Pain During Sex? Here’s How To Make It More Pleasurable

As someone with endometriosis, dyspareunia (aka pain during sex) is something I know all too well. Endometriosis has taught me a lot about pain during sex, but it's not the only reason intimacy can be uncomfortable.

Turns out a lot of people experience pain during sex. We're talking anywhere from 3 to 18% of women worldwide, and it's estimated that 10 to 28% will deal with it at some point in their lives. This pain can stem from a variety of medical conditions, including hormonal imbalances, pelvic floor dysfunction, and more.

If you’re experiencing pain while intercourse is happening, you're not alone. The good news is, there are definitely things you can do to reclaim your pleasure, from medical treatments to self-care strategies.

Keep reading for the lowdown on painful sex and what you can do about it.

Common causes of pain during intercourse

Dyspareunia is categorized as either superficial (meaning pain at the entrance to the vagina) or deep (pain felt further inside). It’s also described as primary (pain during sex from the get-go) and secondary (when pain develops after a period of pain-free sex).
It's important to remember that any type of pain during sex is valid and deserves attention — whether it's a little twinge or something more intense. Now that we understand the different types of pain, let's explore some of the common causes.

Endometriosis

If you have it, you know. If you don't, here's the deal: Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside the uterus. This tissue breaks down and bleeds every month, just like the lining inside, but it has nowhere to go. This leads to inflammation, irritation, and scar tissue. All this inflammation and scar tissue can make sex super painful, especially deep penetration.

“These inflamed lesions generate pain without touch, but if they are located in areas that would be stretched or compressed during penetrative intercourse, they can be especially painful,” says Heather Jeffcoat, DPT and owner of Femina Physical Therapy. “One common area for endometriosis lesions to be found is in the rectovaginal cul-de-sac, an area that is behind the vagina and in front of the rectum,” adding, “With endometriosis in this area, it can also affect bowel function or may produce rectal pain.”

Vulvodynia

Vulvodynia is way more serious than Charlotte made it out to be on Sex and the City — it's not just a “depressed vagina.” It's a real, excruciating condition that causes chronic pain or discomfort in the vulva, the external female genitalia.

“More specifically, the vulvar vestibule tends to be involved, which is the external portion just to the inside of the labia minora (the inner 'lips'), but not inside the vaginal canal,” says Jeffcoat. “This is literally the entrance to the vagina, so there is pain, inflammation, or nerve hypersensitivity — it will create pain when any pressure or stretch is applied to the area.”

Some people describe it as a burning sensation, while others feel a sharp, stabbing pain or a rawness that makes even sitting or wearing clothes uncomfortable. There can be aching, swelling, and throbbing, too.

“This can also occur with inserting a finger or tampon and is not limited to a larger stretch that a penis would apply,” Jeffcoat adds. 

Vaginismus

Vaginismus is like your vagina's way of saying, “Nope, not happening!” It's when the muscles around your vagina involuntarily tighten up whenever something tries to enter, whether it's a penis, finger, or even a tampon (in severe cases).
It's a vicious cycle of fear and muscle tension. While fear is often the main driver, it's not the only factor. Jeffcoat recommends looking at any underlying contributors for a more holistic approach to treatment that might include physical therapy and emotional support.
And remember, this isn’t something you can just “think” your way out of. As Jeffcoat puts it, “You cannot talk this pain away in therapy.” It often requires a combination of physical therapy and emotional support to overcome.

Menopause

Menopause can cause all kinds of issues, from brain fog to hot flashes to, you guessed it, pain during sex.
“There are two major changes that those assigned female at birth may face,” says Jeffcoat. “The first is after pregnancy when they will experience a major drop in estrogen, essentially putting them in a short-term menopausal state. The second is eventually hitting menopause,” adding, “In both instances, the drop in estrogen has effects on your bladder and sexual health.”

So, what does this drop in estrogen actually mean for your vagina? It can lead to reduced folds and elasticity (making the vaginal canal more narrow and less flexible), inflammation, and dryness.

Polycystic ovary syndrome (PCOS)

PCOS, or Polycystic Ovary Syndrome, is another common condition that can affect your sex life. Like endometriosis, PCOS often involves inflammation, cysts, and hormonal imbalances, all of which can contribute to pain during sex.

“Pain during sex with PCOS is due to direct, deep pressure during penetrative sex and the associated hormonal imbalance that can lead to less lubrication,” says Jeffcoat.

PCOS can also affect your mental health and self-esteem, which can further impact your sexual experience. Some common symptoms of PCOS include irregular periods, acne, excess hair growth, and weight gain. These symptoms can make you feel less confident or desirable, which can make intimacy even more challenging.

Practical solutions for more comfortable sex

Prioritize foreplay, no matter what

Foreplay is so important. Honestly, it’s just as important, if not more so, than the main event. (Foreplay can also be the “main event” — there’s no rulebook that says you have to have penetrative sex!) It’s also one of the best strategies if you’re wondering how to reduce pain during sex.

“Focus massaging around the vagina before entering with a dildo or vibrator,” says Sofie Roos, licensed sexologist and relationship therapist at Passionerad. “This increases the blood flow and makes you more relaxed, elastic, and ready for sexual activity!”

Roos also recommends regular masturbation for women who are struggling with menopause-related dryness, discomfort, or pain during sex.

“Masturbating during menopause can have a relaxing and calming effect on the body and enhance self-comfort, release stress, and make you recognize yourself more,” says Roos. “It can also help to maintain your libido and sexual desire for your partner as well as higher the blood flow to the vagina and therefore maintain a better vaginal health, mainly healthier vaginal tissues, and a decreased risk for vaginal dryness.”

Roos says to grab toys you know will make you come easily and use them pretty much every day (for at least five minutes). Some good options include air pulsators (like anything by Womanizer, or if you want to play for a long time, the Namii is hands-down the best for getting things extra wet), G-spot vibrators, rabbit vibrators, and wand vibrators (my fave is the VIM). If you know penetration is painful, focus on external stimulation.

“Heated sex toys can also be incorporated in the early phases of arousal and in prep for penetrative intercourse to aid in muscle relaxation,” adds Jeffcoat. “Muscles respond well to heat when they are tight or guarded.”

Use lube for less pain during sex

A good lube can reduce friction and make penetration much more comfortable and there are plenty of lubricants for natural dryness.

Personally, I’ve found that the best lube for painful sex is SUTIL Rich. Of course, this is based on my own experience and trial and error, but I've had the best luck with this particular formula. It's super smooth, water-based (so it won't get sticky!), and it's even safe for condoms and toys. Plus, it doubles as a post-menopausal vaginal moisturizer (meaning it’s a great lube for vaginal dryness), which is a nice bonus.

But everyone is different, and what works for one person might not work for another. I'd recommend trying out a few different lubes to see what feels best for you. Sometimes, you can get lube sets with small sample sizes, so you can try out different formulas without committing to a full-size bottle. 

Experiment with non-penetrative pleasure and outercourse

If penetrative sex is out of the question, there are lots of other ways to explore intimacy and pleasure that don't involve penetration.
Focusing on activities like massage, oral sex, mutual masturbation, and sensual touching can help take the focus off of penetration and allow you to enjoy intimacy in a way that feels good for your body.

If you can handle penetration but prefer shallow depth or softness, I highly recommend trying the OhNut. The OhNut is a cushy barrier made of four stackable rings that let you control the depth and sensitivity of penetration. Just put the rings on your partner’s shaft or a toy before entering, and voila! You can do one ring, two rings, or all four, depending on what feels right for you. (Note: These definitely require lube to work properly!)

Relax with vaginal dilators

For anyone dealing with vaginal tightness or pain, using a set of vaginal dilators can be really helpful. They're basically graduated sizes of dildos that allow you to size up at your comfort, gently stretching and relaxing the muscles over time.

“Dilators are medical devices that are used inside the vagina to stretch and massage muscles and tissue that are tight or restricted, and are especially helpful when pain with initial penetration is present,” says Jeffcoat. “Many come with basic instructions that recommend inserting the device and holding for 10 to 15 minutes to gently stretch these restrictions.”

But before you run out and buy a set, it's a good idea to chat with a pelvic floor therapist. They can assess your specific needs and guide you on how to use them properly.

FAQs about pain during intercourse

Below, I’ve answered some common questions about painful sex and how to improve intimacy:

Why does it hurt when I have sex?

If you’re wondering, “why does sex hurt?” you’re not alone. There are lots of potential reasons why sex might be painful, ranging from medical conditions like endometriosis, vulvodynia, and vaginismus to hormonal changes, pelvic floor dysfunction, and even psychological factors. If you’re experiencing pain during sex, the best thing to do is see a healthcare professional who can help you get to the root of the issue.

How do I make sex less painful?

If you're experiencing pain during sex, there are several things you can try to make it more comfortable:

• Prioritize foreplay: Take your time and focus on activities that feel good before moving on to penetration.
• Use lube: Lube can reduce friction and make sex more comfortable, especially if you're experiencing vaginal dryness.
• Experiment with different positions: Certain positions may put less pressure on sensitive areas. For example, putting a pillow underneath your stomach while your partner enters from behind can reduce deep thrusting. It’s called the modified doggy style.
• Communicate with your partner: Open and honest communication can help you both find ways to make sex more enjoyable.
• Consider pelvic floor therapy: A pelvic floor therapist can help you identify and address any muscle tension or dysfunction that may be contributing to your pain.

Does PCOS cause painful sex?

Yes, PCOS can cause painful sex due to hormonal imbalances that can lead to decreased lubrication and vaginal dryness. PCOS sex drive issues can be caused due to hormonal fluctuations and other related symptoms like fatigue and mood changes.

What does abdominal pain after sex indicate?

Pain in the abdomen or pelvic floor pain during sex can be a symptom of several conditions, including endometriosis, pelvic inflammatory disease, or pelvic floor dysfunction. It's important to see a doctor to determine the cause of pelvic floor pain after sex (or during it) and get appropriate treatment.

What is the best lube for sex?

If you’re trying to figure out how to be comfortable during sex, lube can greatly help. There is no one "best" lube for sex — the right lube really depends on your personal preferences and needs. If you're experiencing vaginal dryness, look for a lube that also has moisturizing properties.

Can vulvodynia feel like a UTI?

Yes, vulvodynia can sometimes feel like a UTI, with symptoms like burning, stinging, and discomfort. However, unlike a UTI, vulvodynia is not caused by a bacterial infection. If you're experiencing these symptoms, see your doctor to get a proper diagnosis.

Can you treat vaginismus at home?

There’s no proven method of how to treat vaginismus at home. Still, there are some self-care strategies that may help, like using dilators, doing pelvic floor exercises, and practicing mindfulness and relaxation techniques. That said, it's best to work with a pelvic floor physical therapist or other qualified healthcare professional to develop an effective treatment plan.

Tabitha Britt is an editor, journalist, and the founding editor-in-chief of DO YOU ENDO, the first no-BS digital endometriosis magazine for people with endometriosis by people with endometriosis. You can find her byline in several online pubs, including Medical News Today, HuffPost, Well+Good, and many others.