Pain During Sex
Pain during sex isn’t something to push through or ignore. When sex hurts – whether at entry, during penetration, or deep in the pelvis – it affects more than the body.
It shapes desire, confidence, intimacy, and how safe sex feels. Pain is often the body signalling protection, not dysfunction.
What this is
Pain during sex, sometimes described as painful sex or painful intercourse, refers to physical pain experienced before, during, or after sexual activity. Pain may occur at the point of entry, during penetration, or deeper within the pelvis. It can be occasional or persistent, and may change over time or across different sexual experiences, including for people who are sexually active and otherwise healthy.
In medical settings, pain during sex is sometimes referred to using terms such as dyspareunia or Genito-Pelvic Pain/Penetration Disorder, as described by the World Health Organisation and the American Diagnostic and Statistical Manual – edition 5. These terms aim to categorise patterns of sexual pain, but they don’t fully capture the lived reality of what it means when sex hurts – emotionally, relationally, or psychologically.
Pain during sex can present in different ways, depending on the body and the type of sexual activity involved. For some people, pain is felt more superficially at the vaginal opening, often described as vulvodynia or vaginal entry pain. For others, pain is felt deeper in the pelvis or pelvic region during penetration, sometimes linked to the pelvic floor muscles or the deeper female reproductive organs.
Pain can also occur during anal sex, where muscle tension, sensitivity, previous pain, or trauma may make penetration feel painful or unsafe. Some people experience involuntary muscle tightening or guarding linked to pelvic floor dysfunction, which contributes to pain and makes penetration difficult. Importantly, pain during sex is real. It is not something to push through, minimise, or ignore. Pain is often the body’s way of signalling protection rather than dysfunction.
Common experiences
People experience pain during sex in different ways. This may include the following:
Pain can affect desire, arousal, emotional safety, and a person’s sense of agency within sexual experiences.
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Pain at the vaginal opening or during initial penetration, often described as vaginal pain
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Deep pain during penetration or in certain sexual positions
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Pain during anal sex that makes penetration feel difficult or unsafe
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Muscle tightness or involuntary spasms around penetration
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Burning, aching, or piercing pain in the pelvic or genital region
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Pain linked to vaginal dryness or reduced natural lubrication
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Avoidance of penetrative sex due to fear of pain
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Emotional distress, frustration, or loss of confidence around sexual activity
Possible Causes
Pain during sex is rarely caused by just one thing. It often develops through a combination of physical factors, emotional responses, relationship dynamics, and lived experience, all of which can influence one another over time and contribute to patterns causing painful sex.
Physical and medical factors
Pain during sex often develops through a combination of physical factors, emotional responses, and lived experience. Physical contributors may include pelvic floor tightness, hormonal changes, vaginal atrophy, skin conditions, pelvic inflammatory disease, ovarian cysts, uterine fibroids, irritable bowel syndrome, urinary tract or yeast infections, sexually transmitted infections, or recovery from cancer treatments or surgery.
Trauma and protective responses
Experiences of trauma – including sexual abuse, medical trauma, or repeated painful examinations – can leave the body more alert and guarded. Over time, this can increase muscle tension, fear of pain, and difficulty relaxing during intimate moments. Previous pain itself can also create cycles of anticipation and avoidance, which make discomfort more likely. These responses are often protective rather than intentional.
Relational and contextual factors
Relational and contextual factors matter too. Pressure to perform, fear of disappointing a partner, difficulty talking openly about pain, or a sense of needing to “push through” can all increase distress and physical tension. Pain during sex can also affect partners, sometimes contributing to anxiety, avoidance, erectile difficulties, rapid ejaculation, or changes in desire.
Diverse bodies and identities
Pain during sex affects people across a wide range of bodies, identities, and sexual experiences. Gay, lesbian, bisexual, and queer people may experience pain in ways that don’t fit heterosexual or vaginal-centric assumptions. Trans and gender-diverse people may experience pain linked to dysphoria, medical transition, or surgical recovery. People living with disability may experience pain shaped by medical treatment or hormonal changes.
How therapy can help
Psychosexual therapy offers a space to explore pain during sex without rushing toward penetration or performance. Therapy works alongside medical care, not instead of it, and supports the emotional, relational, and bodily aspects of pain. In therapy, you might explore how pain, fear, and muscle tension interact, and develop breathing and relaxation practices that support safety and ease without forcing exposure.
You might work on developing awareness of pelvic floor responses, including gentle pelvic floor exercises when appropriate. Therapy can help you find language to talk openly about pain, boundaries, and needs. It can support working through shame, fear, or past experiences at a pace that feels manageable, and help partners understand pain and reduce pressure or misinterpretation.
Therapy can also support people in reconnecting with pleasure, agency, and choice, including redefining intimacy in ways that feel respectful of the body’s limits and signals. You might consider seeking support if pain is persistent, affecting your sex life or relationships, or leaving you feeling disconnected from your body.
Our Psychosexual and
Relationship Therapists
Abigail Waud
Psychosexual and Relationship Therapist
Olivia Mackinder
Psychosexual and Relationship Therapist
Eva Oyon
Psychosexual and Relationship Therapist
Viktoria Szabo
Psychosexual & Relationship Therapist, Psychologist, Counsellor
FAQ
Is pain during sex common?
Pain during sex is more common than many people realise, though it’s often not spoken about. Experiencing pain doesn’t mean something is “wrong” with you, and support can make a meaningful difference.
What’s the difference between vaginismus and dyspareunia?
Vaginismus is often associated with involuntary muscle tightening around penetration, while dyspareunia refers more broadly to pain during sex. They can overlap, but they are not the same, and support is tailored to the individual.
What if sex hurts, but medical tests are normal?
This is a common and frustrating experience. Pain can still be very real even when tests don’t show a clear cause. Therapy can help explore bodily, emotional, and relational factors alongside medical care.
Can pain during sex affect my partner or relationship?
Yes. Pain can affect intimacy, communication, and confidence for both partners. Therapy can help individuals and couples navigate these impacts with care and understanding.
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