Painful sex
Painful sex: possible causes such as dryness or irritation, and solutions to enjoy intimacy again.
Understanding painful sex
Pain during sex (dyspareunia) is common and far from inevitable. We distinguish superficial pain, at the vaginal entrance (the most common), from deep pain, felt on deep penetration. Identifying which helps find the cause.
The most common causes:
- Dryness and atrophy (menopause, post-partum, breastfeeding): a major cause.
- Infections and irritation (yeast, vaginosis, cystitis).
- Pelvic-floor overactivity, vestibulodynia/vulvodynia.
- Lack of lubrication or arousal, emotional factors.
Superficial or deep, why it hurts
At the entrance, pain often comes from a dry or irritated lining: without enough lubrication, the slightest friction is painful. After menopause, falling estrogen (genitourinary syndrome of menopause) thins the lining and amplifies this.
Two common and reversible mechanisms:
- Lack of lubrication (insufficient arousal, dryness, stress).
- Reflex tightening of the pelvic floor, creating a pain-tension-pain cycle.
“The most important message: you should not get used to pain during sex. Pain is not ‘normal’, it is a signal. Very often the cause is dryness or a lack of lubrication, which corrects well. When the pelvic floor or chronic pain are involved, dedicated care, physiotherapy, gynaecologist, sex therapist, truly changes things.”
What to do day to day
Relieve entrance pain and do not get used to suffering.
1. Lubricant + moisturiser
A water-based lubricant during sex, and a regular intimate moisturiser otherwise, treat the most common cause: lack of lubrication.
2. Take your time
Enough foreplay and full arousal improve natural lubrication and reduce entrance pain.
3. Treat dryness and infections
Dryness, yeast or irritation make sex painful: addressing them often relieves pain on its own.
4. Pelvic floor
For tension or entrance pain, pelvic-floor rehabilitation (physiotherapy) helps relax the muscles and break the pain-tension cycle.
5. Communicate and get support
Talk with your partner and seek care (gynaecologist, sex therapist, pelvic-floor physiotherapist): pain should not be silenced or endured.
What to expect
An indicative guide: depending on the cause, improvement can be fast.
Immediate
Lubricate
A suitable lubricant often reduces entrance pain from the very next time.
Immediate
Lubricate
A suitable lubricant often reduces entrance pain from the very next time.
2-4 weeks
Hydrate the lining
A regular moisturiser repairs a dry lining and improves comfort lastingly.
2-4 weeks
Hydrate the lining
A regular moisturiser repairs a dry lining and improves comfort lastingly.
A few weeks
Rehabilitation
For pelvic-floor tension, physiotherapy brings gradual improvement.
A few weeks
Rehabilitation
For pelvic-floor tension, physiotherapy brings gradual improvement.
Support
Complex causes
Vulvodynia or deep pain: specialist, sometimes multidisciplinary, care is key.
Support
Complex causes
Vulvodynia or deep pain: specialist, sometimes multidisciplinary, care is key.
Why act, and when to see a doctor
Painful sex is treatable; do not get used to it.
Comfortable sex again
Removing pain means regaining desire, pleasure and closeness.
Treat the dryness
Often, lubricating and hydrating the lining is enough to transform sex.
Soothe the pelvic floor
Pelvic-floor rehabilitation helps release the tension that sustains pain.
When to see a doctor
See a doctor if pain persists, is deep or intense, comes with bleeding, or weighs on your intimate life: you do not have to deal with it alone.
Your questions about painful sex
No. It is common, but it is not normal and you should not get used to it. Pain is a signal: in most cases the cause is found and improved.
Yes, it is one of the most common causes, especially after menopause, post-partum or while breastfeeding. Lubricant and intimate moisturiser help markedly.
For entrance pain from lack of lubrication, often yes. If pain is deep, intense or persistent, a cause to treat (infection, pelvic floor, vulvodynia) should be looked for.
It is chronic vulvar pain with no infectious cause found. It needs dedicated, often multidisciplinary care (gynaecologist, pelvic-floor physiotherapist, sometimes psychosexual support).
See a doctor if pain persists, is deep or intense, comes with bleeding, or weighs on your intimate life (dyspareunia: etiology and management, 2023).
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