Painful Sex (Dyspareunia): Causes & What Can Help

Published 12 September 2023 Last reviewed 9 October 2026 By Brenda Tootell 13 min read

Pain during or after sex can have many possible causes. It may occur at the vaginal opening, deeper in the pelvis, during penetration or thrusting, or continue after sexual activity has finished.

Dyspareunia is the medical term used for pain associated with sexual intercourse. It can be linked to vaginal dryness, pelvic floor tension, vaginismus, infections, hormonal changes, endometriosis and other pelvic or vulvovaginal conditions.

If sex is frequently or persistently painful, it is worth speaking with a qualified healthcare professional to find out what may be contributing rather than simply trying to push through it.

What is dyspareunia?

Dyspareunia is a term used to describe pain associated with sexual intercourse. Pain may happen before, during or after penetration and can feel very different from one person to another.

Some people experience pain around the vulva or vaginal opening, while others feel pain deeper in the pelvis. It may feel burning, aching, sharp, throbbing, tender or like pressure.

Pain may happen every time, only with particular positions or types of penetration, or only under certain circumstances.

Dyspareunia does not necessarily have one single cause. Several physical, hormonal, muscular and emotional factors can sometimes overlap.

What does painful sex feel like?

The location and timing of pain can provide useful clues, although they cannot diagnose the cause on their own.

Pain at the vaginal opening

Entry or superficial pain occurs around the vulva, vaginal opening or just inside the vagina.

Possible contributors include:

vaginal dryness or insufficient lubrication
irritation or inflammation
vaginal or genital infections
vulval or vaginal skin conditions
pelvic floor muscle tension
vaginismus
previous injury or scarring
pain conditions affecting the vulva, including vulvodynia

Deeper pain during penetration

Deep pain is felt further inside the pelvis and may be more noticeable with deeper penetration or particular sexual positions.

Possible contributors include pelvic conditions such as endometriosis, pelvic inflammatory disease, some ovarian or uterine conditions, pelvic organ prolapse, bladder or bowel conditions and other causes of persistent pelvic pain.

Pain after sex

Pain can sometimes continue after sexual activity has finished.

This may occur alongside pelvic floor tension, irritation, dryness or an underlying vulval, vaginal or pelvic condition.

If pain keeps returning, is becoming more severe or is affecting the sexual activity you want to have, seek professional assessment rather than repeatedly pushing through it.

What can cause painful sex?

There is no single cause of dyspareunia. Physical, hormonal, pelvic-floor, emotional and contextual factors can overlap.

Vaginal dryness

Not having enough lubrication can increase friction and make penetration uncomfortable or painful.

Dryness can be associated with hormonal changes, some medicines, breastfeeding, lower oestrogen around and after menopause or simply not having enough arousal or lubrication for the type of sexual activity taking place.

Lubricant can reduce friction, but persistent vaginal dryness is worth discussing with a healthcare professional because lubricant alone may not address the underlying reason.

Hormonal changes and menopause

Lower oestrogen around perimenopause and menopause can affect the vaginal and urinary tissues and contribute to dryness, irritation and discomfort during sex.

These changes may form part of what is known as genitourinary syndrome of menopause (GSM).

Treatment depends on your symptoms and medical history and may include lubricants, vaginal moisturisers or local hormonal treatment recommended by a healthcare professional.

Pelvic floor tension

The pelvic floor muscles support structures in the pelvis and contribute to bladder, bowel and sexual function. They also need to relax and lengthen appropriately.

If the pelvic floor remains tense or tightens in response to actual or anticipated pain, penetration can become uncomfortable or difficult.

An overactive pelvic floor may occur alongside pelvic pain, painful penetration, urinary symptoms or bowel symptoms.

It is important not to assume that everyone with painful sex needs more pelvic floor strengthening. A pelvic health physiotherapist can assess whether relaxation, strengthening, coordination work or another approach is appropriate.

Vaginismus

Vaginismus involves involuntary tightening around the vaginal opening that can make penetration painful, difficult or sometimes impossible.

Anticipating pain can contribute to further muscle tightening, which may then make penetration more uncomfortable. This can create a difficult cycle, but the tightening is not something a person is deliberately choosing to do.

Management may include pelvic health physiotherapy, relaxation strategies, vaginal trainers or dilators, psychological or psychosexual support and treatment of other contributing factors.

Infections and irritation

Some vaginal, genital or urinary infections can cause burning, irritation or pain during sex.

Sexually transmitted infections can also cause pelvic or genital symptoms.

If pain occurs with unusual discharge, sores, itching, burning when urinating, bleeding or other new symptoms, seek medical advice rather than assuming friction is the cause.

Endometriosis and other pelvic conditions

Some pelvic health conditions can contribute to deep pain during sex.

Endometriosis is one possible cause. Others can include pelvic inflammatory disease, some types of pelvic organ prolapse, ovarian or uterine conditions, bladder conditions, bowel conditions and other causes of persistent pelvic pain.

Pain during sex cannot tell you which condition, if any, is responsible, which is why ongoing symptoms are worth assessing.

Previous injury, surgery or childbirth

Some people experience pain after childbirth, pelvic surgery or injury.

Scarring, tissue sensitivity, pelvic floor changes or other changes in the pelvis may contribute.

Persistent pain should not simply be accepted as an inevitable consequence of childbirth or surgery.

Emotional and contextual factors

Stress, anxiety, fear of pain, previous painful experiences, trauma and relationship context can influence how the body responds to sexual activity.

This does not mean the pain is “just psychological”. Pain is real, and physical and emotional factors can interact.

Counselling, sex therapy or trauma-informed psychological support may be useful for some people, particularly where fear, anxiety, trauma or relationship concerns are part of the picture.

How is painful sex assessed?

A GP, sexual health clinician or other healthcare professional will usually start by asking about the pattern of the pain.

They may ask:

where the pain occurs
whether it happens at the vaginal opening or deeper in the pelvis
whether it happens every time or only in certain situations
whether depth or position makes a difference
when the symptoms started
whether pain continues afterwards
whether you have dryness, bleeding, discharge, itching or urinary symptoms
about your menstrual cycle, menopause or hormonal changes
about childbirth, surgery or previous injury
about medicines and other health conditions

Depending on your symptoms, further assessment may include urine testing, swabs, a pelvic examination, imaging or referral to a gynaecologist, pelvic health physiotherapist, sexual health clinician or another appropriate specialist.

If a vaginal examination is recommended, the clinician should explain why it may be useful and what it involves. You can ask questions, request changes or stop the examination at any time.

What may help make sex more comfortable?

The most useful approach depends on what is causing the pain, but some practical changes may reduce friction or make sexual activity more comfortable.

Use suitable lubricant

A suitable personal lubricant can reduce friction during penetration. Water-based lubricant is a common starting point.

Use enough to keep the area comfortable and add more if needed. If you use condoms, sex toys or another sexual product, check the manufacturer's guidance about lubricant compatibility.

If you regularly need lubricant because of persistent dryness or pain, consider discussing the symptoms with a healthcare professional.

Allow more time for arousal

Arousal can increase natural vaginal lubrication and may make penetration more comfortable.

There is no requirement to move quickly to penetration. Taking more time, changing activities or choosing non-penetrative sexual activity may be more comfortable when penetration hurts.

Adjust position, depth and speed

Some people experience pain only with deeper penetration or particular positions.

Changing the position, depth, speed or type of sexual activity may help. Communication can make it easier to pause or change what you are doing when something hurts.

Don't push through pain

Pain is useful information.

If penetration hurts, stopping or changing the activity is reasonable. Repeatedly forcing penetration when your body is tightening or hurting can make the experience more difficult.

Intimacy and sexual pleasure do not have to involve penetration.

Consider pelvic floor relaxation when appropriate

If pelvic floor tension is contributing to the pain, relaxation and coordination work may be more useful than simply doing more strengthening exercises.

Our guide to pelvic floor relaxation techniques includes gentle breathing and body-awareness approaches that may be useful alongside professional guidance.

How is dyspareunia managed?

There is no single treatment for dyspareunia because management depends on what is contributing to the pain.

Dryness and hormonal changes

If vaginal dryness is contributing, management may include lubricant, vaginal moisturisers or treatment of an underlying hormonal cause.

For some people experiencing symptoms related to lower oestrogen, local hormonal therapy may be considered. Suitability depends on individual symptoms and medical history.

Pelvic health physiotherapy

Pelvic health physiotherapy may help when pelvic floor tension, coordination problems or other muscle dysfunction is contributing to painful sex.

A pelvic health physiotherapist can assess whether you would benefit from relaxation, strengthening, coordination work, manual treatment or another approach.

Research suggests pelvic health physiotherapy can improve pain and quality of life for some people with dyspareunia, although studies use different treatment techniques and there is no single exercise program that works for everyone.

You can find a pelvic health physiotherapist in Australia using our directory.

Psychological or sex therapy

Counselling, sex therapy or other psychological approaches may be useful when fear, anxiety, trauma or relationship factors are contributing to the pain experience.

This does not replace physical assessment when physical symptoms are present. For some people, addressing both physical and emotional factors is more helpful than focusing on only one.

Vaginal dilators

Vaginal dilators are graduated devices that can be used to help someone become progressively more comfortable with vaginal penetration.

They may form part of treatment for some people with vaginismus, penetration difficulties or pelvic pain, but they are not appropriate for every cause of dyspareunia.

Dilators should not be used to push through pain. Professional guidance can help with sizing, technique, progression and identifying when to stop or modify treatment.

Treating an underlying condition

If an infection, vulval condition, endometriosis, pelvic floor disorder, hormonal change or another health problem is contributing to painful sex, treatment should address that condition where possible.

This is why persistent painful sex deserves assessment rather than relying only on general comfort measures.

When should you seek medical advice?

Consider seeing a healthcare professional if:

sex is frequently or persistently painful
pain is worsening or affecting your everyday life
penetration has become difficult or impossible
you have unusual vaginal discharge, odour, itching or sores
you have bleeding during or after sex, particularly if it is new or recurrent
you have pain or burning when urinating
you have persistent pelvic or abdominal pain
you suspect endometriosis, pelvic organ prolapse or another pelvic health condition
pain began after childbirth, surgery or an injury
pain continues for a significant time after sexual activity
you have experienced sexual trauma and would like support

Seek urgent medical care for severe or rapidly worsening pelvic or abdominal pain, particularly if it occurs with heavy bleeding, fever, vomiting, fainting or feeling very unwell.

In Australia, a GP is a useful starting point and can refer you to a gynaecologist, pelvic health physiotherapist, sexual health clinician or other specialist if needed.

If talking about pelvic or vaginal symptoms feels difficult, see our guide to talking to a doctor about intimate health concerns.

Frequently asked questions

Why has sex suddenly become painful when it wasn't before?

New painful sex can have many possible causes, including vaginal dryness, hormonal changes, infection, irritation, pelvic floor tension, injury or a pelvic health condition. If the change is persistent or unexplained, seek medical advice rather than assuming it is simply due to ageing or not enough lubrication.

Why does penetration hurt at the entrance?

Pain around the vaginal opening may be associated with dryness, irritation, infection, vulval skin conditions, vulvodynia, pelvic floor tension or vaginismus. The location provides a useful clue but does not identify the cause on its own.

Why does deep penetration hurt?

Deep pelvic pain during sex can occur with conditions such as endometriosis, pelvic inflammatory disease, some ovarian or uterine conditions, pelvic organ prolapse or other causes of pelvic pain. Persistent deep pain should be assessed rather than repeatedly managed by simply changing position.

Can menopause cause painful sex?

Yes. Lower oestrogen around and after menopause can change vaginal and urinary tissues and contribute to dryness, irritation and pain. Lubricants and moisturisers may help with comfort, while some people may benefit from hormonal treatment prescribed by a healthcare professional.

Can a tight pelvic floor cause painful sex?

Pelvic floor overactivity or difficulty relaxing can contribute to painful penetration for some people. However, painful sex can have many causes, so symptoms alone do not prove that the pelvic floor is tight. A pelvic health physiotherapist can assess how the muscles are functioning.

Can lubricant help painful sex?

Lubricant can reduce friction and may make sex more comfortable when dryness or insufficient lubrication is contributing. It will not treat other causes such as infection, endometriosis or pelvic floor dysfunction, so persistent pain still deserves assessment.

Can vaginal dilators help with painful sex?

They can be useful in some treatment plans, particularly for vaginismus or difficulty with vaginal penetration. They are not a general treatment for every type of painful sex and should not be used to force penetration through pain.

When should I see a doctor about painful sex?

Seek professional advice if pain is frequent, persistent, worsening, severe or affecting your quality of life, or if it occurs with symptoms such as bleeding, unusual discharge, urinary symptoms or ongoing pelvic pain.

The bottom line

Pain during or after sex is not something you have to simply tolerate.

Dyspareunia can have many possible contributors, including vaginal dryness, hormonal changes, pelvic floor tension, vaginismus, infections, vulval conditions, endometriosis and other pelvic health conditions.

Practical changes such as suitable lubricant, more time for arousal, adjusting penetration and avoiding activities that cause pain may help with comfort, but persistent or recurring symptoms deserve proper assessment.

If you experience pelvic floor tension or penetration difficulty, our guides to vaginismus, overactive pelvic floor and pelvic floor relaxation may be useful next steps.