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Healthy Woman

Sexual & Reproductive Health

What Causes Painful Sex?

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It should be one of life’s most basic pleasures. But for some women, sex can be painful. What do you do when something you should look forward to becomes something you dread?

Fortunately, the cause of uncomfortable sex can sometimes be easy to figure out, says Shari Lawson, M.D., division director, General Obstetrics and Gynecology, at The Johns Hopkins Hospital. “Painful sex can be caused by an infection or a hormonal imbalance,” she says. The good news is that these things are easy to treat.

So don’t take it lying down — there are ways to make sex something to enjoy again.

Common Reasons for Painful Sex

Usually, women with painful sex have a clear-cut reason for experiencing discomfort, Lawson says. Common reasons for painful sex include:

  • Sexually transmitted diseases (STDs): Roughly 20 million STIs occur every year in the United States. Common STDs, such as chlamydia and gonorrhea, can cause vaginal irritation, which can create pain during sex.
  • Genital herpes: Blisters and sores caused by herpes can lead to pain on penetration.
  • Vaginitis: Vaginitis refers to any vaginal inflammation. In particular, bacterial or yeast overgrowth (caused by a fungus called candida) in the vagina can cause irritation, discharge, tenderness and itching.
  • Previous injuries: Women who have given birth to large infants might have small tears in the vagina, which will heal over time. This is more common if the baby was delivered with forceps.
  • Lower levels of estrogen: Postmenopausal women in particular might experience a dip in estrogen, which makes the vaginal lining thinner and less able to stretch. “It’s like trying to stretch a rubber band that’s lost its elasticity,” says Lawson. In this case, sex can often cause microscopic cuts, which can lead to burning and irritation.
  • Lichen sclerosus: Postmenopausal women might also suffer from lichen sclerosus, a condition in which the skin on the genitals becomes scaly and inflamed.
  • Previous sexual abuse or injury: Women who have experienced sexual trauma might associate sex with pain, leading to tense muscles.

How to Make Sex Less Painful

Your doctor will discuss your sexual history and perform an internal exam. If your doctor suspects a yeast infection or bacterial vaginosis (an infection of the vagina caused by bacteria), he or she will take a sample of your vaginal discharge and look at it under a microscope for signs of infection. Doctors also check the pH levels in your vagina. A too-high pH points to vaginosis, but a yeast infection usually has a normal vaginal pH. 

Your doctor will also look at your vagina and your vulva, the exterior of your genitals, for other lesions that might contribute to pain. You might also be screened for STDs through a urine test or vaginal swab.

Depending on the cause, common treatment options for painful sex include:

  • Topical estrogen creams: If you have vaginal atrophy, or thinning and inflammation of the vagina, estrogen creams can help restore thickness and elasticity to vaginal skin.
  • Antibiotics: If you have an STD or bacterial vaginosis, antibiotics frequently cure the infection within two weeks.
  • Antifungal creams or tablets: If you have a yeast infection, your doctor might prescribe a cream or pill to get rid of the fungus.

Getting Help for Sexual Abuse

If you have suffered sexual abuse or trauma, your doctor might refer you to a psychiatrist, therapist and pelvic floor physical therapist, who can work to release tense and tight pelvic muscles.

“I can’t emphasize enough that patients with a previous history of sexual abuse might experience painful sex due to psychosocial causes — but it can be addressed with help,” Lawson says.

So put your worries to bed: No matter what the reason for painful sex, it’s usually temporary and can almost always be treated.

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