Symptom Guide

Pain During Sex

Pain during sex is common. It is not normal — and it is treatable.

Painful intercourse — medically called dyspareunia — affects an estimated 10–20% of women in the United States at some point in their lives. Yet it remains one of the most underreported and undertreated gynecologic complaints, often dismissed as psychological or simply accepted as something to endure.

At Haven OBGYN, we create a safe, non-judgmental space to discuss this symptom openly. You deserve a thorough evaluation and a real treatment plan.

Where Is the Pain Occurring?

The location of pain during sex is one of the most important pieces of diagnostic information — it points toward very different underlying causes and requires different evaluation and treatment.

Entry or Insertional Pain

Pain at or near the vaginal opening, during or immediately after penetration. May feel like burning, tearing, or stinging.

Common causes include:

  • Vulvodynia (chronic vulvar pain without identifiable cause)
  • Vaginismus (involuntary pelvic floor muscle spasm)
  • Vaginal atrophy / genitourinary syndrome of menopause (GSM)
  • Vaginal dryness (hormonal, including while breastfeeding)
  • Infections (yeast, bacterial vaginosis, herpes)
  • Lichen sclerosus or other vulvar skin conditions

Deep Pelvic Pain

Pain felt deep in the pelvis or lower abdomen during deep penetration. May worsen in certain positions.

Common causes include:

  • Endometriosis — particularly affecting the uterosacral ligaments and posterior pelvis
  • Adenomyosis — diffuse uterine tenderness during intercourse
  • Uterine fibroids — depending on size and location
  • Ovarian cysts
  • Pelvic inflammatory disease (PID) or prior pelvic infection
  • Pelvic floor muscle dysfunction or hypertonic pelvic floor

When to Be Evaluated

Pain with sex is never something you should simply push through or be told to relax more. Any of the following warrant evaluation:

Pain with sex that is new, worsening, or has been present for more than a few weeks
Pain that is preventing intimacy or causing anxiety about sexual activity
Pain accompanied by abnormal bleeding, discharge, or odor
Pain coexisting with painful periods or chronic pelvic pain
Difficulty or inability to tolerate penetration at all (may suggest vaginismus)
Pain that persists or worsens after menopause, or during breastfeeding

Key Conditions We Evaluate

A thorough evaluation helps pinpoint the cause — which determines the right treatment approach.

Endometriosis

Deep pelvic pain with sex is one of the hallmark symptoms of endometriosis, particularly when implants involve the uterosacral ligaments or the posterior cul-de-sac. Pain may be worst in specific positions. It often coexists with painful periods and pelvic pain throughout the cycle.

Vulvodynia & Vestibulodynia

Chronic vulvar pain without an identifiable cause — a condition formally recognized by ACOG — affects millions of women. Localized vestibulodynia (pain specifically at the vaginal opening) is the most common subtype causing pain with insertion. It is a real, diagnosable condition that responds to targeted treatment.

Vaginismus & Pelvic Floor Hypertonia

Involuntary contraction of the pelvic floor muscles in response to attempted penetration is now understood as a spectrum with pelvic floor hypertonia (excessive muscle tension). This is a treatable condition — pelvic floor physical therapy is highly effective and is a recommended first-line intervention.

Genitourinary Syndrome of Menopause (GSM)

Declining estrogen during perimenopause and menopause — and also during breastfeeding — causes thinning, dryness, and loss of elasticity of vaginal tissue. This leads to pain with intercourse, dryness, and urinary symptoms. Highly treatable with local vaginal estrogen therapy, which ACOG affirms is safe for the vast majority of women.

Adenomyosis & Fibroids

Both conditions can cause deep pelvic pain with sex due to uterine tenderness, enlargement, or distortion. Evaluation with 2D/3D ultrasound is the starting point; MRI may be used for further characterization when needed.

Pelvic Infections & Skin Conditions

Active or recurrent vaginal infections (yeast, BV), STIs, and vulvar skin conditions such as lichen sclerosus or lichen planus can all cause significant pain with sex and require specific targeted diagnosis and management.

Dr. Mishra's Approach

A safe, thorough, judgment-free evaluation

"Pain with sex is one of the most underreported symptoms I see — because women are too often embarrassed to bring it up, or have already been dismissed. I want patients to know this is a completely valid clinical complaint with a real differential diagnosis and effective treatment options. We take it seriously from the first visit."

Evaluation includes a detailed history, careful pelvic examination, vulvar assessment, and imaging when indicated. When pelvic floor dysfunction is part of the picture — which it frequently is — we coordinate with skilled pelvic floor physical therapists as part of a comprehensive treatment plan. The approach is always individualized, compassionate, and trauma-informed.

Frequently Asked Questions

Common questions about pain during sex, answered by Dr. Nikita Mishra

Mild initial discomfort due to inadequate lubrication or insufficient arousal can occur and is generally addressable with simple measures (lubricants, more time for arousal). However, consistent pain with sex — particularly pain that is significant, persistent, or worsening — is not normal and should not be tolerated or dismissed. ACOG explicitly states that pain with sex warrants medical evaluation and that effective treatments exist. The most common reason women don't seek care is the belief that nothing can be done, or that they will be dismissed.

Yes — for many causes of painful sex, particularly vaginismus and pelvic floor hypertonicity, pelvic floor physical therapy is among the most effective treatments available. A pelvic floor PT uses internal and external manual techniques, guided relaxation, dilator therapy, and biofeedback to retrain the pelvic floor muscles. Studies consistently show significant improvement in pain and sexual function. It is also beneficial as an adjunct treatment for vulvodynia and post-surgical pain. At Haven OBGYN, we coordinate care with pelvic floor specialists for patients where this is part of the treatment plan.

Genitourinary Syndrome of Menopause (GSM) is the current medical term that encompasses the full range of vaginal and urinary symptoms caused by estrogen decline — including dryness, burning, irritation, pain with sex, urinary urgency, and recurrent UTIs. Unlike hot flashes, which often improve over time, GSM symptoms tend to persist and worsen without treatment. Local vaginal estrogen therapy (cream, ring, or tablet applied directly to the vagina) is highly effective, has minimal systemic absorption, and is considered safe for most women including breast cancer survivors — though always discussed individually with your provider.

Deep dyspareunia (pain with deep penetration) is one of the three classic symptoms of endometriosis, along with painful periods and chronic pelvic pain. It occurs when endometrial implants affect the uterosacral ligaments, the space between the uterus and rectum (posterior cul-de-sac), or surrounding pelvic structures. During intercourse, movement causes traction or pressure on these sensitive implants. Pain is often worst in specific positions and may be accompanied by low back pain or rectal pressure. This symptom alone can significantly suggest endometriosis and warrants evaluation.

This depends entirely on the underlying cause. An acute vaginal infection or postpartum healing may resolve with time and appropriate treatment. However, most structural causes — endometriosis, vulvodynia, pelvic floor hypertonia, or GSM — do not resolve without targeted intervention and can worsen over time if left unaddressed. Avoidance of intercourse due to pain can also create a pain-fear-avoidance cycle that makes treatment more complex. Early evaluation and intervention generally leads to better outcomes.

Clinically reviewed by Nikita Mishra, MD, FACOG

Board-Certified OB-GYN & Minimally Invasive Gynecologic Surgeon
Haven OBGYN · Folsom, CA

Published: May 2026  ·  Last reviewed: May 2026

References

Sex Shouldn't Be Painful

You deserve a thorough, compassionate evaluation in a safe, judgment-free environment. Schedule at Haven OBGYN.

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