Pain During Sex: Causes and How It Impacts Fertility

Woman Touching Abdomen In Pain While Sleeping On Bed At Home

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In This Article

Sex shouldn’t be painful. However, nearly three out of four women will experience some sort of painful sex in their lifetime. Painful sex (also known as dyspareunia) can interfere with getting pregnant. For one, painful sex may indicate an underlying medical condition that is negatively affecting your fertility.

Second, painful sex itself can make getting pregnant difficult to impossible. If you can’t tolerate sexual intercourse, especially around the time of ovulation, you won’t be able to get pregnant. Learn what's normal and what's not when it comes to sexual pain, what medical conditions may cause painful intercourse, and what you should do if you're facing this problem.

Note: While this article is focused on sexual pain in women, it’s important to state that men can also experience sexual pain. Sexual pain in men can also cause difficulties with conception. 

Is Pain During Sex Ever Normal?

Occasional discomfort during sex can be normal. For example, the first time a woman has sex may involve some discomfort. This may be due to inexperience and anxiety for both partners. However, a first sexual encounter isn’t supposed to hurt. The myth that sex for the first time “should” cause pain and bleeding is untrue. Even first time sex can feel good.

Another possible normal cause of painful sex is having sex in an uncomfortable position. Positions that allow for deep thrusting can lead to the cervix getting bumped, which can be painful. Changing positions or avoiding uncomfortable ones can resolve this issue easily.

Another possible normal cause of discomfort during sex is not taking enough time for foreplay. The reproductive organs actually shift during sexual arousal. The cervix moves up and back when you're turned on, and this shift makes sex more comfortable.

With all that said, pain and occasional discomfort are not the same things. Pain that is consistent or prevents you from having sex is another ball game altogether.

Causes of Painful Sex and Infertility

The medical term for painful sex is dyspareunia. Painful sex can be a symptom of an underlying medical condition. Some of those conditions can negatively impact fertility or make staying pregnant more difficult.

There are several possible causes of painful intercourse that may also impact fertility:

  • Adhesions: Adhesions are bands of tissue that can lead to pain during sex, as well as infertility and repeated miscarriage. Also known as Asherman's syndrome, uterine adhesions can be caused by intrauterine procedures, like a D&C (sometimes performed after a miscarriage), or after a hysteroscopic myomectomy. Discuss this issue with your doctor.
  • Endometriosis: Painful sex with endometriosis may be worse around ovulation and near menstruation. This pain is usually felt deeper, rather than upon entry. Other endometriosis symptoms may include severe menstrual cramps, pain on urination or defecation (especially around your period), or general pelvic pain.
  • Fibroids: Fibroids are non-cancerous tumors that grow on or inside the uterine walls. They can cause painful intercourse. Fibroids can occur anywhere on the uterus, but those that grow by the cervix are most likely to cause painful intercourse. They may also lead to spotting during or after sex.
  • Intact or especially tight hymen: The hymen is a thin membrane that encircles the vaginal opening. It doesn't typically cover the entire opening but has a small hole that stretches out over time. Sometimes, the hymen doesn't naturally stretch or is unusually thick or tight, causing painful intercourse. Surgery can correct this without impacting fertility.
  • Ovarian cysts: Most ovarian cysts will eventually disappear on their own, but 5 to 10% may require surgery. Ovarian cysts don’t usually cause painful sex, but more problematic ones can. A cyst alone is not necessarily a fertility issue, but cysts can be caused by conditions (like PCOS and endometriosis) that do impact fertility.
  • Pelvic Inflammatory Disease (PID): PID is another possible cause of painful sex, typically pain felt deeply as opposed to upon entry. PID symptoms can be similar to endometriosis and other diseases.
  • Vaginal agenesis: Affecting 1 in 5,000 women, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, or vaginal agenesis, occurs when the vagina is not fully developed. Surgery can create a “neovagina,” allowing for a normal sex life. Malformations or absence of a uterus make pregnancy impossible. Some women can still have a biological child via surrogacy.
  • Vaginal dryness: This can range from a slight discomfort issue to a pretty intense pain, especially when combined with overall low estrogen levels. This pain tends to occur upon vaginal entry. A lack of cervical mucus can indicate hormonal imbalance, but it can also occur due to medication side effects.

While infertility related to these conditions may not easily be dealt with, the pain caused by them should be treatable with medications, physical therapy, lifestyle changes, or surgery. Don’t assume you have to learn to live with the pain. Talk to your doctor about your options.

When Painful Sex Makes It Difficult to Get Pregnant

Sometimes, the cause for painful sex doesn’t directly affect fertility—but the fact that sex is painful makes getting pregnant difficult to impossible. Two common sex pain conditions are vulvodynia and vaginismus. Vulvodynia is pain in the vulva area or near the entrance of the vagina. The pain may be present all the time, sometimes, or just when touched. 

Between 6 and 20% of women experience vulvodynia for up to three months at some point in their lifetime. It’s unclear what causes vulvodynia. Treatment frequently requires some experimentation. What works for one woman may or may not work for another. 

Another common sex pain condition is vaginismus. Women with vaginismus experience pain upon penetration of the vagina. Some describe the pain as a “tearing” or feeling as if they are being “ripped open.” There are no reliable estimates for the number of women who experience vaginismus because it frequently goes under-reported, making it difficult to research.

The pain condition may seem to always have been present or may begin after months or years of pain-free experiences. Like vulvodynia, vaginismus is not quite understood. It was once thought to be an involuntary contraction of the vaginal muscles, leading to pain during penetration. However, this theory has been called into question.

Treatment of both conditions may require help from multiple specialists. Medical professionals who may be able to help include gynecologists, physical therapists, pain specialists, sex therapists, and psychologists.

Discussing Painful Sex With Your Doctor

Many women do not discuss painful intercourse with their doctors. According to one study, in a group where up to 36 percent of women reported dyspareunia, only 15% had discussed the problem with their doctor. You should talk to your doctor about your pain. You do not need to suffer. There are possible treatments available.

When you go to your appointment, be ready to share when, how, and where it hurts. This will help your doctor determine the possible cause. If talking about the pain with your doctor would be too difficult, consider writing down the answers to the following questions ahead of time.

  • Are gynecological exams painful, too? (Please tell your doctor if so, as she may be able to do things to make it more comfortable for you.)
  • Are you breastfeeding? Did the pain start after childbirth?
  • Are you interested in alternative options for conception, like insemination?
  • Does sex hurt during entry? Or is the pain a deeper kind of pain?
  • Does the pain occur only during sexual intercourse? Do you experience it others times as well?
  • Does the pain seem to occur or worsen during certain times of your cycle? For example, does it hurt more around ovulation? Or around menstruation?
  • If it’s a deeper kind of pain, does sexual position matter? Is the pain sharp or dull?
  • If penetration is what causes pain, does it matter what is being inserted into the vagina? For example, can you use tampons? Does finger insertion also hurt or only penile insertion?
  • If you hope to get pregnant, has the pain prevented you from having sex frequently enough to conceive?
  • Is the pain different depending on what is being touched? For example, do you experience pain in the vulva area, before penetration is even attempted?

A Word From Verywell

Pain during sex is not your fault. It is not something you should feel ashamed of. It’s a medical condition and doesn’t define you. Unfortunately, not every doctor knows how to properly respond to or treat pain conditions. If your doctor can't help or doesn't take you seriously, go to someone else. Keep speaking up until you find the help you deserve.

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Article Sources
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  4. Fontana L, Gentilin B, Fedele L, Gervasini C, Miozzo M. Genetics of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Clin Genet. 2017;91(2):233-246. doi:10.1111/cge.12883

  5. Vieira-baptista P, Lima-silva J, Pérez-lópez FR, Preti M, Bornstein J. Vulvodynia: A disease commonly hidden in plain sight. Case Rep Womens Health. 2018;20:e00079. doi:10.1016%2Fj.crwh.2018.e00079

  6. Perez, Samara, Brown, Claudia, Binik, Yitzchak. Vaginismus: When Genito-Pelvic Pain/Penetration Disorder Makes Intercourse Seem Impossible. Commentary: Hypoactive sexual desire in men. 2016. pp.273-285. doi:10.1007/978-1-4939-3100-2_24. 

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