Pain during sex in women (Dyspareunia)

Pain during sex also known as dyspareunia, is surprisingly quite common in women and a lot of women would have experience sexual pain during sex at some point during their lives. Men can also experience pain during sex but it is much less common than in women. Dyspareunia is often more common in the young and inexperienced and also in peri- or menopausal women.

This topic is usually not discussed or talked about with your friends, doctor or even sexual partner as it is still a taboo. Besides not being able to enjoy sex, it will also be distressing if you experience pain during sex which may make the situation worse as it will make you tighten up and hence make the pain worse. It is important to recognise that dyspareunia often has an emotional affect not only on yourself but also with your partner and this may occasionally lead to a negative effect on a relationship.

In general most causes of dyspareunia are not serious. However there is a few that can be detrimental to your health and well being. Hence if you are experiencing persistent dyspareunia, it is crucial to get the problem sorted out as soon as possible not only for the benefit of your relationship but also from a medical point of view.

Usually dyspareunia can be divided into deep or superficial pain.

Causes of superficial pain during sex:

herpes blister

1.      Vaginismus

Vaginismus can cause both deep and superficial pain and is due to spasm of the vaginal muscles, mainly caused by fear of being hurt.

Vaginismus can make sex painful or impossible. Women with vaginismus may never been able to use tampons or even have a pap smear test due to the fear of vaginal examinations.

Although vaginismus is often no one’s fault, it causes a lot of strong emotions in women who has vaginismus and they are usually angry with themselves, their partners or doctors.

Common causes of vaginismus include a restrictive upbringing, a history of rape or childhood sexual abuse and a history of painful vaginal infections such as genital herpes.


2.      Lack of vaginal lubrication

This is the most frequent cause of pain during sex, which can be due to nervousness, failure to relax, not enough foreplay, or unskilled foreplay by the man. Usually the pain can be resolved if the female becomes more relaxed, increased foreplay or if the couple uses lubricants.

In peri or menopausal women, vaginal dryness is common due to a fall in female hormone oestrogen. Using lubricant during sex will be helpful. Other treatment options includes hormone replacement therapy (HRTs) or vaginal hormone creams.


3.   Vaginitis

Vaginitis which is inflammation of the vagina can be caused by infections such as thrush (candida), trichomonas or bacteria vaginosis (BV). Usually symptoms would include abnormal vaginal discharge, itching and burning of the vagina and vulva.

Also, superficial infections such as genital herpes can also cause pain.

Other causes of vaginal infection such as foreign body in the vagina, such as forgotten tampon can cause pain especially if it is associated with an infection.

Generally, curing the infection gets rid of the dyspareunia.

4.      Vulvitis

Vulvitis due to inflammation of the vulva (opening of the vagina) may results in cracks in the skin of the vulva. A common skin disorder  –  contact dermatitis can affect the vulva where the vulva becomes inflamed as a result of a reaction to an irritant such as perfumed soaps, douches or lubricants. Vulvitis can cause itching, burning and pain including contact pain during sex.

5. Vulvodynia

This is a distressing condition in which the vulva is very sensitive and just touching can make the area very painful. The cause is unknown but there are many treatments available and is usually successfully treated.


6. Genital warts

Genital warts can sometimes cause pain especially if they become infected.

7. Injury

Commonly, women can get injury around the vulva or vagina caused by an episiotomy cut or tears during labour which may cause pain during sex that can last for several months. Badly healed stitches can also cause pain.

If you experience any of these problems, you see should see a doctor sooner.

Causes of deep pain during sex:

1.      Vaginismus

As mentioned above, vaginismus can cause both deep and superficial pain during sex.

2.      Problems with the cervix

During sex the man’s penis is able to hit the cervix. Hence infections of the cervix, such as that cause by STDs such as gonorrhoea, Chlamydia, trichomoniasis, genital herpes, etc and tender areas on the cervix can cause pain during deep penetration. This is also known as ‘collision dyspareunia’.

Also, occasionally an intrauterine contraceptive device (IUCD) or ‘coil’ sitting at the cervical canal can also cause pain during sex especially if it has been displaced.

3.      Problems in the uterus (womb) or ovary

Various womb disorders such as fibroids, fixed retroverted uterus, can cause deep pain during sex. Ovarian cysts can also cause dyspareunia.

4.      Endometriosis

Endometriosis is usually a painful disorder in which the type of tissues normally lining the uterus starts growing outside the uterus. The location of these tissues usually determines the amount of pain you may experience during sex. If the endometriosis is behind the vagina and lower part of the uterus, it is more likely to cause pain during sex.

5.      Pelvic inflammatory disease (PID)

PID is caused by infection in the upper female genital tract. Commonly the infection is sexually transmitted (STD). In PID, the affected tissues become badly inflamed and pressure during intercourse can cause deep pain.

6.      Pelvic adhesions

Pelvic adhesions are due to tissues in the pelvis (upper female genital tract) that has become stuck together, usually developing after surgery, injury (trauma), radiation treatment or infection (eg: a complication of pelvic inflammatory disease (PID)) which can cause pain including pain during sex.

7.      Ectopic pregnancy

In ectopic pregnancy (pregnancy outside the womb), the pregnancy is usually in the fallopian tube, but can be in other places such as the cervix and ovary. As the ectopic pregnancy progresses, it stretches the surrounding tissue and pressure on it during sex can be very painful.

If you are experiencing repeated pain during or after sex, do not hesitate to see a doctor or visit our clinics as this is not normal and often the underlying cause is curable. The longer you leave it, the more issues it may cause to yourself and also may lead to a detrimental effect on your relationship with your partner.

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Other related links:

STD general info

Costs of STD/HIV screening at our clinics

Vaginal discharge

Abnormal Vaginal bleeding

Vaginal bleeding in early pregnancy




Bacteria vaginosis

Pelvic inflammatory disease (PID)

Genital herpes

HPV vaccines

Genital warts (HPV) 


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