Sex is supposed to feel good. So when it doesn’t, it can feel confusing, isolating, and honestly pretty demoralizing.
Painful sex (a condition doctors call dyspareunia) is genuinely common. Research suggests it affects up to 30% of women at some point in their lives, though many never speak to a doctor about it. Though it may be common, it’s not normal. Luckily, in the vast majority of cases, painful sex has a real, identifiable cause and a real, treatable solution.
Keep reading to learn about the most common causes of pain during sex, what to look out for, and what you can do about each one.
Common causes of pain during sex
Painful sex rarely has a single, simple explanation. More often, it's the result of several factors layered on top of each other — physical, hormonal, psychological, or some combination of all three. Understanding what's going on is the first step to feeling better. Here are the most common causes to know about.
Arousal dysfunction
One of the most common (and most overlooked) causes of painful sex is insufficient arousal. When you’re not fully turned on before or during sex, your body doesn’t produce enough natural lubrication, and penetration can feel dry, uncomfortable, or even painful.
Arousal dysfunction (sometimes called female sexual interest/arousal disorder, or FSIAD) is when the body doesn’t physically respond to sexual stimulation the way it should (even when there’s desire present). That physical response includes increased blood flow to the genitals, swelling of the clitoris and vulva, and the production of natural vaginal lubrication. When any part of that process is disrupted, sex can become uncomfortable or painful.
Arousal dysfunction can be caused or worsened by:
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Stress, anxiety, or depression
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Hormonal changes (particularly low estrogen, which is common during perimenopause and menopause)
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Certain medications, including antidepressants and hormonal contraceptives
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Relationship issues or lack of emotional connection
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A history of trauma
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Simply not having enough foreplay.
More time for foreplay is the simplest starting point. Beyond that, a good lubricant can make a significant difference. Vella’s Everslide is a long-lasting lubricant designed to reduce friction and make sex more comfortable from the outset. For arousal specifically, Vella’s Pleasurewave is the only product scientifically proven to help women achieve easier, longer-lasting, and more satisfying orgasms. It supports sensation and natural lubrication through a topical, hormone-free formula developed by the doctor who led Viagra’s clinical development.
If arousal difficulties are linked to menopause, low-dose vaginal estrogen is often the most effective longer-term option. It works locally to restore tissue health without significant absorption into the bloodstream. Beyond that, pelvic floor physical therapy can help when muscle tension is part of the picture, and psychological approaches like cognitive behavioral therapy (CBT), sex therapy, or mindfulness-based therapy are worth exploring if stress, anxiety, or fear of pain are contributing factors. If you think medication or hormones might be a factor, it’s worth raising with your doctor or a sexual health specialist. If a medication (such as antidepressants) is affecting your sexual arousal, your provider may consider adjusting it or switching it.
Perimenopause and menopause
The hormonal shifts that happen during perimenopause and menopause can have a significant impact on your sexual comfort. As estrogen levels fall, the vaginal tissues can become thinner, drier, and less elastic, a condition known as genitourinary syndrome of menopause (GSM), though it was previously called vaginal atrophy.
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Vaginal dryness
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Burning or stinging during sex
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Increased sensitivity or soreness around the vulva
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Discomfort or light bleeding after sex
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Recurrent urinary tract infections (UTIs).
Around 50–60% of postmenopausal women experience symptoms of GSM, but more than half of them aren’t using any treatments to alleviate their discomfort, and around 70% don't discuss their symptoms with a healthcare professional. This is a gap worth closing, because effective options exist.
For everyday comfort, vaginal moisturizers (used regularly, not just before sex) and quality lubricants can help. Vella’s Meltwater is an ultra-lightweight, water-based formula that contains hyaluronic acid and aloe vera to provide moisture and restore everyday comfort.
For longer-term management, you can discuss several treatment options with your doctor. Topical estrogen therapy (which is applied directly to the vaginal area as a cream, ring, or suppository) helps restore moisture and tissue health locally, with minimal absorption into the bloodstream, making it considered safe for most women, including many who can't use systemic hormones.
Systemic hormone replacement therapy (HRT) addresses GSM as part of broader menopause symptom management, and may be a good option if you're also dealing with hot flashes, sleep issues, or mood changes.
If hormones aren't right for you, there are non-hormonal prescription alternatives too. Ospemifene is an oral medication that acts on vaginal tissue without systemic estrogen, and vaginal DHEA (prasterone) is another option that converts locally to estrogen and androgen to support tissue health.
Vaginismus
Vaginismus is a condition where the muscles around the vaginal opening involuntarily tighten or spasm, making penetration painful, difficult, or sometimes impossible. It’s not something you’re doing consciously, but rather an automatic muscular response, a bit like how your eye blinks when something gets too close.
Vaginismus can cause:
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Pain, burning, or stinging during attempted penetration
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A feeling of “hitting a wall”
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Difficulty or inability to use tampons or have a gynecological exam
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Ongoing fear or avoidance of sex.
Vaginismus can be primary (present from the first attempt at penetration) or secondary (developing after a period of pain-free sex). Vaginismus is often linked to anxiety, fear of pain, and previous negative sexual experiences, though it can also develop without a clear psychological trigger.
Vaginismus is very treatable, but there’s no quick fix. The most evidence-backed approach combines pelvic floor physical therapy (to retrain the muscles) with psychological support, such as CBT. Dilator therapy (using progressively larger vaginal dilators at home) is also commonly recommended. A doctor can refer you to the right specialists.
Vulvodynia
Vulvodynia is persistent, unexplained pain around the vulva (the external part of the genitals). Unlike other conditions that have a clear physical cause, vulvodynia is considered a diagnosis of exclusion. This means that healthcare providers must first rule out any other potential causes of the pain. That doesn’t make the pain any less real; it just means it’s a condition of the nervous system, not a sign of infection or disease.
Symptoms of vulvodynia include:
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Chronic burning, stinging, or a feeling of “rawness” around the vulva
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Pain that’s localized to the vaginal opening (vestibulodynia) or more widespread
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Discomfort that worsens with touch, sex, or sitting for a long time
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Pain that may be constant or come and go.
Vulvodynia affects an estimated 8–10% of women at some point in their lives, according to research in Obstetrics & Gynecology. Despite how common it is, many women go years without a diagnosis, often being told their pain is psychological or “all in their head.”
Treatment for vulvodynia is highly individual. Options include topical anesthetics or hormone creams, pelvic floor therapy, nerve pain medications, and psychosexual therapy. Avoiding irritants like fragranced products, harsh soaps, and synthetic fabrics can also help manage symptoms. Speaking to a gynecologist or vulvar specialist is the best first step.
Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it, such as on the ovaries, fallopian tubes, or other pelvic structures. This misplaced tissue can cause significant pain, particularly during sex, periods, and bowel movements.
Endometriosis can cause:
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Deep pain during penetrative sex (particularly in certain positions)
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Severe period pain
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Pain during or after bowel movements or urination
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Bloating, fatigue, and sometimes infertility.
Endometriosis affects roughly one in 10 women of reproductive age, yet the average time to diagnosis is still around seven to eight years in the US. Deep dyspareunia (pain felt internally during sex) is one of the condition’s most telling symptoms.
There’s no cure for endometriosis — yet — but symptoms can be managed through hormonal treatments (such as the pill or progestogen), pain relief, and surgery to remove endometrial tissue. Certain sexual positions (those with shallower penetration) may reduce discomfort during sex. A referral to a gynecologist or endometriosis specialist is the right starting point.
Period pain
For some people, sex during or around their period can be particularly uncomfortable. Not just because of pain, but because of cramping, bloating, and increased sensitivity in the pelvic region. Severe period pain (dysmenorrhea) can also persist beyond bleeding days and affect how comfortable sex feels throughout the cycle.
Over-the-counter pain relief like ibuprofen (an anti-inflammatory) taken before and during your period can help manage cramping. Topical solutions are another option. Vella’s EbbTide is a targeted vaginal insert, designed to ease physical discomfort associated with menstruation and pelvic tension. Unlike oral medications that work systemically, EbbTide is a vaginal suppository made to deliver active support directly to the tissue where discomfort is experienced.
Hormonal birth control can also significantly reduce dysmenorrhea for many people. If period pain is severe or is getting worse over time, it’s worth exploring whether endometriosis or another underlying condition might be involved.
Vaginal infections
Some of the most common vaginal infections can cause inflammation, irritation, and discomfort that makes sex painful. Two of the most frequent are bacterial vaginosis (BV) and yeast infections.
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BV happens when the balance of bacteria in the vagina is disrupted, allowing harmful bacteria to overgrow. Symptoms include a thin, grayish discharge with a strong fishy smell, and sometimes itching or burning, which can get worse during sex. It’s estimated that 30-50% of US women suffer from BV.
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A yeast infection is caused by an overgrowth of the fungus Candida. It typically causes thick, white discharge, intense itching, and soreness around the vulva, all of which can make sex deeply uncomfortable.
Both BV and yeast infections are treatable with medication: BV with antibiotics (usually metronidazole), and yeast infections with over-the-counter antifungal treatments or a prescription from your doctor. If you experience recurrent infections, your doctor can investigate possible underlying triggers.
Sexually transmitted infections
Certain sexually transmitted infections (STIs) can cause inflammation, ulcers, or discharge that make sex painful. Chlamydia, gonorrhea, genital herpes, and trichomoniasis are all worth being aware of.
Most STIs don’t cause any symptoms, but when they do, they can include:
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Unusual vaginal discharge
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A burning sensation when you pee
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Sores, blisters, or ulcers around the genitals
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Pelvic pain or pain during sex.
Regular STI testing is the most reliable way to stay on top of your sexual health, especially after you’ve had sex with a new partner. Most STIs are straightforward to treat once diagnosed. You can test via your doctor, a sexual health clinic, or using a home testing kit.
Skin conditions
Several skin conditions can affect the vulva and cause pain during sex. These include lichen sclerosus (a chronic condition that causes thin, white patches of skin around the genitals), lichen planus, and contact dermatitis (a reaction to an irritant or allergen, such as a soap, lubricant, or latex).
Signs of these skin conditions include:
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Itching, burning, or soreness around the vulva
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White, thickened, or discolored patches of skin
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Skin that tears or bleeds easily
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Scarring over time (with lichen sclerosus).
A doctor or dermatologist can diagnose vulvar skin conditions, often with a visual examination or biopsy. Lichen sclerosus is typically managed with a potent topical steroid. Avoiding potential irritants (including fragranced products and non-breathable underwear) can help reduce flare-ups.
When to see your healthcare provider
If painful sex is a regular occurrence for you, or even if it’s happened a few times and you’re not sure why, it’s worth speaking to a healthcare provider. Pain during sex is not something you should simply put up with.
Seek advice sooner rather than later if you notice:
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Pain that is getting worse over time
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Unusual vaginal discharge, bleeding, or sores
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Pain that affects your day-to-day life, not just sex
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Symptoms that don’t improve after trying over-the-counter treatments.
