Pain During Sex: Understanding the Causes and Looking After Yourself

Pain during sex is common, and still it is nothing you have to put up with. It is a signal. Usually the body, tension and the relationship all play a part, and all three can be looked at: the physical side first by a doctor, the rest with support as well.

Where and how it hurts

Pain during sex comes in many forms. Some people feel a burning at the vaginal opening as soon as anything enters. Others feel a dull pressure deep inside, especially in certain positions. For some, the vulva hurts at the slightest touch; for others, the pain only comes hours later. People with a penis can have pain during sex too.

The medical term for painful intercourse is dyspareunia. It only says that it hurts, not why. Careful observation helps with the why: Where does it hurt? At what moment? Since when? With every partner or only with one? When you touch yourself or insert a tampon, too? A doctor needs the answers to these questions, and they also help you take the pain seriously.

Possible causes

There is rarely just one reason. Physical, emotional and relationship factors interlock and reinforce each other. The overview below is meant to help you talk to your doctor. It does not replace a diagnosis.

In the body

Many causes are physical. They include dryness of the mucous membrane, inflammation and infections, skin changes on the vulva, endometriosis, or scars, for example after giving birth. Hormonal changes while breastfeeding or during menopause can make the mucous membrane more sensitive. Sometimes the vulva hurts without any cause being found. The term for this is vulvodynia. How sex can change after giving birth, you can read under sex after birth.

In tension

The vagina widens and becomes wet when a person is aroused. That takes time. If penetration starts before the body is ready, the risk of pain goes up. This often happens when sex is supposed to be quick, or when foreplay is treated as a box to tick. More on this under enough time for arousal.

Once it has hurt, the body expects pain the next time. It tenses up before anything has happened. The pelvic floor and thighs tighten, breathing gets shallow. Arousal drops, the mucous membrane stays drier, and it hurts again. This can turn into a cycle of expectation, tension and pain that has little to do with the original cause.

In the relationship

Many people who come to me have ignored pain for a long time. They didn’t want to disappoint their partner, didn’t want to say no yet again, didn’t want to lose closeness. So they gritted their teeth. Behind this there are often old patterns: wanting to please, having to function.

The body remembers. Sex becomes something to endure, and desire withdraws. Unresolved conflicts or sex out of duty can also lead the body to close up. The pain is not imagined. It is real, and it is telling you something.

When the vagina closes completely

Sometimes the muscles at the vaginal opening tighten so much that penetration is barely possible or not possible at all, even with a tampon or during a gynaecological exam. This is called vaginismus. I write about it in detail under when the muscles at the vaginal opening close.

Why seeing a doctor comes first

Many causes of pain during sex are physical and can be examined well. So go to a gynaecologist first, or to a urologist if you have a penis. In Germany you can book an appointment with either directly. Bring what you have noticed: Where does it hurt, when, since when, what does it feel like? Write it down beforehand if you find it hard to talk about during the appointment.

Some women have already seen several doctors and been told “everything is fine”. That is wearing. If you don’t feel taken seriously, you are entitled to a second opinion. Sex therapy can run alongside medical care. It does not replace it.

Men have pain during sex too

Pain in the penis, during ejaculation or in the pelvis also happens to men. Possible causes include inflammation, a tight foreskin or tension in the pelvic floor. Here too: see a urologist first. And here too, expecting pain can make the body tense up and feed the cycle.

What you can do, on your own and as a couple

The first step is the hardest and the most important: stop when it hurts. That is not failure. Every time you push through pain, your body learns that sex is dangerous.

Agree on a way to stop

Agree with your partner on a signal that always counts. A word, a gesture. What matters is what happens next: you stop without anyone feeling hurt, and you stay in contact. Maybe you just lie next to each other. Maybe you carry on with something else. A stop without drama makes it easier to let closeness happen at all.

Rethink what sex is

Sex is more than penetration. If penetration hurts right now, it can take a break for a while. What is left? Kissing, stroking, touching with hands and mouth, touching yourselves side by side. In a break like this, many couples discover what they actually enjoy.

Pay attention to pace and arousal. Take your time until your body is really aroused. Notice where you are holding tension, and breathe all the way down into your pelvis. When you try penetration again, you decide the pace and the depth.

Talk about it

“I didn’t want to disappoint you” is something many people say out loud for the first time when they talk about pain. For the other person this is often shocking and a relief at the same time. Most people don’t want to cause pain. They just didn’t know.

Helpful sentences are short. “It hurts when …” “I’d like us to go slower.” “I want to feel you, just not like this right now.” How to get past the shame, I describe in the shame of talking about sex.

How sex therapy can support you

In sex therapy we look at what happens in your body and between you when it hurts. Your body is not the enemy here. It responds to what you experience, sometimes to things you aren’t even aware of. I work with it, not against it.

One approach I use is Sexocorporel, a body-oriented approach from clinical sexology. We pay attention to how you breathe, where you hold tension and how you build arousal. Alongside that, we talk about your history, about expectations and about what you need in your relationship. In sex therapy I don’t touch you, and you stay fully clothed. If you like, you get exercises to try at home. You can read more about working with the body under body-oriented therapy.

You can find more about what I offer under sex therapy for pain during sex.

The next step

You can come on your own or together, in Neukölln or in Prenzlauer Berg, in English or German. Conversations, for example as a couple about closeness and sex, are also possible online. You usually pay the fees yourself; German statutory health insurance does not cover them. Write me a few lines. That is all I need to begin with.