Sex is supposed to feel good, but sometimes it hurts. Pain before, during or after sex is called dyspareunia and can be caused by an infection, an injury or a condition like herpes sores or vulvodynia.
The pain you feel may be a simple fix, such as using extra lube or trying out different sex positions. But the pain can also signal a serious problem.
Yeast infections, like Candida vaginalis, cause inflammation and itching. Bacterial vaginosis (BV) happens when certain types of bacteria that normally live in the vagina grow out of control. This can cause pain down there and a fishy-smelling discharge. It can also be triggered by using the wrong lubricant with sex toys or an allergic reaction to a condom or sanitary product. Hormonal changes can also cause BV, like pregnancy or menopause.
Sexually transmitted diseases (STDs) also often cause soreness down there. If you’re experiencing itching, burning, or an abnormal discharge and think you might have an STD, talk to your doctor right away.
You can avoid painful intercourse in the future by practicing good hygiene, wearing cotton underwear that allows for airflow, and wiping from front to back after you use the toilet to reduce the spread of fecal bacteria. You can also use a warm compress or take a hot bath with Epsom salts to help soothe the area and ease pain.
For pain down there, try sitting or lying on an ice pack for about 10 minutes a day, says Dr. Greves. However, don’t apply ice directly to your vulva, as this can cause more irritation. And don’t engage in penetrative masturbation or partnered sexual activity until your soreness clears up. This could take a few hours or up to a day, but it should go away on its own and won’t require any prescription treatment.
Anal inflammation, or proctitis, is a serious condition that can be caused by sexually transmitted infections (STIs) such as gonorrhea and chlamydia, and herpes and genital warts. These infections can be passed to other partners during anal, oral, or skin-to-skin contact. This infection can be very painful and may cause a lot of blood in bowel movements or rectal discharge.
If you have this condition, you should stop all sexual activities until you see your doctor for treatment. Treatment for proctitis will include antibiotics. Infections from STIs can go away after a few weeks of treatment. But some STIs — especially herpes and genital warts — can become chronic and lead to permanent damage to the anal area.
Other causes of anal inflammation include a reaction to cow or soy milk as a baby, Crohn’s disease, or inflammatory bowel diseases such as ulcerative colitis. These conditions can also cause severe rectal pain and itching.
Infections of the anal and rectum can be life-threatening. If you have severe bleeding and pus in your bowel movements, or if you’re having lots of diarrhea, seek emergency medical care. These symptoms can be a sign of a serious problem such as an intestinal blockage or fistula (an abnormal connection between different parts of your digestive tract). If this happens, you’ll need surgery to remove the damaged section of your colon.
Pelvic Floor Inflammation
If your vulva hurts after sexual penetration, you may have pelvic floor dysfunction. The pelvic floor muscles support the bladder, uterus and bowel and help to prevent incontinence, prolapse and reduce urinary tract infections. The muscles can become weakened by pregnancy, childbirth, cancer treatment, chronic constipation or obesity.
If you have weak pelvic floor muscles, they can involuntarily spasm around the vaginal opening during sexual activity. This is called vulvodynia, and symptoms include pain during sexual intercourse, burning or stinging, itching, swelling and rawness of the vulva. It is possible to diagnose vulvodynia by doing a cotton swab test with a doctor.
Weak pelvic floor muscles can also cause internal organs like the bladder and uterus to slide down into the vagina. This is called a prolapse and can cause painful intercourse.
Pelvic muscle problems can also be caused by a condition called endometriosis, which is when tissue that looks like the uterus grows outside of the uterus in areas such as the abdomen or pelvis, according to the National Library of Medicine MedlinePlus resource. Another pelvic muscle problem is uterine fibroids, which are non-cancerous growths that form on or in the uterus and can cause pelvic pain during sexual intercourse.
Pelvic floor dysfunction can be treated with a combination of lifestyle changes, pelvic physical therapy and a trained mental health or sexual therapist. Your therapist can use techniques such as Thiele Stripping, where she finds an internal trigger point in the pelvic muscles and massages it directly.
Pain during sex is a problem that affects both men and women of all ages. It’s called dyspareunia and can be caused by a variety of factors. Some of the more common causes include lack of lubrication, injury or infection. Dyspareunia may also be caused by medical treatments like pelvic surgery or hysterectomy; some cancer treatments; or pelvic adhesions (tissue that becomes stuck together, often from surgical procedures or pregnancy).
Pelvic pain is more likely to happen in women than in men and can be caused by conditions including endometriosis (a condition where cells similar to the lining of the uterus grow outside the uterus in places such as the pelvis, ovaries, bladder, and rectum); fibroids; cysts; pelvic inflammatory disease; and adenomyosis. It can also be a symptom of an ectopic pregnancy (when a fertilized egg grows inside the fallopian tube instead of in the uterus). This is a medical emergency and requires immediate care from your OB-GYN.
Some kinds of pelvic pain, particularly in young people, can be a sign of sexually transmitted diseases such as chlamydia and gonorrhea. This can cause pain during sex, as well as other symptoms such as painful urination and abnormal vaginal discharge. Getting diagnosed and treated can help prevent long-term complications. In some cases, the cause of pelvic pain may be unknown, but physicians can recommend treatment strategies such as diet, exercise, and a change in lifestyle.