Reviewed by: Maureen Christian, PT, WCS and CLT
Written by: Abbi Havens
There is no shortage of depictions of sex in pop culture. Movies and television shows would have you believe that sex is always romantic, seamless and frequently occurs in a field of wildflowers. Unfortunately, this is not reality. Painful intercourse is rarely a topic of discussion, but it occurs more frequently than you might think.
Many associate dyspareunia (painful intercourse) with women. Although many women do experience pain during sex, dyspareunia is not exclusively a women’s issue. Studies show that approximately one to five percent of men experience pain during sexual intercourse. However, due to social stigma surrounding men and sex, this number may be underreported. For women, dyspareunia is even more prevalent. One in ten women report that they experience pain during or after sex, but unlike men, many women believe that experiencing pain as a result of intercourse is normal and to be expected (this is not the case).
No matter your sex, intercourse can and should be enjoyable for all parties involved. When intercourse is not enjoyable, it’s time for a conversation with your partner(s) and your health care provider. There are many factors, mental and physical, that contribute to painful intercourse ranging from emotional trauma to sexually transmitted infections. Here are just a few of those potential causes for men and women:
Causes of Painful Intercourse for Women
Vaginismus is involuntary contractions or spasms of the pelvic floor and vaginal muscles resulting in pain during sex (many women with vaginismus also experience pain when inserting a tampon or during a gynecological exam). Vaginismus can be caused by emotional factors, physical factors or both.
Vulvodynia and Vulvar Vestibulitis
Vulvodynia is burning, stinging, itching, aching, soreness or swelling (or a combination of multiple types of pain) felt in the entire vulva or a specific area of the vulva for longer than three months. Vulvar vestibulitis is pain that occurs in the vestibule (the area of the vulva surrounding the vaginal opening). Both often lead to pain and burning during sex, particularly upon entry.
Trauma to a woman’s genitals including female genital mutilation, injury from an accident, tearing from intercourse, recent childbirth or pelvic surgery are common causes of painful sex for women.
Approximately 17 percent of women from the ages of 18 to 50 experience vaginal dryness during sex, leading to pain and tearing that puts women at risk of infection. Women often experience vaginal dryness as a result of lack of arousal or emotional stress. According to another study, approximately 56 percent of women experience vaginal dryness post-menopause.
Endometriosis is a condition in which cells like the cells of the uterine lining grow outside the uterus (on the ovaries, fallopian tubes or bowel). Penetration and movement during sex can stretch the endometrial tissue causing painful sex.
Sexually Transmitted Infections
Many sexually transmitted infections (STIs) can cause pain during sex due to local swelling, irritation, blisters and more. STIs associated with painful intercourse for women include gonorrhea, herpes, molluscum contagiosum, trichomoniasis and chlamydia. Although pelvic inflammatory disease is not an STI itself, it often results from an untreated STI and causes pain during sex.
Causes of Painful Intercourse for Men
Peyronie’s disease is the most common cause of painful intercourse for men and is caused by plaques, or hard scar tissue that forms inside the penis. For many men, this causes curvature of the penis during erections, painful sex and difficulty having sex due to curvature. In some cases, men may notice their penis has shrunk in size as a result.
Pain during sex can be caused by multiple sexually transmitted infections (STI’s) including herpes, chlamydia, gonorrhea and trichomoniasis. If you suspect you have an STI, get tested immediately to prevent the spread of the infection to partners and counteract undesirable side effects of the infection including painful intercourse.
Phimosis and Paraphimosis
Problems related to the foreskin are another common cause of pain during intercourse for men. Paraphimosis occurs when the foreskin is stuck behind the head of the penis and unable to pull forward. Phimosis occurs when foreskin is too tight to be fully retracted over the head of the penis. Tears and damage to the foreskin can also cause pain during intercourse.
Men can be allergic to chemicals found in various contraceptives, latex condoms or even a partner’s vaginal fluids. A post-coital test can determine if you are allergic to your partner’s vaginal fluids, and if so, a barrier form of contraception may be necessary to avoid contact.
Prostatitis is an often-painful condition in which the prostate and surrounding area become inflamed and can result in pain during ejaculation. It’s most often caused by bacterial infections and cannot be sexually transmitted to a partner. Although prostatitis itself cannot be transmitted, on rare occasions it is caused by an STI that can.
If you or a loved one are experiencing painful sex, you’re not alone. Pain during intercourse can and should be addressed by your health care provider to help you reach an enjoyable and safe experience for you and your partner(s). There is no shame in dyspareunia, so be proactive about your symptoms and get to it!