11 Surprising Reasons for Painful Sex

Nearly three out of four women have pain during sex at some time during their lives—and one of these culprits may be the reason sex hurts.

You’re not having enough sex

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If you haven’t had sex for two years, it’s going to hurt, says Raquel Dardik, MD, clinical associate professor, department of obstetrics and gynecology at the NYU Langone Joan H. Tisch Center for Women’s Health. "It's like saying, 'I’m going to run three miles,' when you haven't done more than 10 steps in three years." Just like any muscle, regular activity can keep your vagina healthy and strong. “If you have regular intercourse, the vaginal walls stay stretched and the vaginal muscles stay flexible,” she adds. Here are other health secrets your vagina wants to tell you.

You’re stressed out

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Stress alone won't result in painful sex, but it does impact arousal. “If you’re thinking about moving in two weeks or you and your partner were just in a fight—whatever the stressor—it can decrease the amount of lubrication and muscle relaxation,” Dr. Dardik says. A bad case of the nerves has also been linked with pelvic floor muscle spasms and bacterial infections—both common causes of painful sex.

You’re going through the change

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Perimenopause and menopause top the list when it comes to below-the-belt issues that can affect sex drive. Are you aware of these perimenopause symptoms? Atrophic vaginitis is one of the most common culprits during this time of life. “Atrophic vaginitis essentially means the vaginal area doesn’t have enough estrogen—so the vaginal skin is not as stretchy and there’s not as much lubrication,” Dr. Dardik explains.

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You’re skipping lubricant

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Though menopause is generally blamed for vaginal dryness, many other factors can play a role. “If you’re not as aroused or are taking some medication, you can have less lubrication than you normally have,” Dr. Dardik says. The result: increased friction and pain during or after sex, she explains. If you’re dry down there, a little lube can go a long way. Avoid oil-based lubes like petroleum jelly, however, as they can lead to bacterial infection.

You have a bacterial or yeast infection

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Once again you can blame those fluctuating hormones. During menopausal years, bacterial or yeast infections are more common. “Often times women don’t know they have an infection,” says Dr. Dardik, “but they know that it feels very uncomfortable and irritated when they do have intercourse.” Here's why UTIs can be worse during menopause.

You have pelvic-floor dysfunction

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Pelvic-floor dysfunction (PFD) is hard to diagnose yet surprisingly common. By some estimates, it affects one in three American women. During intercourse, the pelvic floor—the melon-size web of muscles, ligaments, and nerves that support the uterus, vagina, and area around the rectum—can spasm and cause searing pain. Hormonal declines in menopause and loss of muscle mass with age are common culprits. Here's how pelvic floor dysfunction can be treated.

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You have digestive problems

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For women who have irritable bowel syndrome (IBS) or Crohn’s disease, the bowel is right next to the uterus so any type of movement of the uterus can trigger inflammation and irritation of the bowel. “People may say 'It hurts when I have sex' and point to their abdomen rather than their external organs or their vagina,” Dr. Dardik notes. Try these tips to relieve IBS naturally.

You have endometriosis

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According to a recent study by researchers in Italy, more than half of all women with endometriosis (a condition where endometrial tissue grows outside the uterus) experience intense pain during sex. The location of the endometriosis determines the level of pain; for instance, if the endometriosis is behind the vagina and the lower part of the uterus, the pain may be more intense.

You’re in a bad state of mind

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It’s not too surprising that your emotions play a role—fear, guilt, shame, embarrassment, or awkwardness about having sex can make it hard to relax, notes the American College of Obstetricians and Gynecologists (ACOG). And when you can’t relax, arousal becomes difficult, and pain may result.

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Your partner has erectile dysfunction

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If your partner is among the one in five men ages 20 and up with erectile dysfunction (ED), you may be having some discomfort down there during sex. ED treatments, like Viagra, Levitra, or Cialis, can delay his orgasm, which may cause long, painful intercourse for some women, according to ACOG. ED can also be a symptom of clogged arteries.

You’ve ignored the pain

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If painful sex becomes a chronic problem you can start having a physical reaction every time you have intercourse. This is because you’re anticipating that it’s going to hurt, Dr. Dardik explains. And now you’re dealing with the psychological component of pain in addition to the initial cause. “Don’t pretend it’s going to go away,” she urges. See your gynecologist and find out how to make sex enjoyable once again. Here are other topics patients are too embarrassed to ask their ob-gyn.

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