Why Does Sex Hurt? 4 Root Causes + A Few Silver Bullets

If you’re experiencing painful sex, you may feel alone, like you’re the only one.

It’s actually pretty common. In fact, 3 out of 4 women/vulva owners will have painful sex at some point in their lives. The good news for most vulva owners is that it isn’t long-term and quickly gets resolved.

But for many others, painful penetration is part of an underlying health issue. It can occur in different ways because there is a multitude of different reasons why sex hurts. What makes these issues so complicated is that several healthcare providers may give you different diagnoses based on the same symptoms. Even the experts can’t always agree on why sex hurts sometimes – or all the time- never mind how to diagnose these issues.

Let’s dig into some of the most common reasons why sex hurts.

Why does sex hurt when you have Vaginismus?

Vaginismus is the tightening of or the automatic spasm of the vaginal muscles. These muscles extend from the pubic bone in the front to the tailbone in the back. And they are really important.

Think of these muscles kind of like a hammock that stretches between those areas. They’re actually holding up all of your internal organs. Of course, both men and women have these muscles. But with women specifically, when these muscles automatically tense up, it’s called vaginismus.

So why does sex hurt? It’s like your muscles have a mind of their own. You have no control over what they’re going to do. Whenever penetration is even attempted, they just tighten up automatically. This leads to painful experiences either in the muscle or in the skin tissue of the vaginal area. Researchers at the National Health Service in the UK¹ say this can even happen if you enjoyed pain-free sex in the past.

Does sex hurt with dyspareunia?

Dyspareunia is defined as pain during intercourse, which includes any kind of intercourse, whether you’re using fingers, sex toys, or penal-vaginal penetration. And the pain can occur before, during, or after sexual activity.

People who struggle with dyspareunia experience different types of pain. It may be a throbbing, itching, or burning sensation. And these symptoms can last for hours after sex.

Sometimes, the cause is relatively simple to figure out, which means an easy fix – Yay! 

It can be as straightforward as insufficient lubrication. There are many reasons this happens. More often than not, insufficient lubrication is a result of not enough “warm up” (some people call it “foreplay” but don’t get me started on the myth of foreplay — that’s for another time). So tell your partner you want to take it slow and really enjoy your time together.

But it’s not always that simple. Many women don’t understand why sex hurts, but here are a few reasons: estrogen levels also fluctuate around normal life events like childbirth or menopause. And there are some medications like blood pressure medicine, antidepressants, and some birth control pills that affect desire or arousal. Using a little oil-based personal lubricant can often do the trick.

Sometimes the causes are a lot more complex. According to the Mayo Clinic², dyspareunia can occur after some surgeries or medical procedures. Or maybe a complication related to a physical disorder or psychological issue. If this is the case, your healthcare professional can create a treatment plan for you.

Why does sex hurt when you have vulvodynia?

Vulvodynia refers to pain or inflammation in the vulvar area. This can be an issue at your gynecological exams or even with tampon insertion… and of course when having penetrative sex. It’s not just a little glitch. Vulvodynia is a chronic condition that causes patients to experience sex that hurts and their symptoms last longer than 3 months.

Dr. Trina Pagano from WedMd³ says that any part of the external genitalia can be affected. That means your clitoris, labia, or vaginal opening. You may experience pain that comes and goes in one specific area. Or it can be more generalized. Any kind of touching or pressure usually makes it worse, which is why sex hurts.

You need answers, but many times, your doctor just doesn’t have any. That’s because these symptoms can be caused by hormonal changes, genetic factors, nerve injury, trauma, or a history of sexual abuse. And it’s possible you don’t have any of these risk factors, and sex still hurts.

What does it mean if I have anorgasmia?

Anorgasmia is the inability to orgasm, or even difficulty reaching orgasm. This can relate to a specific situation or be more generalized. This could mean that you can’t orgasm or just that sometimes you don’t. This issue can affect all genders, but today, we’re discussing how it affects painful sex in bodies with vulvas.

Contrary to what we see in movies and romance novels, this is actually a very common problem. According to the National Institute of Health⁴, studies suggest that anywhere from 11%-41% of women struggle with some type of anorgasmia.

That’s a really big deal. It can have a huge impact on your relationships and overall well-being. And it can be really tough to pin down the cause.

It can be anything from genetics, medication, and medical conditions… to more mundane things like stress, communication issues, and the normal ups and downs of a relationship. 

Why does sex hurt sometimes?

Unfortunately, there are no easy answers. The reasons why sex hurts can vary so much. It’s usually very difficult to figure out what the exact causes are. Why is that?

Sometimes, the cause is something that happened many years ago. You may not even have realized what was happening at the time; years later, you start feeling the effects.

The causes can be either physical or psychological. That means the reason why sex hurts can be psychological trauma. Or something like chronic yeast infections. Maybe it was scar tissue in the vulvar area left over from uncomplicated childbirth.

Even for anorgasmia, the cause may be a little abstract. It’s often about the way the vulva owner was brought up in childhood. What messages were given about sexuality? Or it could be about body image and how someone carries themselves sexually.

What can you do if sex hurts?

Maybe you’re thinking it doesn’t matter why it started, just fix it!

But trying to identify the specific reason why sex hurts can actually be quite helpful in directing your treatment. 

What if you and your doctor can’t pin down the cause? Don’t worry; it’s not completely necessary. You can still begin treatment for any of these issues.

Whether you understand the cause or not, it’s important to start to address these concerns through therapy, with a trusted friend, or a qualified sexual health professional.

Not ready to talk to someone else about why sex hurts? There are some great tools out there to get you started on your pain relief journey. Check out this free course created by a pelvic pain expert.

You deserve to figure out what’s going on and why you’re struggling. So whether you start with research on your own or reach out for help, there are solutions. You don’t have to continue to suffer in silence because relief is possible.

1. Vaginismus ↩︎
2. Painful intercourse (dyspareunia) – Symptoms and causes ↩︎
3. Vulvodynia: Causes, Symptoms, and Treatments ↩︎
4. Female orgasmic disorder ↩︎