Pain during sex: causes and treatment
What causes pain during intercourse (dyspareunia) — dryness, vaginismus, vestibulitis, scarring, skin conditions, endometriosis — and the treatment options available today.
Pain, soreness, stinging or burning during sex — dyspareunia, in medical terms — is something many women encounter at some point in their lives and yet often hesitate to talk about. It can affect quality of life, confidence and communication with a partner.
The first thing to say is that pain during sex is not something to be endured. Once the underlying cause is correctly identified, medicine today offers a number of ways to deal with it.
What causes it?
The cause may be physical, psychological, or a combination of the two. The commonest are these:
- Vaginal dryness and the menopause: particularly during the menopause or while breastfeeding, falling oestrogen thins the tissue lining the vagina and it loses elasticity. Without adequate lubrication, friction can cause considerable pain.
- Vaginismus (involuntary spasm): the muscles around the vagina tighten involuntarily, beyond the woman's control, making intercourse impossible or very painful. Fear, anxiety or difficult experiences in the past often lay the ground for it.
- Tenderness at the vaginal opening (vulvar vestibulitis): marked tenderness and irritation at the entrance to the vagina. Although there may be nothing obviously visible, even slight contact with the area — during intercourse or when using a tampon — causes sharp pain.
- Scars and tears from childbirth: scars left after a difficult vaginal birth (episiotomy) or small fissures at the vaginal opening caused by strain can cause pain during sex later on.
- Skin conditions: chronic skin conditions affecting the external genital area, such as eczema or lichen sclerosus, can make the tissue thin and tight and cause itching along with pain.
- Endometriosis: the underlying cause may be endometriosis. This should be suspected where the complaints have lasted a long time and are accompanied by painful periods.
What treatments are available?
Treatment is planned individually, according to the underlying cause. As medical technology has developed, non-surgical options have become common.
- Local creams and moisturisers: for dryness caused by a lack of hormones, local oestrogen creams or hormone-free moisturising gels used on a doctor's advice give the tissue the moisture it needs and can reduce the pain of friction.
- Laser and radiofrequency (non-surgical): laser and radiofrequency devices deliver heat energy beneath the surface of the tissue and stimulate the repair cells there. This supports the production of new collagen and improves the blood supply and elasticity of the tissue. For dryness related to the menopause, for skin conditions such as lichen sclerosus, and for loss of elasticity, these are considered options that allow a quick return to ordinary life.
- PRP and hyaluronic acid injections: healing cells obtained from the woman's own blood (PRP), or hyaluronic acid, which brings intensive moisture to the tissue, are injected into the painful areas. These methods support tissue renewal and help to ease dryness and tenderness.
- Therapy and muscle-relaxing approaches: where the pain comes from muscle spasm, as in vaginismus, pelvic floor physiotherapy, sex therapy, relaxation exercises and sometimes botulinum toxin injections to relax those muscles give good results.
- Surgical correction: where the pain comes from hardened scar tissue in old birth repairs, small surgical corrections under local anaesthesia (perineoplasty) can remove that painful tissue and restore the anatomy.
Remember: pain during sex is not your fate. To have your complaints correctly diagnosed and the right treatment planned, do see a gynaecologist for an examination.
This page is for information. It does not replace an examination or individual medical advice.