Pelvic & Sexual Health

Painful Sex (Dyspareunia) in Women: Causes and Treatment

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

Painful sex, called dyspareunia, is pain in the vulva, vagina or pelvis during or after sex. It's common: ACOG notes that nearly 3 out of 4 women have pain during sex at some point in their lives. Causes range from dryness and infections to endometriosis and tight pelvic floor muscles, and nearly all of them can be treated.

Many people put up with it for years before saying anything, often because they assume it's normal, or that it's in their head, or they're embarrassed. It isn't normal to hurt regularly, it isn't in your head, and gynecologists hear about it every week. The first step is figuring out where it hurts and when.

Where does it hurt? Entry pain vs. deep pain

Clinicians sort painful sex into two groups, because the likely causes differ.

Some people have both. Try to notice which before your appointment; it's the first thing you'll be asked.

The common causes

Not enough lubrication or arousal

Dryness is one of the most common causes. It can come from not enough time for arousal, stress, breastfeeding, some birth control, antihistamines, certain antidepressants, cancer treatment and menopause.

Menopause and low estrogen

After menopause, lower estrogen can make vaginal tissue thinner, drier and less stretchy. This is genitourinary syndrome of menopause (GSM). It often also brings urinary urgency and repeated UTIs. Unlike hot flashes, GSM usually gets worse over time without treatment.

After childbirth

Healing tears or episiotomy scars, low estrogen while breastfeeding, and pelvic floor changes can all make sex painful for months after birth. A common worry is "Will it always feel like this?" For most people, no, especially with treatment. ACOG advises discussing sexual health at postpartum visits, so bring it up.

Infections and skin conditions

Yeast infections, bacterial vaginosis, trichomoniasis, herpes and skin conditions like lichen sclerosus or lichen planus can all cause pain. See vaginal discharge for signs of infection.

Vulvodynia and vaginismus

• Vulvodynia is ongoing vulvar pain for at least three months without another clear cause, often burning or rawness at the opening.
• Vaginismus is an involuntary tightening of the pelvic floor muscles that makes penetration painful or impossible. Many people with it also find tampons or speculum exams hard.

Pelvic conditions

• Endometriosis commonly causes deep pain with sex, along with painful periods.
• Fibroids and ovarian cysts may cause pressure or pain in certain positions.
• Pelvic inflammatory disease from untreated STIs can cause deep pain.
• Interstitial cystitis (bladder pain syndrome) often causes pain during or after sex.

Mind and body together

Anxiety, past trauma, relationship stress or fear of pain can tense muscles and make lubrication harder, which leads to more pain, which leads to more fear. That loop is real and physical. It doesn't mean the pain is imaginary, and both sides of it can be treated.

What happens at the appointment

Your clinician will ask where and when it hurts, how long it's been going on, and about your periods, births, birth control and medicines. A gentle exam may include:

• Looking at the vulva for skin changes
• A cotton swab test, lightly touching spots on the vulva to map where it hurts
• A one-finger exam to check pelvic floor muscles for tightness or tenderness
• Swabs for infections
• A pelvic ultrasound if deep pain suggests cysts, fibroids or endometriosis

You're in charge of the exam. You can ask to go slowly, use a smaller speculum, skip the speculum if it isn't needed, or stop at any point. Saying "I'm nervous about the exam because sex hurts" at the start helps the clinician adjust.

How to bring it up

• Say it early in the visit, or write it on the intake form, so there's time.
• Describe the pain: where (opening or deep), what it feels like (burning, sharp, aching), when (entry, during, after) and how long it lasts.
• Mention what you've tried, like lubricants or yeast treatments, and whether they helped.
• Share related symptoms, like painful periods, bladder urgency, bowel symptoms or dryness.
• Say what you want, whether that's comfortable penetration, easier tampons and exams, or just understanding what's going on.

If you feel brushed off, it's reasonable to ask for a referral or see someone else. Painful sex deserves a real workup.

Treatment options

Treatment depends on the cause. Common approaches:

• Lubricants: water- or silicone-based during sex. Oil-based products can damage latex condoms.
• Vaginal moisturizers: used regularly, not just before sex, for ongoing dryness.
• Low-dose vaginal estrogen or other vaginal hormone treatments for menopause-related pain. These act mainly on local tissue.
• Treating infections or skin conditions with the right medicine.
• Pelvic floor physical therapy to relax tight muscles, release scar tissue and work with dilators. Sessions are usually one-on-one in a private room, and the therapist explains everything first.
• Treating endometriosis or other pelvic conditions with medicine or surgery.
• Sex therapy or counseling, alone or with a partner, to ease anxiety and rebuild comfort.
• Practical changes: more time for arousal, positions that let you control depth, and non-penetrative intimacy while you heal.

Pain or bleeding after sex

Some people feel fine during sex but have burning, aching or cramping afterward. This can happen with dryness, bladder pain conditions, pelvic floor spasm or endometriosis. Light spotting after sex can come from dryness or irritation, but bleeding after sex can also come from infections, cervical polyps or, rarely, cervical changes that need testing. Bleeding after sex should always be checked, especially if it happens more than once.

Can it affect plans for pregnancy?

Some causes, like endometriosis and untreated infections, can also affect fertility, so they're worth evaluating. If penetration isn't possible yet and you want to conceive, a clinician can talk through options while you're being treated.

When to see a doctor

See a gynecologist if sex hurts more than occasionally, if the pain is new, or if it's affecting your relationship or wellbeing. Go sooner if pain comes with:

• Bleeding after sex
• Fever, pelvic pain or unusual discharge
• Sores, blisters or skin changes on the vulva
• Very painful periods
• Bleeding after menopause

Many general gynecologists treat painful sex, and some focus on vulvar and pelvic pain. If prolapse, bladder pain or pelvic floor problems are part of it, a urogynecologist can help. Browse gynecologists in Brooklyn or gynecologists across New York by borough and county.

Frequently asked questions

Sources

• ACOG — When Sex Is Painful (patient FAQ)
• ACOG — Female Sexual Dysfunction (Practice Bulletin 213)
• ACOG — Persistent Vulvar Pain (Committee Opinion 673)
• The Menopause Society — Genitourinary syndrome of menopause position statement

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.