7 Common Reasons Sex Hurts (And What You Can Do About It)

There are lots of people out there suffering through painful sex and telling absolutely nobody about it.

Dyspareunia—the clinical term for pain during sex—affects up to 20% of women, according to the American Academy of Family Physicians, with men experiencing it far less frequently. The causes range from mechanical to hormonal to neurological, and most are treatable. The main obstacle is that people either assume the pain is normal or feel too embarrassed to bring it up with a doctor. Neither instinct is going to help. Here’s what’s actually going on.

1. Insufficient Arousal

Under-arousal is probably the most common cause of painful sex and the least likely to get named as such. The body needs time to prepare—lubrication, increased blood flow, tissue elasticity—and when that process gets cut short, penetration creates friction against tissue that hasn’t done its job yet. Slowing down and communicating what works fixes most of this. Pushing through does not.

2. Vaginal Dryness

Vaginal dryness and insufficient arousal overlap, but dryness has its own causes that have nothing to do with desire. Hormonal shifts during menopause, postpartum breastfeeding, and long-term use of hormonal contraceptives can all reduce natural lubrication regardless of how turned on someone is. Women with vaginal dryness are nearly eight times more likely to report painful sex—a gap that lubricants can bridge in the short term. When dryness is tied to estrogen decline, topical estrogen therapy prescribed by a doctor typically addresses it more directly.

3. Endometriosis

Deep pelvic pain during sex is one of the hallmark experiences of endometriosis, a condition where tissue similar to the uterine lining grows in places it has no business being. Intercourse can aggravate those growths directly, and the pain that follows doesn’t always stop when sex does — it can drag on for hours afterward. Positions that give the person control over depth and angle can help in the short term. Longer term, surgical excision of the growths is the most effective treatment available for deep pain.

4. Vaginismus

With vaginismus, the pelvic floor muscles contract involuntarily the moment penetration is attempted—during sex, a gynecological exam, or even inserting a tampon. It affects between 1% and 7% of women and is frequently connected to prior trauma, fear of pain, or history of sexual assault. The good news is that it responds well to treatment — pelvic floor physical therapy, graduated vaginal dilation, and sex therapy are the most common approaches.

5. Vulvodynia

Vulvodynia is chronic pain in the vulvar area with no obvious explanation — no infection, no injury, no clear trigger. It can feel like burning, stinging, or what some researchers have described as knife-like pain concentrated at the vaginal opening or spread across a wider area. It’s believed to involve nerve hypersensitivity and inflammation, though the exact mechanism isn’t fully understood. Treatment options include topical medications, nerve blocks, pelvic floor therapy, and sex therapy—usually in combination.

6. Menopause-Related Changes

Perimenopause and menopause get discussed in a lot of contexts, but their effect on sex is still weirdly underdiscussed. Estrogen decline changes vaginal tissue—it gets drier, thinner, and more fragile—and roughly half of menopausal women end up with painful intercourse as a result. Local estrogen therapy applied directly to the area, in the form of creams, rings, or tablets, addresses the tissue changes more effectively than oral options.

7. Sexually Transmitted Infections

Painful sex and STIs don’t always get connected, even when they should. Chlamydia frequently shows up without obvious symptoms, which means people can have it for months without knowing—and attribute the resulting pelvic pain or discomfort during sex to something else. Gonorrhea and herpes can also cause pain during intercourse. Without regular testing, there’s no way to know what’s there and what isn’t.

If sex hurts more than occasionally, you should talk to a doctor. The conversation is uncomfortable. The alternatives are worse.

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