If sex is uncomfortable or even painful for you, it’s understandable to wonder if sex is just supposed to hurt. And, if this has been the way sex has always been for you, you may simply think this is the way it should be.
Doctors say they see this regularly in patients. “This is a big issue we have as ob-gyns — that there is almost this expectation that sex is supposed to hurt,” Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells Yahoo Life. “People who have always had pain just assume that this is normal. It’s not.”
If you’re having pain during sex, it’s generally an indicator that something is off with your health, women’s health expert Dr. Jennifer Wider tells Yahoo Life. “Frequent or moderate to severe pain usually indicates that something isn’t right, and is a strong indication that it should be addressed with a health care provider,” she says.
There is a medical term for this — dyspareunia — and it’s used to describe having genital pain before, during or after intercourse. Unfortunately, pain during sex is common. Nearly 3 out of 4 women have pain during intercourse at some point in their lives, according to the American College of Obstetricians and Gynecologists (ACOG). Sometimes it’s short-term; other times it’s long-term. Worth noting: Only 5% of men report experiencing serious pain while having sex.
There are “a multitude of things” that can lead to painful sex, Wider says, stressing that it’s important to talk to your doctor if you’re experiencing this so you can get help. But what are the signs of painful sex (besides pain) and what conditions can they indicate? Ob-gyns break it down.
What are the signs of painful sex?
At baseline, painful sex involves pain during intercourse. But it can be more specific than that. You can feel pain in your vulva (the area around the opening of your vagina) or within your vagina, according to ACOG. You may also feel pain in your perineum, which is the spot between your vaginal opening and anus, or pain in your lower back, pelvic region, uterus or bladder.
It can be even more specific. “You can have pain at entry or during thrusting; burning, sharp or shooting pain sensations; throbbing or aching during or after intercourse,” Wider says.
What conditions are often linked with painful sex?
There are quite a few, including:
Vaginismus. This is a condition that causes an involuntary tensing or contracting of muscles around the vagina, Cleveland Clinic explains. It’s not known why some women experience this, but it’s linked to anxiety disorders, childbirth injuries, prior surgery, fear of sex or a history of sexual abuse or rape. Women with vaginismus have pain during vaginal penetration, painful sex, and trouble having a pelvic exam due to muscle spasms or pain.
Infections. A range of infections can lead to pain during sex, including chlamydia, gonorrhea and genital herpes, Streicher says. The symptoms of each vary slightly, but they’re generally caused by having unprotected sex with an infected partner.
Menopause. Menopause causes women to experience a loss of estrogen, and that can lead to vaginal dryness. This can make sex hurt from penetration, Minkin says.
Irritable bowel syndrome. Also known as IBS, this condition is a group of symptoms that include abdominal pain, along with changes in your bowel movements, including diarrhea, constipation or both, per the National Institute of Diabetes and Digestive and Kidney Diseases. It can also cause pain during sex in women, Streicher says.
Endometriosis. This is a condition where cells similar to the lining of the uterus — or endometrium —grow outside the uterus, Mayo Clinic explains. Symptoms include painful periods, pain during intercourse, excessive bleeding and pain with bowel movements. The exact cause of endometriosis isn’t known, Mayo Clinic says.
Fibroids. Uterine fibroids are growths that develop from the muscle tissue of the uterus, ACOG says. They can cause symptoms such as longer periods, back pain, pain during sex and infertility. It’s not clear what causes fibroids.
“If the vagina is dry, sex usually hurts from penetration on,” Minkin says. “The most common cause of vaginal dryness is associated with loss of estrogen, like menopause. However, breastfeeding women are often dry because they too have very low estrogen levels.” If sex hurts with deep penetration, it usually isn’t a vaginal issue “but related to something going on in the pelvis, like endometriosis,” she explains.
How to talk to your doctor and partner if sex is painful
It’s crucial to talk to your partner if sex is painful, Wider says. “Be upfront and honest,” she advises, noting that this will allow you to work on the issue together.
“The fallout of painful sex is far more than the sex itself — it has an impact on relationships too,” Streicher says. “You may go into avoidance mode and not want to tell your partner that sex is painful. If you just put up with it, that can make the problem worse.”
Streicher recommends making a specific appointment to talk to your ob-gyn about having pain during sex rather than bringing it up at a well-woman visit. “So many women wait until their annual visit, but there often isn’t enough time to really dive into what’s going on,” she says. “It’s meant to be a well-woman visit, but this isn’t a well woman — it’s a problem.”
Wider says it’s crucial to be clear with your doctor about how you’re feeling. And, if you don’t feel that they’re helpful, it’s important to see another doctor. “If your doctor is not an expert in this, they may say, ‘Take a bath, have a glass of wine, you need to relax more’ and that there are no real solutions,” Streicher says. “If your own doctor is not able to help, you need to see an expert.”