Why does sex hurt? 16 reasons you’re in pain after sex

Experiencing pain after intercourse? Here, we look at the possible reasons and what you can do about it.

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Pain during and after sex, also known as dyspareunia, can occur for many reasons. It affects both men and women. Some causes are more likely to affect you during sex, while others afterwards or both. It is important to understand what is causing the pain, as it may be a sign of an underlying condition that needs treating or something that can be easily treated so that you get on with your sex life.

1. Lack of sexual arousal

Not feeling in the mood or being ready for sex can make it more painful. Always make sure you build up foreplay so you are ready then you should feel more comfortable.

2. Lack of lubrication

Not having enough lubrication is a common problem. This can be related to where you are in your natural cycle or around or after the menopause time, vaginal dryness can be caused by a lack of oestrogen. Dryness can also be caused when women are undergoing hormonal treatments for certain types of cancers and this can be very upsetting. You can try using a generous amount of lubrication in all cases and if this is not enough in the case of the menopause or after cancer treatment it may be worth talking to your doctor about whether hormonal treatments are appropriate (e.g. oestrogen gel). They will explain the side effects and cautions necessary.

3. Vaginismus

Pain during sex can be due to vaginismus where the muscles in and around the vagina contract making sex difficult or impossible. This can be due to many reasons – anxiety about past trauma, difficult childbirth or after episiotomy, or just underlying anxiety. Your doctor may prescribe you something to help called 'vaginal dilators'. These don't actually dilate the vagina but are differently sized cones that you gently place in the vagina (using a lubricant) to help you get used to something being there. You should also make sure you have a good pelvic floor strength as having control here allows you also to relax the area. Physiotherapists and psychosexual therapists help people with this problem, one that many are too frightened to talk about.

4. Vulvodynia

Vulvodynia refers to the sensation of vulval burning and soreness in the absence of any skin condition or infection, usually as a result of irritation or hypersensitivity of the nerve fibres in the vulval skin. The causes are still largely unknown. Vulvodynia may cause pain after sex, as well as throbbing, burning or stinging in the vagina area.

5. Vaginitis

Vaginitis refers to inflammation of the vagina, which can sometimes result in soreness and swelling, as well as itchiness, pain and discharge. The most common cause of vaginitis are infections, but sometimes it is the result of an allergic reaction. Sex may make the inflammation caused by vaginitis worse.

6. Thrush

Pain during and after sex can be due to vaginal infection or inflammation. Thrush is an easily treatable cause and may be accompanied by itching, burning, swelling or a thick white discharge. Discuss with your pharmacist if you think this is the case as treatment over the counter is easy.

7. Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) can cause pain during and after sex. You should see your local Genitourinary Medicine (GUM) clinic to exclude these as possible causes – chlamydia, gonorrhoea, herpes etc. For example chlamydia, if left untreated, can lead to pelvic inflammatory disease leading to long term problems with uncomfortable sex and also potential reduced fertility. Your partner or sexual contacts may also need to be treated.

8. Lichen sclerosis

A condition called lichen sclerosis, local infection in glands around the vulval area or nerve problems are all further causes of pain during sex and the pain here is more commonly felt on the outside around the vulval area.

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9. Ovarian cysts

Pain during or after sex can also be due to problems within the pelvis such as ovarian cysts or endometriosis. These can cause deep pain that may also radiate through to the back and down the legs. Ovarian cysts can be 'knocked' during sex causing fluid to leak out of them and subsequent pain. Women also naturally sometimes have pain around the time of ovulation and this can be a normal cause of discomfort.

10. Endometriosis

Endometriosis is a condition where the cells that normally line the uterus have spilled out through the fallopian tube to settle in other places around the body e.g. around the ovary on the back of the bladder and uterus, causing pain or discomfort at period times or during and after sex. These areas bleed every month and the bleeding can cause discomfort and scarring.

11. Urinary tract infection (UTI)

A urinary tract infection can cause pain in your vaginal area and pelvis. This may result in inflammation or irritation during sexual intercourse.

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12. Sexual cystitis

Another cause of these symptoms can be a simple urine infection called cystitis.

Sexual cystitis is a term we now use in place of honeymoon cystitis to describe a condition where the mechanical irritation of the urethra, (the pipe from the bladder to the outside) becomes irritated through the mechanical action of sex.

You can have bacteria present in the urine in which case the condition will respond to antibiotics but it could be worsened by having sex before you are fully treated.

In these cases tests on urine samples often reveal no bacteria, and the condition does not respond to antibiotics.

Over the counter cystitis remedies can help by making the urine more alkaline so this makes it less painful. If you are not improving you need to see your doctor or nurse for a urine test to exclude infection and the need for antibiotics.

Sometimes changing your sexual position to one where there is less pressure on the front of the vagina may help and remembering to empty your bladder immediately after sexual activity is a good idea.

13. Allergic reaction

A general irritation or allergic reaction to a latex condom, lubricant, soap, shampoo or other products may cause pain during or after sex.

14. Sperm allergy

You might also like to ask your doctor about the possibility of sperm allergy (fairly rare) as it has been known for a partner's sperm to irritate a woman's vagina, symptoms of which would occur after sex rather than during it. This can also include hives and general itching.

You could try using condoms to see if this helps (without spermicidal cream which can also irritate) but if your symptoms persist despite this speak to your doctor.

15. Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is a bacterial infection that affects the female upper genital tract, including the womb, fallopian tubes and ovaries. It is often caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhoea. PID is most common in sexually active women aged between 15 and 24. PID can cause pain around the pelvis or lower tummy, and discomfort or pain during sex that is felt deep inside the pelvis. If you think you have PID, you should see your doctor or visit a sexual health clinic. If detected early, it can be treated with a course of antibiotics.

16. Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a condition that affects the digestive system. It can cause stomach cramps and constipation, which can cause discomfort during sex.

How to find relief

It is important to talk to your doctor or nurse about your symptoms so they can work out the appropriate course of action to help you. This may include examination, swabs and urine testing in the surgery or possible referral to a GUM clinic or gynaecologist or psychosexual therapist or physiotherapist. Do not be embarrassed as this is a common problem that doctors and nurses are used to treating carefully.

Last medically reviewed: 6-7-2020

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