnosis of the underlying cause. It is a description of the symptom. The cause still needs to be investigated.
Vaginismus
Vaginismus refers to involuntary tightening of the muscles surrounding the vaginal opening when penetration is attempted. This can make penetration painful, difficult or impossible. It may affect sexual penetration, tampon use or gynaecological examinations.
Vaginismus may be present from a person’s first attempts at penetration or develop after a period of pain-free penetration. It is an automatic physical response, not something a person is choosing or deliberately controlling.
The reasons for vaginismus are not always clear. Anxiety, fear of pain, a previous painful sexual experience, sexual trauma, an unpleasant medical examination, childbirth and painful medical conditions may all contribute. This does not mean that vaginismus is “all in your head”. The muscle response is real and involuntary (NHS, 2024a).
Vulvodynia
Vulvodynia is persistent vulval pain lasting for at least three months when no specific cause can be identified. The pain may be described as burning, throbbing, stabbing, soreness or irritation. It may occur constantly or only when the area is touched, for example during sex, tampon use or sitting (NHS, 2024b).
When the pain is focused around the entrance to the vagina and triggered by touch, it may be described as provoked vestibulodynia.
Genito-pelvic pain/penetration disorder
Genito-pelvic pain/penetration disorder, or GPPPD, is a diagnostic category in the DSM-5-TR. It brings together symptoms involving difficulty with penetration, pain during attempted penetration, fear or anxiety about pain and involuntary tightening of the pelvic floor muscles (American Psychiatric Association, 2022).
These terms can be useful when accessing healthcare, but you do not need to identify the correct label before asking for help. A healthcare professional should investigate the pattern, location, duration and possible causes of the pain.
What causes painful sex?
There is no single cause of painful sex. It may arise from physical, hormonal, psychological, relational or contextual factors. For many people, several factors interact.
Insufficient lubrication
One of the most common causes of discomfort during penetration is insufficient lubrication. Natural lubrication depends on arousal, and many factors can interfere with it, including not having enough time or suitable stimulation, stress, hormonal changes, menopause and certain medications.
People differ in how much time and what types of stimulation they need. A lack of lubrication does not necessarily mean that someone is not attracted to their partner or does not want sex.
Hormonal changes
Changes in oestrogen levels can make the vaginal tissues thinner, drier and less elastic. This is particularly common during perimenopause and menopause, but it can also occur after childbirth, during breastfeeding, after certain cancer treatments or while taking particular medications.
These changes can make penetration feel sore, burning or abrasive.
Infections and skin conditions
Thrush, bacterial vaginosis, sexually transmitted infections, urinary tract infections and certain skin conditions can all cause pain, irritation or inflammation.
Conditions such as lichen sclerosus can affect the vulval skin and require medical assessment and treatment. Persistent itching, unusual discharge, bleeding, visible skin changes or sores should be discussed with a healthcare professional.
Endometriosis
Endometriosis occurs when tissue similar to the lining of the uterus grows elsewhere in the body. It can cause deep pain during or after penetration, as well as painful periods, pelvic pain, fatigue and difficulties becoming pregnant.
Diagnosis can take a long time. Recent UK reporting places the average time to diagnosis at nine years and four months (Royal College of Obstetricians and Gynaecologists, 2026).
Pelvic inflammatory disease
Pelvic inflammatory disease is an infection of the female reproductive organs. It may cause pelvic pain, deep pain during sex, unusual vaginal discharge, bleeding between periods or after sex and fever.
It requires medical assessment and treatment, as untreated pelvic inflammatory disease can lead to complications.
Pelvic floor dysfunction
The pelvic floor muscles can become tense, overactive or poorly coordinated. This can make penetration difficult or painful and may cause pain during examinations, tampon use or bowel movements.
Pelvic floor dysfunction can occur alongside vaginismus, vulvodynia, endometriosis and other pelvic pain conditions.
Injury, surgery or childbirth
Scar tissue, vaginal tears, episiotomy, pelvic surgery and other injuries can affect sensitivity and comfort during sex. Pain after childbirth is common, but persistent or severe pain should not simply be dismissed as an inevitable consequence of giving birth.
Psychological and relational factors
Stress, anxiety, fear of pain, trauma, relationship difficulties, poor communication and feeling unsafe or pressured can all affect arousal, lubrication and pelvic floor tension.
This does not mean that pain is “all in your head”. Psychological and relational factors can create or amplify real physiological responses and are worth addressing alongside possible physical causes.
A useful explanation of how the brain, nervous system and body contribute to pain is Lorimer Moseley’s talk, Why Things Hurt (Moseley, 2011).
The pain and fear cycle
When penetration has hurt before, the body may begin to anticipate pain. This anticipation can cause anxiety and involuntary pelvic floor tightening. The tightening may then make penetration more painful, reinforcing the expectation that it will hurt next time.
This is sometimes described as the fear-avoidance cycle. Avoidance is an understandable protective response, but over time the cycle may increase fear, tension and sensitivity.
Breaking this cycle does not mean forcing yourself through pain. It means creating safety, removing pressure and addressing the physical and emotional factors contributing to the response.
Paths forward
Once the possible cause or causes have been explored, appropriate treatment and support can be considered. The right approach will depend on the individual and may involve more than one form of care.
Speak to a healthcare professional
A GP, sexual-health clinician or gynaecologist can help investigate persistent pain. They may ask about where the pain occurs, when it began, what it feels like and whether it is associated with periods, discharge, bleeding, urinary symptoms or other health changes.
You are entitled to ask for a female clinician, request a chaperone and ask the clinician to stop an examination at any time. You can also ask what will happen before agreeing to an examination.
If you feel dismissed, you may seek another opinion.
Pelvic-health physiotherapy
A pelvic-health physiotherapist can assess whether the pelvic floor muscles are tense, overactive, weak or poorly coordinated. Treatment may include education, breathing techniques, relaxation, movement, manual therapy and exercises tailored to the individual.
Pelvic floor exercises are not always about strengthening. For someone with overactive or tense muscles, learning to relax and lengthen them may be more appropriate. Guidance from a suitably qualified professional is important (NHS, 2024a; NHS, 2024b).
Lubricants
Lubricants can reduce friction and may make sex more comfortable when dryness contributes to the pain. However, they do not treat every cause of painful sex, and persistent pain should still be investigated.
Water-based lubricants are widely available and compatible with condoms and most sex toys, although they may need to be reapplied. Silicone-based lubricants usually last longer but may not be suitable for use with some silicone toys. Oil-based products can damage latex condoms.
A product should be stopped if it causes burning, irritation or another reaction.
Vaginal moisturisers and vaginal oestrogen
Vaginal moisturisers are designed for regular use rather than only during sexual activity. They may help some people experiencing ongoing dryness.
NICE recommends offering vaginal oestrogen for genitourinary symptoms associated with menopause. It can be used alone or alongside vaginal moisturisers or lubricants. Its suitability depends on individual symptoms and medical history, so it should be discussed with a qualified healthcare professional (National Institute for Health and Care Excellence, 2026).
Psychosexual therapy
Psychosexual therapy can help individuals or couples explore anxiety, fear, communication, desire, arousal and the emotional effects of painful sex.
It should not be used to suggest that the pain is imaginary. Instead, it can form part of a wider approach that considers both physical and psychological factors.
Vaginal trainers or dilators
Vaginal trainers, sometimes called dilators, may be recommended as part of treatment for vaginismus or other penetration difficulties. They allow a person to become gradually accustomed to insertion at their own pace and without pressure to proceed to intercourse.
They are generally best used with guidance from a qualified pelvic-health physiotherapist, psychosexual therapist or other suitably trained healthcare professional (NHS, 2024a; NHS, 2024b).
Remove penetration as the goal
Sex does not have to involve penetration. Taking penetration off the table can reduce pressure and create space to explore forms of intimacy and pleasure that feel safe and comfortable.
This is not failure or avoidance. It can be an important part of rebuilding trust in the body and discovering what genuinely feels pleasurable.
Communicate clearly
A partner should never expect someone to endure pain for their benefit. Honest communication can help establish what feels good, what does not and when an activity needs to stop.
Consent is ongoing and can be withdrawn at any time. Pain is a valid reason to pause or stop, but no reason is required.
Final thoughts
Painful sex is common, but it is not something you should have to endure in silence. It is not a personal failure, evidence that your body is broken or simply the price of having sex.
There may be several contributing factors, and finding the right support can take time. A thoughtful assessment should consider physical health, hormones, pelvic floor function, emotional wellbeing, relationships and the wider context in which sex is taking place.
You deserve sex that feels safe, consensual and pleasurable. You also deserve to be listened to when something hurts.
Educational information only. This article is not therapy, medical advice, diagnosis or crisis support. If you are experiencing persistent or severe pain, speak to a qualified healthcare professional.
References
American College of Obstetricians and Gynecologists (2020) When Sex Is Painful. FAQ020. Last reviewed May 2026. Washington, DC: American College of Obstetricians and Gynecologists.
American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders. 5th edn, text rev. Washington, DC: American Psychiatric Association Publishing.
Moseley, G.L. (2011) ‘Why Things Hurt’. TEDxAdelaide, 21 November.
National Institute for Health and Care Excellence (2026) Menopause: Identification and Management. NICE guideline NG23. Published 12 November 2015, last updated 15 April 2026. London: National Institute for Health and Care Excellence.
NHS (2024a) Vaginismus. Page last reviewed 13 May 2024. London: National Health Service.
NHS (2024b) Vulvodynia (Vulval Pain). Page last reviewed 16 January 2024. London: National Health Service.
Royal College of Obstetricians and Gynaecologists (2026) RCOG Responds to Endometriosis UK Report Showing Rise in Endometriosis Diagnosis Times. 2 March 2026. London: Royal College of Obstetricians and Gynaecologists.
IMPORTANT CONTEXT
Educational information only. Not therapy, medical advice, diagnosis or crisis support.