Sex is supposed to feel good, so if you feel any pain or discomfort, it’s a sign that something deserves attention (either physically, emotionally or psychologically). People of all sexes and genders can experience pain or discomfort during any type of sexual activity. This might range from feeling mildly uncomfortable to feeling intense sharp pain, to chronic pain that persists for a long time. Sometimes this pain can have visible signs (e.g. redness, bumps, rash, sores, swelling) and other times, it is invisible. This pain can be felt in the penis, testicles, anywhere in the vulva area, at the vaginal opening, inside the vagina, the anus or deeper inside the body.
It’s important to talk about discomfort and pain if it is happening during sex. Often, gender stereotypes or depictions of sex we see on TV or the internet might make us think that sex sometimes just is painful – for example how young women’s first experience of sex is often shown as being painful and uncomfortable – but it shouldn’t be (unless this is something you’re explicitly consenting to). And too often, we might feel like we just have to put up with this pain. It shouldn’t be this way!
Genital and pelvic discomfort and pain, including chronic pain, can seriously affect our quality of life and have a big impact on our overall health, mental health, as well as our relationships. When genital or pelvic discomfort and pain interfere with our lives and well-being, it is important that you chat with a trusted health care provider for support, treatment and care.
When should I talk to my doctor?
Talk to your health care provider if you feel pain in your pelvic or genital area and it’s disrupting your quality of life and / or interfering with your enjoyment of sex. If you know or think you might have a medical condition that causes pain, or if you feel pain during non-sexual activities (e.g. urinating, exercising, biking, sitting) you should talk to your healthcare provider as soon as possible.
So, what causes discomfort and pain during sex?
There are many physical and non-physical factors that can cause discomfort and pain during sex. Many can be managed through treatment, or through changing up the types of sex we are having. No one deserves to feel pain or discomfort during sex or to suffer from chronic genital pain.
Psychological, emotional, or relationship factors
Psychological, emotional or relationship factors can play a big role when it comes to sexual discomfort or pain.
In addition to many emotional, psychological and relationship factors that can make sex uncomfortable or painful, lots of physical factors can also be at play. Read on to find out more about physical infections, conditions and experiences that might cause us discomfort and pain.
Urinary tract infection (UTI)
A urinary tract infection (UTI) is an infection in any part of our urinary system — kidneys, ureters, bladder, and urethra. Most infections happen in the bladder and the urethra. Often, this happens when bacteria find its way into our urethra or bladder after having sex, or because of different bodily bacteria moving around our bodies (for instance, when we wipe after going to the bathroom).
Anyone can get a UTI, regardless of their sex or gender, including babies and little kids, because UTIs aren’t only caused by sex. A UTI can be painful and annoying, but it can also be potentially serious if it spreads to kidneys. The good news is, UTIs can be easily treated with antibiotics.
UTIs don’t always have symptoms, but the common signs include pain and discomfort, a burning sensation when we pee, pee that smells stronger or different than usual, or feeling like we constantly have to go pee (even if we just went) or like we have to push out more urine when we are done emptying our bladder. The pee might also look cloudy and/or bloody (red, pink or cola colored). Some of us may experience pelvic pain as a result of a UTI and some, mental fog and fever.
Vulvodynia is a chronic syndrome that causes burning, stinging, irritation, or sharp pain in the vulva area and affects about 16% of people with vulvas.
This pain can happen suddenly without an obvious cause or be caused by things like intercourse or inserting a tampon. Since it can impact our ability to form intimate relationships, it can impact our mental health and wellness. Vulvodynia is also more common among people who have depression or Post Traumatic Stress Disorder (PTSD), indicating a complex link between genital pain and our mental health and wellness.
Dyspareunia (painful sex)
Painful sex or dyspareunia is a common but often neglected sexual health problem. Dyspareunia is an umbrella term that refers to painful sex that can be caused by physical and emotional / relationship factors. Often, this can be an indication that we are experiencing sexual difficulties such as lack of desire and arousal, or strain within our sexual relationships. The impact of experiencing this kind of pain can lead to mental health issues like negative body image, low self-esteem and depression. It’s important to get the advice of a trusted health care provider if you’re experiencing painful sex – lots of different treatments or interventions can help us get back to feeling our best or addressing the root causes of this pain.
Vaginismus is a painful vaginal spasm occurring during penetration. This can severely impact the sex you are having, as spasms will typically prevent penetration from happening comfortably. Open communication with your partners is key and changing up the type of sex you are having if you are experiencing spasms can help. Different treatments, including the use of vaginal dilators, can help make penetration more comfortable if you are experiencing vaginismus. Working with a pelvic floor physiotherapist can help reduce the symptoms of vaginismus. Chat with a trusted health provider if you think you might have this condition, and they can help you find ways to get back to having comfortable and enjoyable sex.
Skin conditions and lichen sclerosus
Painful sex can also result from a range of skin conditions, including vulval skin conditions like as lichen sclerosus. Lichen sclorosus is a condition that creates patchy, white skin on the genital and anal areas that appears thinner than normal, causes great discomfort, swelling and pain, can tear and bleed, and can be very itchy. Often, this makes sex extremely painful. It is thought to be caused by an overactive immune system and/or a hormonal imbalance and can be treated using steroidal creams and medications if it is impacting your life.
Other skin conditions like eczema and psoriasis can also happen around the genitals, penis and vulva, as well inner thighs, which can cause discomfort, pain or embarrassment during sex and intimacy. Chat with your health care provider about treatments – lots of different creams and medication options can help you manage your psoriasis and eczema. It’s also important to keep the areas clean, as a rash like eczema or psoriasis can allow bacteria to get in more easily, and possibly cause a secondary infection.
People with penises / testicles
There are lots of causes of pain and discomfort that can impact the penis, testicles, and scrotum. These range from pain sustained through an injury to different genital conditions.
Many other conditions and injuries can cause pain and discomfort in the penis, testicles, and scrotum. It’s important to see a healthcare provider if you have concerns, discomfort, or notice anything different about your penis or scrotum. Often, it can feel embarrassing or scary to see a doctor about your genitals but they are there to help you. Seek support if you notice any pain, discomfort or unusual symptoms (lumps, bumps, rashes or discharge) on or around your penis and testicles.
Some of the common forms of penis and testicle pain other than trauma to the genitals (which can be caused by sports, vigorous workouts, injuries, sex and accidents) include:
Testicular conditions include testicular torsion, which occurs when a testicle twists or rotates. This twists the spermatic cord and restricts blood-flow to the scrotum and testicles. This can cause sudden severe pain and requires medical intervention. Other testicular conditions include cryptorchidism (undescended testicles), where one or both testicles haven’t moved down into the scrotum. Other things that can impact the testicles include testicular cancer, which can be identified through growths or lumps in the testicles or scrotum – that being said, lumps do not always mean you have cancer!
Hypospadias is a condition where the urethra does not extend to the tip of the penis, which impacts how one urinates. With this condition, urine will flow from the bottom or from a different spot on the penis instead of from the tip. This doesn’t always require surgical repair, but some people with hypospadias will have surgery for functional and cosmetic reasons.
Foreskin conditions include phimosis (a condition that makes it hard to pull the foreskin back from the head of the penis) and paraphimosis (a retracted or tightened foreskin that cannot be pulled back over the head of the penis). The good news is, different creams and ointments can help manage these conditions, so chat with your health care provider. With phimosis, if the foreskin is making it hard to pee or causing pain, people might opt to get their foreskin removed through surgery.
Peyronie’s disease refers to a build-up of scar tissue in the penis that causes the penis to curve or bend. While penises naturally are usually bent or slightly curved, Peyronie’s refers to a more serious bend in the bend in the penis that causes pain or makes sex more difficult. There are many causes of Peyronie’s, and symptoms can develop slowly over time, or suddenly if they are due to trauma (for instance, a penis slipping out of an anus or vagina in a way that causes injury). People with Peyronie’s don’t always need treatment, however, treatment options including medication and surgery can help if you’re experiencing pain.
What can I do to reduce the pain?
The ways of addressing pain during sex will depend on the cause of the pain. For example, people with vaginismus might try pelvic muscle training, the use of dilators, relaxation techniques, or counselling to address the root causes of their pain. For pain that might be caused by lowered hormones, hormone therapy or estrogen creams can help. For spasms, a pelvic floor specialist can help.
If you continue to feel pain during sex, it might be a good time to explore other activities that feel good – there are lots of way of expressing intimacy! Or, you can choose to stop sexual activity altogether until the pain and discomfort goes away.
You should never feel guilty, ashamed or embarrassed about sexual pain, or embarrassed or ashamed to tell your partner(s) that you’re uncomfortable. Pretending that everything is fine can actually make things physically and emotionally worse or make you even more anxious about sex.
If you’re worried that your pain might be more about emotional or relationship, it can be helpful to ask yourself if there’s anything about sex, your relationship, or your partner(s) that’s making you uncomfortable.
If you are being abused or forced to have sex, it’s important for you to tell someone and to get support.
This condition is more common in older people as a result of menopause, but it can happen at any age. Vaginal dryness happens when the tissues of the vagina are not well lubricated enough, which can cause pain and discomfort during sex. It can also mean we become more susceptible to bacterial or yeast infections. Symptoms include soreness, itching and burning, painful sex, light bleeding after sex, and mild discharge. The good news is, lots of treatments exist for vaginal dryness, and the treatments will depend on the cause of the dryness.
Some things that can contribute to vaginal dryness:
- Low levels of estrogen, a hormone that helps keep the tissues of the vagina lubricated and healthy.
- Using douches and other irritating things like perfumes, certain soaps, lotions, and some laundry detergents. These products can disrupt the natural balance of bacteria and chemicals in the vagina and cause dryness.
- Antihistamines (commonly found in allergy, cold, and asthma medicines) can have a drying effect. Certain antidepressants can also cause vaginal dryness. Other medicines like allergy, cold, and asthma medicines that contain antihistamines can have a drying effect on the body and contribute to reduced vaginal lubrication.
- A low libido or other sexual issues may lead to dryness. At the same time, dryness and pain may decrease your libido.
- Other causes include menopause and perimenopause, childbirth, breastfeeding, smoking, ovaries being removed, certain immune disorders, cancer treatments, and anti-estrogen medicine, including hormone replacement therapy.
Depending on the cause of your vaginal dryness, a health care provider can help you find the treatment that will work best for you!
Endometriosis is a painful reproductive disorder where the lining of the uterus, called the endometrium, grows in other places, such as the fallopian tubes, ovaries, or along the pelvis. When that lining breaks down, like the regular lining in the uterus that produces the menstruation, it has nowhere to go. This causes cysts, heavy periods, severe cramps, severe pelvic pain, and in some cases, infertility. The pain, which can be debilitating, is due to internal bleeding from the lining being shed inside the body and can also lead to scar tissue formation, blocked fallopian tubes, and bowel problems. A 2015 study found that endometriosis can affect quality of life and mental health.
It can be difficult to get a diagnosis for endometriosis. This is one of the reasons why people’s mental wellness can be impacted by endometriosis as their experience of severe pain is not taken seriously or they feel hopeless because no one knows what is happening to them and able to help. People, including health care providers are getting more familiar with this disorder and so, if you suspect you have endometriosis, don’t give up and seek the support and care you need.
Pain after giving birth
Pain after giving birth is a common occurrence but it’s rarely talked about. It can be hard to know what amount of pain is normal, or how long pain should last as we recover from birth. In the case of vaginal birth, most healthcare practitioners advise you to wait 6 weeks after delivery to have vaginal sex. The same goes for births by c-section. The 6-week delay gives you some time to heal, which is super important especially if you experienced a tear on the perineum (the skin in between the vaginal opening and the anus), C-section, an episiotomy (a cut made on the perineum), or surgical instruments like forceps were used. For some, it may take longer than 6 weeks before they feel ready to have penetrative sex again. During this time, you might choose to focus on other sexual activities for a while, if you’re up for it, or wait a bit longer to resume having sex. You should be supported in your decision around when to resume having sex. Low estrogen levels in the vagina Scar tissue Muscle spasm Irritation The bottom line is that sex shouldn’t be painful. If months have gone by since your delivery and sex is still painful, you deserve to get care – see a health care provider.
- Low estrogen levels in the vagina
- Scar tissue
- Muscle spasm
The bottom line is that sex shouldn’t be painful. If months have gone by since your delivery and sex is still painful, you deserve to get care – see a health care provider.