Quick answer: Pain during sex (dyspareunia) affects up to 75% of women at some point. Common causes include insufficient lubrication, pelvic floor tension (vaginismus), infections, endometriosis, hormonal changes, and skin conditions. Most causes are treatable. If sex hurts, stop doing the thing that hurts, and see a GP or gynaecologist. Pain is information, not something to endure.
If sex hurts, your body is telling you something. Not "try harder", not "relax more", not "it'll get better if you just keep going." It's telling you that something needs attention. And yet, an uncomfortable number of people, especially women, treat painful sex as something to tolerate rather than something to solve. A 2017 NATSAL study found that almost 1 in 10 women in Britain experienced painful sex in the past year. The actual number is likely higher, because many people don't report it.
Types of pain (and what they suggest)
Not all pain during sex is the same, and where and when it happens gives useful clues about the cause.
Pain at entry (superficial dyspareunia)
Pain felt at the vaginal opening during initial penetration. This is the most common type and often relates to:
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Insufficient lubrication: Good lubricant solves this one quickly.
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Vaginismus / pelvic floor tension: The pelvic floor muscles involuntarily tighten, making penetration painful or impossible. This isn't a choice, it's a reflexive muscle response. It can develop after painful experiences, infections, trauma, or seemingly without a specific trigger. A pelvic health physiotherapist is the right professional for this. More in our pelvic floor guide.
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Vulvar skin conditions: Lichen sclerosus, lichen planus, and vulvar dermatitis can cause thinning, inflammation, or cracking of the vulvar skin, making contact painful. These are dermatological conditions treated with topical medications.
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Infections: Yeast infections, bacterial vaginosis, herpes outbreaks, and UTIs can all cause pain at the vaginal opening. If pain is accompanied by unusual discharge, itching, or burning, an infection is a likely cause.
Deep pain (deep dyspareunia)
Pain felt deeper inside during penetration, often described as a dull ache, pressure, or sharp pain with certain positions or depths. This often relates to:
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Endometriosis: Tissue similar to the uterine lining grows outside the uterus, causing inflammation and pain. Deep pain during sex, especially in certain positions, is one of the most common symptoms. Read our endometriosis and intimacy guide.
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Ovarian cysts: Fluid-filled sacs on the ovaries can cause deep pain when pressure is applied during penetration.
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Pelvic inflammatory disease (PID): An infection of the reproductive organs, often caused by untreated STIs. Deep pain during sex is a key symptom, usually accompanied by unusual discharge and sometimes fever.
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Uterine fibroids: Non-cancerous growths in the uterus that can cause deep pain depending on their size and location.
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Cervical sensitivity: The cervix can be sensitive to direct contact. This is position-dependent and doesn't indicate a medical problem, it just means adjusting angle or depth.
Pain after sex
Aching, cramping, or soreness after sex can relate to pelvic floor tension (muscles that tightened during sex and didn't fully relax), endometriosis, or ovarian cysts. Occasional mild soreness after vigorous sex is one thing. Regular post-sex pain that lasts hours is worth investigating.
The role of the mind
Pain during sex isn't always purely physical. Anxiety, past trauma, relationship stress, and negative associations with sex can all amplify pain signals or create muscular tension that causes pain. This doesn't mean the pain is imaginary, it's real, physical pain. It just means the trigger might be psychological rather than structural.
The brain and body are not separate systems. Anxiety about pain causes muscular tension, which causes pain, which causes more anxiety. Breaking this cycle often requires both physical treatment (pelvic floor therapy, lubrication, medical assessment) and psychological support (therapy, counselling, mindfulness practices).
What to do right now
Step 1: stop pushing through it
If sex hurts, stop. Continuing through pain reinforces the pain-tension cycle and can cause physical damage (micro-tears, inflammation). Pain is your body's communication system. Listen to it.
Step 2: try the simple fixes first
Add lubrication, a good water-based lube addresses the most common cause. Spend more time on foreplay. Try different positions (positions that allow the receiving partner to control depth and angle are often more comfortable). Use a vibrator for arousal before penetration, external stimulation increases blood flow, natural lubrication, and relaxation.
Step 3: see a professional
If simple fixes don't resolve it, or if pain is severe, recurring, or accompanied by other symptoms (bleeding, discharge, fever), see your GP or gynaecologist. Be specific about when the pain occurs, where, and what it feels like. Many people minimise their symptoms in medical appointments, don't. Say: "Sex hurts and I need help figuring out why."
In the UK, you can access sexual health services through NHS Sexual Health Services. A pelvic health physiotherapist is the right referral if pelvic floor tension is suspected. A gynaecologist can investigate structural causes like endometriosis, fibroids, or cysts.
Treatments that work
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Pelvic floor physiotherapy: For vaginismus and pelvic floor tension. Involves internal and external manual therapy, exercises, dilator therapy, and biofeedback. Success rates are high when treatment is consistent.
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Lubrication and moisturisers: For dryness-related pain. Water-based lube for sex; vaginal moisturisers for ongoing dryness. Topical oestrogen (prescription) for menopause-related vaginal atrophy.
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Medical treatment: Antibiotics for infections. Hormonal management for endometriosis. Surgery in some cases for cysts, fibroids, or severe endometriosis.
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Psychological support: CBT, sex therapy, or trauma-informed therapy for pain with psychological components. Particularly effective when combined with physical treatment.
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Dilator therapy: Graduated vaginal dilators used to gently retrain the pelvic floor to accept penetration without pain. Used for vaginismus and post-surgical recovery.
Communicating with a partner about pain
Telling a partner that sex hurts is vulnerable. It can feel like you're rejecting them, criticising their technique, or admitting something is wrong with you. None of those things are true. Pain during sex is a physical issue, not a comment on attraction or compatibility.
Be direct: "That position/depth/speed hurts me. Can we try something else?" is more useful than enduring in silence. A partner worth having will want to know. If they respond with frustration or dismissal, that's a them problem, not a you problem.
Some practical approaches: guide their hand, suggest specific positions that work better, introduce a vibrator for arousal before penetration, or agree on a word that means "pause" without killing the mood entirely. Sex should be collaborative, not something one person endures while the other remains oblivious.
How toys can help
Sex toys aren't just for pleasure, they can be part of pain management. External vibrators provide arousal without penetration pressure. Small, slim vibrators can serve as gentle introduction to penetration at your own pace. Vibration itself can help tense pelvic floor muscles relax. The VUSH collection includes options that work well for this.
If penetrative sex hurts, non-penetrative sex is still sex. External stimulation, oral sex, mutual masturbation, and vibrator play are all valid alternatives while you're working on the underlying cause.
Pain that's dismissed by doctors
This happens more often than it should. People (especially women) report pain during sex to their GP and are told to "relax", "use more lube", or "have a glass of wine." If that's happened to you, know that your pain is valid, your concern is legitimate, and dismissive medical advice is not acceptable.
If your GP isn't taking your pain seriously, you have options. Request a referral to a gynaecologist or pelvic health physiotherapist directly. Ask for your concern to be documented in your medical notes (this alone sometimes changes how seriously it's taken). Seek a second opinion. In the UK, NHS Sexual Health Services can help you find a provider who specialises in sexual pain.
You are the expert on your own body. Medical professionals have training and tools, but you have the lived experience. Pain that you're experiencing is real, regardless of whether a test shows a clear cause. Many conditions that cause sexual pain (vaginismus, vulvodynia, nerve sensitivity) don't show up on imaging or blood work, they're diagnosed clinically based on your symptoms.
Related reads
More from this series: Sexual Health Resource Hub · Pelvic Floor and Sex · Endometriosis and Intimacy · Hormones and Sex Drive · Complete Lubricant Guide
FAQs
Is pain during first-time sex normal?
Some discomfort is common, but significant pain isn't inevitable. Adequate lubrication, relaxation, and a partner who goes at your pace make a big difference. If first-time pain is severe or penetration feels impossible, it may indicate vaginismus, see a professional rather than pushing through it.
Can pain during sex be a sign of something serious?
Occasionally, yes. Persistent deep pain can be a symptom of endometriosis, PID, ovarian cysts, or (rarely) other conditions that need medical attention. If pain is new, worsening, or accompanied by other symptoms, see your GP. It's almost always something treatable, but getting it checked is the responsible move.
My partner thinks I'm making it up. What do I do?
Pain during sex is well-documented, common, and physiologically real. If a partner dismisses your pain, that's a relationship problem, not a medical one. You're allowed to stop any sexual activity that hurts, and a partner who respects you will support that rather than questioning it.
Will it get better on its own?
Some causes (a temporary infection, cycle-related dryness) may resolve without treatment. Muscular causes, endometriosis, and chronic conditions generally won't, they need specific intervention. The longer pain goes unaddressed, the more the pain-tension-anxiety cycle reinforces itself. Earlier treatment usually means better outcomes.
Sources
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ACOG (2020). Dyspareunia. American College of Obstetricians and Gynecologists Practice Bulletin, No. 223.
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Mitchell, K.R. et al. (2017). Painful sex (dyspareunia) in women: prevalence and associated factors. BJOG, 124(11), 1689-1697.
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Bergeron, S. et al. (2015). A randomized clinical trial comparing group CBT and topical steroid for women with dyspareunia. Journal of Consulting and Clinical Psychology, 84(3), 259.
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NHS Sexual Health Services — sexual health support in the UK.