Painful sex: why it happens and what helps

Painful sex is far more common than most people realize: surveys suggest that around three in four women experience pain during sex at some point in their lives. It is a real physical experience, not something imagined or a sign that anything is wrong with desire, and in most cases it can be treated.

Pain has a cause, and causes can be found

Pain during sex can come from the skin of the vulva, the muscles of the pelvic floor, the vaginal tissue itself or organs deeper in the pelvis. Doctors often call it dyspareunia, an umbrella term rather than a diagnosis. Underneath it sit specific conditions such as vaginismus, vulvodynia and endometriosis, as well as life stages that change the body, like the months after childbirth or menopause.

Where the pain is felt matters. Pain at the entrance usually points in a different direction from pain felt deep inside with thrusting, and a clinician will want to know which one you have.

What usually helps

Most people do best with a combination of approaches rather than a single fix:

• A medical check with a GP or gynecologist to look for infection, skin conditions, hormonal changes or deeper causes.
• Pelvic floor physical therapy, especially when muscles are tense or guarded. A specialist pelvic floor therapist can assess and treat this directly.
• Gradual, self-paced approaches, such as vaginal dilators or depth-limiting rings for deep pain.
• Enough lubrication, often a good water-based lube.
• Honest communication with a partner, so sex can change shape while the body recovers.

Where to start

The articles in this section explain each condition and tool in plain language: what it is, what the evidence says and what to expect from treatment. If you are not sure where to begin, the guide to dyspareunia gives the widest overview, and the piece on talking about pain with a partner can help with the conversation that often comes first.