Painful Intercourse (Dyspareunia)

Pain during sex, or dyspareunia, is persistent or recurring pain just before, during or after sex. Dyspareunia is more common in people assigned female at birth (AFAB), but anyone can experience painful sex.

People AFAB can have pain externally in the vulva — to the labia (lips of the vagina) or at the opening of the vagina. Some feel the pain internally in places like the:

• Pelvic floor muscles.
• Skin of the vaginal canal.
• Uterus.
• Ligaments supporting the uterus.
• Lower abdomen.

People assigned male at birth (AMAB) can feel pain on the head of the penis, on the shaft, in the testicles or in the pelvis.

It’s a common condition that can have negative emotional and psychological effects. In addition to the physical pain, couples may experience loss of intimacy or strain in their relationships.

Your healthcare provider may refer you to a gynecologist who specializes in sexual health. They can determine appropriate treatment based on your symptoms and the underlying condition causing you pain.

Are there different types of dyspareunia?

The location of the pain can help determine what type of dyspareunia you’re experiencing:

• Entry pain (intraoital or superficial dyspareunia): This pain is felt at the entrance to your vagina during initial penetration. Causes could include changes in hormones, vulvar or vagina dryness, chronic irritation, infection and injury.
• Positional pain: This type of pain is usually related to your pelvic floor muscles, vaginal dryness or infection.
• Deep pain (collision dyspareunia): This is pain that occurs in deep penetration. It may feel worse in certain sexual positions. This type can happen due to conditions affecting your bladder or bowel, pelvic floor dysfunction, endometriosis or pelvic congestion syndrome.

Pain during intercourse can also be described as primary, secondary, complete or situational:

• Primary pain is pain you’ve had since becoming sexually active.
• Secondary pain develops after experiencing pain-free sex.
• Complete pain means you feel pain every time you have sex.
• Situational pain is when the pain only happens at certain times.

How common is dyspareunia?

Pain during sex is more common in people AFAB, affecting 3 in 4 people with a vagina at some point in their lives.

Up to about 28% of all people in the United States will experience painful sex at least once. This number may be a low estimate as many people don’t seek help for painful sex because it’s a sensitive topic.

What age is it most likely to occur?

Anyone of any age can experience painful sex. But it’s more likely to affect people AFAB who are past menopause (the average age of menopause is 51). This is mainly due to a decrease in estrogen, a hormone that helps with lubrication and other aspects of your vaginal health.

Don’t assume painful sex is just part of getting older, though, because that’s not always the case.