5 Causes of Painful Intercourse if You’re Not Currently Going Through Menopause

If you experience painful intercourse, it may help to realize just how common it is: It affects nearly 75% of women at some time during their lives. Though menopause often causes painful intercourse, it’s also very common to struggle with the problem long before then.

Here at Fred A. Williams, MD, we understand that it’s not easy to talk about painful intercourse, but we’ve helped many women by determining the reason sex is painful and providing treatment that overcomes the problem. We’re here to help you, too, so give us a call if you have questions. Meanwhile, we thought you’d like to know about the five top causes of painful intercourse.

Gynecologic conditions

Numerous gynecologic problems cause painful intercourse. Here are a few examples:

Pelvic inflammatory disease (PID)

PID is an infection that occurs in your cervix, uterus, fallopian tubes, or ovaries. It’s typically caused by a bacterial infection, which may come from a sexually transmitted infection or bacteria normally found in your vagina. In addition to painful sex, PID causes symptoms such as pain in your lower abdomen, vaginal discharge, and irregular menstrual periods.


Endometriosis develops when tissues like those lining your uterus also grow outside the uterus. Inside the uterus, these tissues respond to monthly hormonal changes, shedding at the end of each month as your menstrual period.

When you have endometriosis, the tissues growing outside the uterus continue to follow the same cycle, bleeding into the pelvic cavity every month. As a result, scarring and pain develop, including painful menstrual cramps and pain during or after sex.

Uterine fibroids

Uterine fibroids are muscular tumors that develop in the wall of your uterus. They’re usually noncancerous and often don’t cause symptoms unless they grow large. In some cases, a fibroid can get as large as a grapefruit, or you could also have many small- to medium-sized fibroids at the same time. When symptoms develop, they cause pain during sex, painful periods, and heavy bleeding.

Painful bladder syndrome (interstitial cystitis)

Interstitial cystitis (IC) has symptoms similar to a urinary tract infection, but it’s not an infection. IC is a chronic problem that causes bladder pressure, bladder pain, pelvic pain, and pain during sex.

Dermatologic diseases

Many women are surprised to learn that common skin conditions also affect the skin outside their vagina, which is an area called the vulva. When a skin problem causes ulcers or cracks in vulvar skin, sex is painful.

One common skin disorder, contact dermatitis, occurs when you have a reaction to an irritating substance such as a douche, perfumed soaps, or lubricants. Other dermatologic conditions affecting your vulva include psoriasis, lichen planus, and lichen sclerosus.

Inadequate lubrication

When your body doesn’t produce enough lubrication, sexual intercourse is difficult and painful. It also causes microtraumas to occur in the vulva and vagina. Chronic vaginal dryness and sexual arousal disorder are two causes of inadequate lubrication.

Chronic vaginal dryness before menopause may develop due to numerous health conditions, such as diabetic neuropathy, anemia, and peripheral atherosclerosis. Certain medications and hormonal contraceptives can cause vaginal dryness. You may also have less lubrication when estrogen levels change right after childbirth.

Vulvar vestibulitis and vaginismus

These two conditions aren’t related, but they’re both often diagnosed as the underlying cause of painful intercourse.


You may be able to identify this condition because it’s an uncontrollable tightening of your vaginal muscles that occurs during attempts at vaginal penetration. Vaginismus often develops when you fear sex may be painful, such as when it’s your first time or after a period of stress or anxiety.

Vulvar vestibulitis

Vulvar vestibulitis, also called vulvodynia, is the most common cause of superficial pain during sexual intercourse. This very painful problem originates in the nerves that carry signals from the vulva to your brain.

For reasons that remain unknown, the nerves turn hypersensitive. As a result, very gentle touch or stimulation is painful. After sex, you may continue to feel a burning pain in the genital area.

Bacterial and yeast infections

Bacterial and yeast infections are among the most common and best-known problems capable of causing painful intercourse. These infections include bacterial vaginosis, candidiasis, and cervicitis, which is an infected and inflamed cervix. Of these, a yeast infection is most likely to cause painful sex.

As you can see, there are many possible reasons for painful intercourse before menopause. The good news is that we can help treat all of them: Call Fred A. Williams, MD, or book an appointment online.


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