If you experience pain during sex, you are certainly not alone. Pain during sex is called dyspareunia, and research shows that about 7% of women experience pain it.[1] Of those 7%, about one-quarter of them reported that the pain had been occurring frequently or every time they had intercourse over at least 6 months. Today, we’d like to look at some of the most common causes so that if you’re experiencing dyspareunia you maybe have a starting point to know how to explore and hopefully resolve this challenge. 

Pain during sexual intercourse is a relatively common issue. Of course, the lifetime prevalence is going to be higher, and I would expect that every person is likely to have at least some discomfort if not some pain during the course of their sexual interactions with their spouse over the lifetime of their marriage. This can be tough to talk about for some people, so we hope that today’s show serves as a bit of an icebreaker and introduction to the subject. 

We’re not sexologists, sex therapists or medical professionals. I am a marriage counselor so we do address sexual issues, but just be reminded that if you are experiencing pain your wisest course of action is first of all to talk to your doctor or gynaecologist, and possibly to book an appointment with a sex therapist.

There are more reasons for pain during sex than what we will cover, for example, we are not going to address urinary tract infections or sexually transmitted infections. But anxiety and menopause are two major causes so we’ll start with them.

Sexual Anxiety

Sexual anxiety (or sexual performance anxiety) is something that affects men and women of all ages, regardless of how much experience they have had with sexual intercourse. There are a variety of possibilities here. A newly married wife may be too self-conscious to tell her husband what she does not enjoy: this could lead to some trepidation or anxiety about having sex which could result in pain during sex.[2] In some cases, the anxiety may be short-lived and go away on its own. In other cases, it may be something that occurs on a regular basis and interferes with a healthy sex life.[3]

According to sex educator Amy Jo Goddard (n.d.), two things are generally the root cause of sexual performance anxiety. She states, “this response is conditioned by the way in which we were brought up to think about certain aspects of sex and our own bodies, and by social expectations that impact our relationship with our own sexuality.”[4] This means that messages from your family of origin, your church, or from locker-room discussions or friends at school — all those sources could potentially contribute to anxiety during sex.

Other times it may simply be a lack of sex education: perhaps not that you don’t understand how sex works, but that you’re just not prepared for all the realities of sexual encounters with your husband. Everyone functions differently and has different needs when it comes to sex, and not being well educated can lead you to feel unsure about the techniques of giving, achieving or receiving pleasure. Additionally, you may experience fear because of myths concerning pregnancy, or myths about how your body is supposed to react during sex, and these beliefs can be very anxiety-inducing.[5]

Of course, anxiety impacts arousal, which impacts your body’s ability to prepare itself for penetration and intercourse. It’s also important to note that the anxiety doesn’t have to be sexual performance anxiety. It could be anxiety about anything: how you’re going to pay the bills, your child’s health, the family get-together that’s coming up, whatever. General anxiety can also impact your sexual experience, potentially resulting in discomfort or pain.

What to do About Anxiety

Obviously, with such a wide variety of potential sources for anxiety it is challenging to cover all the possible solutions. If your anxiety is more generalized then taking care of that anxiety may just as easily end up taking care of the pain during sex as well.  But let’s look at sexual anxiety specifically. 

There are a few things that you can do to reduce your anxiety.

  1. Check is your own expectations of yourself. Don’t expect yourself to be a perfect romantic partner right away (if you are recently married) or even all the time (if you’ve been married a while). It takes time and patience as well as a lot of trial and error to become a proficient lover. It helps if you can learn to talk openly and honestly with your husband if there are certain things you don’t like.[6]
  2. Learning to express your wants and needs is important. If you keep things bottled up, especially fears, they will likely increase your anxiety and make sex more difficult or painful. If you’re worried about taking too long to orgasm, struggling to stay aroused, or just not being aroused in the first place, those are things that you will need to find ways to talk about and work through collaboratively, preferably without either party feeling blamed or taking the problem personally. How can you look at this as a problem to solve together? How can you frame this challenge into something that gets solved between you, real-time, in the context of intimate connection and tender, loving care? It’s important to be kind to yourself as well as respectful to your spouse during this process.
  3. If you know there is a deeper psychological reason behind the pain, it’s worth facing that issue with your spouse and seeing a therapist if it persists. If you always have pain during intercourse, it can create a difficult cycle to break out of because you may involuntarily tighten your muscles in anticipation of the pain, and that tightening causes further pain.[7]
  4. One basic approach to try here is to reassure yourself that your spouse wants to be with you, that he welcomes your presence and your sexual needs, and that he wants you to be at ease and comfortable with him. What you’re doing is really trying to lower the sense of demand or pressure and move yourself to a place of openness and curiosity. 

Menopause and Pain

Menopause may involve falling hormone levels, which can have a variety of effects. You may be less interested in sex than your husband and that may make sexual encounters tense and stressful which could easily lead to pain. There can also be a physical shift towards vaginal dryness, which leads to pain during intercourse.[8]

Dwindling estrogen due to menopause is the number one reason for pain during sex at midlife and beyond. Hormone shifts make the tissues in your vagina to become thinner and dryer. That leads to physical friction during sex; your vagina may also become less stretchy so things may feel tighter during intercourse.[9]

There are a number of ways to compensate for the effects of menopause in order to reduce pain during sex.

  1. The first thing to know is that you can go to your doctor for a prescription of estrogen: this may help make intercourse less painful and comes in three forms: a cream, a tablet or a ring.[10]
  2. For some women, simply using a good water-based lubricant during sex may help with a lack of lubrication, especially if dryness is the issue more than soreness. You can also use a vaginal moisturizer which is something that you would apply regularly, not just during sex. There are both over the counter and prescription options for moisturizers.
  3. Putting more emphasis on foreplay may help: being more aroused before penetration means you will be more lubricated. Give yourself more time to enjoy caressing, perhaps oral sex, or different positions. As well, having sex more often will lead to increased blood flow to your sexual organs, which may help with lubrication, which will make intercourse less painful.

Vaginismus Can Be Painful

Next is a common condition called vaginismus. This involves an involuntary spasm in the vaginal muscles that comes from a tightening of the pelvic floor muscles.[11] Vaginismus sometimes is caused by anxiety about having sex or a fear of being hurt during sex. If you have this condition you may also notice pain inserting a tampon.

In terms of what to do about vaginismus, doing counseling related to the source of fear or anxiety related to sex or penetration can help with this. There are also a set of exercises called Kegel exercises that can help you learn to relax the muscles surrounding your vagina.

Why You May Be Experiencing Pain During Sex (for Wives)

If you’d like to learn more about Kegel exercises, we have written them up in our bonus guide for this week’s episode of The Marriage Podcast for Smart People. That guide is available as a downloadable PDF for our patrons.

In covering anxiety and menopause and vaginismus, we’ve dealt with some of the most common sources, but let’s just run through some more potential sources of pain in case some of our listeners are experiencing these as well.

Uterine Fibroids

Uterine Fibroids are benign lumps that grow on the uterus. Symptoms may also include heavy periods, cramping and an urge to urinate as well as painful sex. Your best option here is to see your doctor. Treatment options may include embolization (a minimally invasive surgical technique and hormone therapy or a hysterectomy (removal of the uterus).[12]


This is a difficult condition where the tissue that lines your uterus can grow elsewhere within or even outside of your pelvis, causing pain in your stomach, pelvis and back during sex.[13] You definitely want to see the doctor if you are experiencing deeper pain, not just pain at penetration so your doctor can diagnose this and recommend treatments.[14]

Pelvic Inflammatory Disease

With PID, the tissues deep inside become badly inflamed and the pressure of intercourse can cause deep pain. Again, you’ll want to see a doctor here for appropriate treatments.[15]

Vaginal Infections

This is possibly one of the simpler causes: you may have a yeast infection which causes pain and itching in the vaginal area. This can be treated with an over the counter product, but you should also see your doctor in case a stronger prescription medication is necessary.

Previous Injuries

It’s also possible that an injury from childbirth such as a tear or even an episiotomy (cut) made in the skin between the vagina and anus during labor will cause you pain. The treatment for this will vary depending on the injury. Sometimes a pain-relieving cream will be sufficient, there may also be work you could do with pelvic floor muscles or even surgery to remove irritated tissue. Again, it will depend on the injury so a doctor is the right place to start here.[16]

A related topic is having sex too soon after childbirth. Doctors advise waiting six weeks after childbirth before having sex.[17]


This is a condition that causes “almost a chronic or constant burning or raw feeling” around the vulva.[18] Doctors are not sure what the cause is but self-care and medical treatments can bring relief.[19]

Tilted Uterus

About one in four women have a tilted uterus. This means that the uterus leans backward at the cervix instead of tipping forward. This normally is not a problem but it can make sex, particularly in certain positions, painful. The solution here is to experiment with different positions to find ones that are not painful.[20]

A History of Sexual Abuse

Not all women who experience pain during intercourse have a history of sexual abuse. And not all women with a history of sexual abuse have pain during intercourse. That said, some women who are survivors of sexual abuse may experience pain.

Again, it’s good to check with a doctor to eliminate other causes, but if you are a survivor and have pain that cannot be explained by another cause, you may wish to do your own personal therapy.

The medical profession may also be able to help in this situation as there are also medications that the doctor can prescribe to reduce pain, including low doses of tricyclic antidepressants such as imipramine, amitriptyline, and nortriptyline, as well as medications used in pain management for nerve-related pain such as duloxetine, gabapentin, pregabalin, and others.[21]

General Tips

Generally speaking, where there is no underlying medical cause, sex therapy is often helpful. Even unrelated to abuse, there could be unresolved issues such as deeper guilt or inner conflicts regarding sex that you may wish to work through with a counselor.

It’s important to note that if you are experiencing very intense pain you should see a doctor right away. If you are unsure of the source of the pain, you should also see your doctor. There are other potential issues besides what we have mentioned here that your doctor can diagnose and recommend treatment for.

Regardless of the source of the pain during sex, it’s always recommended that you seek help: it’s easy to feel embarrassed and sit at home. It makes sense that it can be a difficult topic to talk about. But if you are finding intercourse painful and are unsure why, try talking to your husband, someone you are close to, and to your doctor so that you can try to understand what’s happening.[22]

Note: From BCACC: As podcasts can be subscribed to and accessed all over the world, psycho-educational podcasts should include a disclaimer to the effect that they are a self-help tool and do not replace individual counselling or represent an attempt to solicit clients from jurisdictions where the RCC does not have the legal ability to practice. Further, they are not intended for those experiencing severe symptoms such as suicidal thoughts, for which emergency help should be sought.


[1] Victoria Allen, “Why Sex Is Painful for 7% of Women,” Daily Mail, 2017,
[2] Allen.
[3] “Sex Anxiety: How Can You Overcome It,” Medical News Daily (blog), n.d.,
[4] “Sex Anxiety: How Can You Overcome It.”
[5] “Sex Anxiety: How Can You Overcome It.”
[6] Pamela Connolly, “I Was a Virgin until I Met My Girlfriend and I’m Finding Sex Painful. Is This Normal?,” 2019,
[7] Jessica Ferger, Pain During Sex? What Women Need to Know, 2014, https://www.cbsnews.com/news/pain-during-sex-what-women-need-to-know/.
[8] Allen, “Why Sex Is Painful for 7% of Women.”
[9] “Menopause: When Sex Hurts,” n.d., https://www.webmd.com/menopause/guide/painful-sex#1.
[10] Painful Sex in Women,” n.d., https://www.webmd.com/sexual-conditions/guide/female-pain-during-sex#1;
“Menopause: When Sex Hurts.”
[11] “Painful Sex in Women”; Ferger, Pain During Sex? What Women Need to Know.
[12] “Painful Sex in Women.”
[13] Deborah Weatherspoon, “Why Do I Have Lower Abdominal Pain During Sex?,” 2019,
[14] Ferger, Pain During Sex? What Women Need to Know.
[15] “Pelvic Inflammitory Disease,” n.d., https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/diagnosis-treatment/drc-20352600.
[16] “Vulvar Pain: Symptoms, Causes, and More,” n.d., https://www.healthline.com/health/womens-health/vulvar-pain#treatment.
[17] Kalli Anderson, “Postpartum Sex: Why It Sometimes Hurts,” 2017.
[18] Ferger, Pain During Sex? What Women Need to Know.
[19] “Painful Sex in Women.”
[20] Weatherspoon, “Why Do I Have Lower Abdominal Pain During Sex?”
[21] Stephanie Yeager, “Easing Vaginal Penetration Pain,” 2015, https://www.paindownthere.com/blog/sexual-abuse-vaginal-nerve-pain.
[22] Ferger, Pain During Sex? What Women Need to Know.

  • January 8, 2020