Dyspareunia: Painful sex for women, causes, symptoms & treatment

Dr Louise Hayes Dr Louise Hayes MBBS (Lond.) FRCOG, Consultant in Gynaecology & Women’s Health Published April 24th 2023

Sex can be one of life’s great pleasures but occasionally, it can be painful and cause worry for both partners. Painful sex is more common in women, with around 3 out of 4 affected at some point in their lives. If you’re feeling pain during, or after sex, don’t be embarrassed to talk to a doctor, as there may be a simple solution.

When to see a doctor

Pain during or after sex is known as dyspareunia and there are many reasons why women experience it, including infections, illness, a physical or a psychological problem. Don’t be embarrassed to discuss it with a doctor who is used to dealing with things like this. Remember, your symptoms might be your body’s way of telling you it needs help.

What are the reasons why you might experience painful sex?

  • An infection down below
  • Thrush
  • Cystitis
  • Sexually transmitted infections (STIs)
  • The effects of menopause
  • Not being aroused enough
  • Irritated or inflamed skin
  • Underlying medical causes, including
    • Vaginismus
    • Pelvic inflammatory disease (PID)
    • Endometriosis
    • Fibroids

An infection down below

There are two types of non-sexually transmitted infections that may cause painful sex:


This is an infection caused by the fungus candida albicans. Thrush is very common in women, with around 75% experiencing it at some point in their lives.

Symptoms of Thrush

Symptoms of thrush in women include itching and soreness – particularly around the entrance to the vagina – vaginal discharge and sometimes discomfort during or after sex.

Causes of Thrush

  • Your skin is irritated or damaged.
  • You use products that irritate the skin such as perfumed products, bubble baths, or vaginal washing products.
  • You’ve recently taken antibiotics.
  • You have poorly controlled diabetes.

Treatment of Thrush

Thrush can be treated with over-the-counter antifungal pessaries or cream. You may be able to prevent further episodes of thrush by avoiding soap and shower gels on your genital area, wearing cotton underwear and avoiding tight jeans or leggings. Although it’s not an STI (Sexually Transmitted Infection) It’s best to avoid having sex while you have thrush. If symptoms persist, you should see a doctor.


Around 60% of women will experience a urinary tract infection (UTI) like cystitis at some point.

Symptoms of cystitis

Symptoms of cystitis include a burning sensation when trying to pee, feeling like you need to go to the toilet more often, cloudy or smelly urine and sometimes painful sex.

Causes of cystitis

Causes of cystitis often include:

  • Having sex.
  • Wiping your bottom from back to front after going to the toilet.
  • Urinary catheters (a tube in your bladder used to drain urine).
  • Using spermicide with contraception.
  • Conditions that block the urinary tract, such as kidney stones.
  • Being pregnant.

Treatment of cystitis

Most mild cases will clear up on their own or with over-the-counter products from a pharmacy. But if you suffer from recurring infections, or you have a temperature over 38C and pain in your lower back or side, you should see a Doctor as it may be a sign of a kidney infection.

Sexually transmitted infections

STIs like chlamydia or gonorrhoea can cause symptoms of painful sex, bleeding after sex (chlamydia), vaginal or penile discharge, pain when passing urine or for women, bleeding between periods (gonorrhoea). Sometimes STIs have no symptoms at all. If you suspect you have an STI, it is important to see a Doctor, Gynaecologist or attend a women’s health clinic for tests and treatment.

The effects of menopause

Painful sex is one of the most commonly reported problems in post-menopausal women. During menopause, falling oestrogen levels lead to reduced vaginal secretions, which can cause dryness in the vagina, making sex uncomfortable or even painful. You may also experience these symptoms in the years leading up to menopause. Lubricants can help improve this dryness and can be bought from a pharmacy. But if symptoms persist, despite lubricants, you may wish to discuss other treatments with your GP such as topical hormone replacement therapy (HRT).

Lack of arousal

Painful sex may simply be down to lack of arousal. When a woman is aroused she produces more vaginal secretions, and this lubrication makes penetrative sex easier.

If you’re not aroused, you may not have produced enough natural lubrication to make sex comfortable. You can buy vaginal lubricants from a pharmacy to help with this, but it’s also important to explore and discuss any sexual problems or lack of arousal with your partner to see if there are things that you can do together to improve this. If there are other issues or anxieties in your life that are affecting your libido, it’s important to address these or talk to a Doctor or counsellor.

Irritated or inflamed skin

Skin may become inflamed due to allergies or irritants like latex condoms, soaps or certain spermicides. If you have a skin condition such as eczema or dermatitis, and it’s present around the opening to the vagina, it may cause dry, cracked skin that can lead to painful sex.

Silicone-based lubricants can help in the short term, but it’s important to get the underlying skin condition treated by a Doctor.

An underlying medical cause

Painful sex is often the result of medical conditions. That’s why it’s important to get any symptoms checked by a doctor.


This is the automatic tightening and contracting of the muscles of the vagina at the point of intercourse, making sex either impossible or painful. It’s thought to be one of the most common female psychosexual conditions, although figures vary as to how many women suffer from it.

“Vaginismus is an uncontrolled reaction and often happens due to fear of penetration. Treatment usually focuses on psychological help, relaxation techniques and exercises to help you become accustomed to penetration”.

Pelvic inflammatory disease (PID)

Although it’s not known exactly how many women suffer from PID, it usually affects women under 24 years of age. Pelvic inflammatory disease is inflammation in the pelvis, normally caused by an infection. It may cause pain during sex, pelvic or abdominal pain, a temperature, vaginal discharge or vaginal bleeding. Pelvic inflammatory disease needs assessment and treatment by a Doctor, usually with antibiotics.


Around 1 in 10 women — an estimated 176 million worldwide — suffer with endometriosis. It’s a condition where cells resembling those in the uterus grow in other places in the body, and can cause painful sex, painful periods and abdominal pain. Whilst there’s no known cure, there are different methods of treatment to manage the symptoms, including surgery, hormone treatment and pain relief.


These are benign growths in the womb which may cause no symptoms. But in some women they can cause painful sex, particularly if the fibroids are large and located close to the cervix. Fibroids may also cause heavy menstrual periods, lower back pain and frequent urination. Treatment usually involves medicine from a Doctor but if your symptoms are particularly severe, surgery may be an option.

Meeting with a professional is always recommended when concerned.

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