What Can Cause Pain During Sex?

In some cases, a woman may experience pain during sex due to the following medical reasons:

• Hymen rupture: Most often the cause of painful sex for first-timers, the hymen is a thin membrane that partially covers the vagina and ruptures during penetrative sex. The pain is temporary and often gets better with rest and a warm bath.
• Problems with the cervix (opening to the uterus): If a woman has a cervical infection (cervicitis) or narrow cervix, the movement of the penis inside her may cause pain. In rare cases, pain during sex can indicate cervical ulcers or cervical cancers.
• Problems with the uterus: If a woman has uterine fibroids, they can cause deep pain during intercourse and especially during orgasms.
• Endometriosis: Endometriosis is a condition where the inner lining of the uterus gets implanted outside the uterus, most commonly on the fallopian tube, ovaries, or tissue lining of the pelvis.
• Problems with the ovaries: Ovarian cysts can cause pain during sex.
• Pelvic inflammatory disease (PID): PID causes pelvic tissues to get inflamed and the pressure of intercourse can cause severe pain. The most common causes of PID are various sexually transmitted diseases and reaction to intrauterine contraceptive devices.
• Ectopic pregnancy: In an ectopic pregnancy, the fertilized egg develops outside the uterus.
• Vaginismus: Vaginismus is a condition characterized by involuntary spasms in the vaginal muscle, sometimes caused by the fear of pain.
• Vaginal infections: Yeast infections and bacterial infections caused by poor personal hygiene, diabetes mellitus, etc. can result in painful sex.
• Menopause: Menopause can cause vaginal dryness leading to pain or throbbing during penetrative sex.
• Surgery or childbirth: Sexual intercourse too soon after surgery or childbirth may cause pain.
• Sexually transmitted diseases: Genital warts, herpes sores, etc. also cause painful sex.
• Injury to the vulva or vagina: An example is a tear from childbirth or a cut (episiotomy) made in the skin between the vagina and anus during labor. Injuries also may be caused by an accident or pelvic surgery.
• Vulvodynia: Vulvodynia is chronic pain of the vulva, which includes the labia, clitoris, and vaginal opening. Pain may occur in just one spot or different areas at different times.
• Congenital birth defects: 
  • Vaginal agenesis: Absence of a fully formed vagina.
  • Imperforate hymen: Development of a membrane that blocks the vaginal opening. Having a thick hymen that stretches during intercourse can also cause pain.

Painful intercourse may also be caused by problems with sexual response:

• Negative feelings about sex, such as fear, guilt, shame, embarrassment, or awkwardness, may make it difficult to relax the vaginal muscles.
• Intimacy issues between sexual partners may interfere with sexual response.
• Many medications, including birth control methods, can lessen sex drive.
• Medical conditions, such as arthritis, diabetes, cancer, and thyroid problems, can indirectly affect sexual response.

Painful sex may also be caused by emotions:

• Anxiety
• Depression
• Concerns about physical appearance
• Fear of intimacy or relationship problems
• Stress
• History of sexual abuse