Painful Sex

Painful Sex


Painful sex is a neglected yet common female health issue; often because women are hesitant to approach their physicians about it or their physicians do not inquire about it. Recurrent or persistent pain with sexual activity causes distress or conflict in relationships. It has a significant impact on a woman's mental and physical health, body image, relationships with partners, and efforts to conceive.

There are two primary types of painful sex, medically known as dyspareunia; primary or secondary. Primary dyspareunia occurs at the start of intercourse, whereas secondary occurs after some time of pain-free sex. Depending on the location of the pain, dyspareunia can be superficial and deep. Superficial dyspareunia occurs at the vulvar or vaginal entrance. And deep dyspareunia occurs during deep penetration. Women can experience painful sex due to multiple reasons. Reasons range from hormonal changes to emotional hindrance.


  • Medical conditions: bladder infection, painful bladder syndrome, thyroid issues, diabetes
  • Gynecological disorders: endometriosis, infections (vaginitis, cervicitis), vaginismus, vulvodynia
  • Lack of vaginal lubrication/vaginal dryness: menopause, post-partum, side-effects of medications
  • Low libido: medication side effects such as contraceptives, anti-depressants, emotional hindrance, nutritional deficiency
  • Anatomical: pelvic organ prolapse, pelvic floor muscle dysfunction, uterine retroversion
  • Dermatological-related: this includes conditions that affect the vulvar skin and vaginal mucosa, such as lichen sclerosis, psoriasis, eczema.
  • Emotional hindrance: shyness, sexual anxiety, lack of body confidence, etc.

As hormones, particularly estrogen, begins to dwindle during menopause, so does sexual health. Estrogen plays a significant role in maintaining vaginal health, and when its levels decline, vaginal atrophy occurs. Vaginal atrophy is characterized by thinning of the vaginal tissues and the lack of vaginal secretions, resulting in dry, itching, or burning sensations within the vagina. Vaginal atrophy can also occur after surgical removal of both ovaries, during breastfeeding, medications that influence hormonal levels, chemotherapy, or radiation to the pelvic area.


It is necessary to know and address the underlying cause if one wants to overcome dyspareunia. After this step, it becomes easier to treat dyspareunia.

Vaginal atrophy is treatable with estrogen. Estrogen is available in many forms. Consuming estrogen tablets or pills will also take care of the other symptoms of menopause (hot flashes, night sweats). Vaginal estrogen creams, rings, or suppositories will directly deliver estrogen to the vaginal tissues. Thus, by restoring adequate vaginal secretions, dryness or itchiness are prevented. Sufficient vaginal secretions will also deal with the issue of lack of lubrication. Using lubes will alleviate painful sex due to insufficient lubrication. Menopausal women who do not wish to go for estrogen replacement or cannot for medical reasons opt for lube or vaginal suppositories to deal with pain during sex.

There are many types of lubricants and suppositories available. Lubricants can have a base of oil, silicone, or water. Suppositories can be made with more natural ingredients using cocoa butter and coconut oil as its base.

Hormone free and estrogen free options for vaginal hydration will work great when they include ingredients like hyaluronic acid and vitamin e. In addition, to providing lubrication, CBD-containing suppositories may also enhance sexual pleasure and reduce anxiety related to sex.

If dyspareunia is medically related, do consult your gynecologist about your concerns. Perhaps a particular medication is getting in your way of having a good time. Or there is an underlying medical condition. Under the guidance of a physiotherapist, there are specific exercises that relax your pelvic floor muscles. Moisturizers can hydrate your vulvar skin, making it less dry and itchy.

Penetration isn't necessary for a pleasurable time. Take it slow and steady. Communicate with your partner during intercourse. Communication is also essential to making sex a gratifying experience. Verbally express your desires, needs, and comforts. Ask your partner to focus on clitoral stimulation or any of your erogenous zones. Make it a fun experience by adding toys into the mix.

Chronic dyspareunia can substantially impact a woman's mental health and her relationships. It can increase the risk of depression and anxiety. And also cause negative body image and low self-esteem. For this reason, one should seek help immediately regarding painful sex. Delaying treatment will increase one's suffering, resulting in adverse consequences. So do not neglect your sexual health. Talk to your partner, doctor, and anyone you are comfortable with about sharing your pain. Know that you are not alone and that you will overcome it.



  • Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014 Oct 1;90(7):465-70. PMID: 25369624.
  • Tayyeb M, Gupta V. Dyspareunia. 2021 Feb 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32965830.
  • Ghaderi F, Bastani P, Hajebrahimi S, Jafarabadi MA, Berghmans B. Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. Int Urogynecol J. 2019 Nov;30(11):1849-1855. doi: 10.1007/s00192-019-04019-3. Epub 2019 Jul 8. PMID: 31286158; PMCID: PMC6834927.
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