Painful sex, known medically as dyspareunia, is pain in the vulva, vagina, or deep in the pelvis that happens before, during, or after intercourse. It is one of the most common concerns women bring to a gynecologist, and one of the least talked about. The pain can be sharp, burning, aching, or cramping, and it can be new or something you have lived with for years. It is almost always treatable once the cause is found, and no one should feel embarrassed to ask about it.
Why does sex hurt at the opening?
Pain right at the entrance of the vagina usually points to the skin, the tissue, or the muscles at the vaginal opening. Vaginal dryness is the most common cause. Low estrogen after menopause, while breastfeeding, or on certain birth control thins the vaginal lining and reduces natural lubrication, so friction turns into burning and rawness. Yeast infections, bacterial vaginosis, and some sexually transmitted infections can also make the area inflamed and tender.
Pelvic floor muscles can also be the problem. When those muscles are chronically tight or clamp down involuntarily, a condition called vaginismus, penetration feels blocked or stinging. This often starts after a painful experience, an infection, or childbirth, and the body learns to brace.
Why does it hurt deep inside during sex?
Deep pain with thrusting, or in certain positions, usually comes from the pelvic organs rather than the vaginal opening. Endometriosis is a leading cause. Tissue similar to the uterine lining grows on the pelvic organs and makes them tender, especially around your period. Uterine fibroids, pelvic infection, scar tissue from prior surgery, and a tilted uterus can all cause deep pain too. If the pain is only in one position, changing the angle or depth often helps, and that clue tells your provider a lot about where the pain is coming from.
