Pain during sex

In short

  • Some women feel pain when a penis or a finger enters the vagina. Sex should not hurt — pain is not “part of it”.
  • For sex without pain, you need to be sexually aroused: arousal makes your vagina moist and relaxes your pelvic floor.
  • If that does not happen, sex is often painful.
  • It then helps to learn to feel arousal again by having sex without pain: being intimate, but without a penis or finger entering the vagina.
  • If the pain continues, make an appointment with your GP. Treatment is possible.

What is pain during sex?

Pain during sex means that it hurts when a penis or a finger enters the vagina. People sometimes think that pain is “part of it”. That is not true.

You may feel pain at the entrance of your vagina (the vulva) as the penis goes in — usually a burning pain. The pain can also be deeper in your vagina or in your lower abdomen, or come after sex. The pain can make you dread letting a penis or finger enter your vagina more and more.

In some women the pain is there (almost) all day, also when sitting, sometimes with a throbbing feeling at the entrance of the vagina. This mostly happens in women in or after the menopause.

Pain during sex (painful intercourse) is common: about 20 in 100 women sometimes have it, about 5 in 100 women often have it, and about 11 in 100 women under 25 often have it.

What causes pain during sex?

Pain during sex often happens when you are not (yet) aroused enough: your vagina is not moist enough, your labia have not yet become fuller, and the muscles of your pelvic floor may be tense. There are five common cause groups, and often several play a role at once:

  • Not aroused enough (yet). Difficulty becoming aroused can come from stress, fear of pain, an unpleasant experience, or how you and your partner have sex.
  • Fear of pain. After pain once, you can become afraid of the next time; the fear itself tenses the pelvic floor and makes new pain more likely.
  • Pelvic floor problems. In many women the pelvic floor muscles tense up too quickly.
  • Skin problems and infections, such as eczema, a yeast infection (thrush), the skin condition lichen sclerosus, a bladder infection, or thin or dry skin.
  • The menopause. The body makes less oestrogen, so the inside of the vagina becomes thinner and less supple; becoming moist takes longer.

There is not always a clear cause, and one cause can lead to another. For example: pain from a yeast infection can make you afraid of pain, the fear reduces your desire and arousal, and sex while not aroused enough causes more pain again.

Difficulty becoming aroused can be caused, for example:

  • by stress
  • by an unpleasant experience with sex or a physical examination
  • by fear of pain
  • if you feel guilty, for example because your partner wants sex more often than you do
  • if your parents taught you that sex is bad or dirty
  • if you are not happy with the way you and your partner have sex
  • if you do not dare to say that you do not want sex
  • if you make too little time for sex

  • If you have had pain during sex once, you can become afraid of the next time. You worry about it.
  • The fear and worry reduce your desire for sex. You become more and more tense before sex.
  • Because of the fear, the muscles of your pelvic floor tighten. This happens automatically, without you wanting it to.
  • It becomes harder and harder to get aroused. It takes longer before your vagina is moist enough and your labia are full enough.
  • If you have sex anyway before your vagina is moist, you usually have pain again straight away. The tension in your pelvic floor muscles keeps building.
  • The fear and worry keep getting worse. They reduce your desire for sex more and more.
  • This does not mean your desire for sex is “broken”. You can still become aroused, but it takes longer.

In many women, the muscles of the pelvic floor tense up too quickly. This can be caused by the same things that make it hard to become aroused: stress, an unpleasant experience with sex or a medical examination, fear of pain, feeling guilty, having been taught that sex is bad or dirty, not being happy with the way you and your partner have sex, not daring to say that you do not want sex, or making too little time for sex.

Pelvic floor problems can also be caused by:

  • giving birth
  • some sports, such as horse riding or gymnastics
  • holding in urine or stools for too long

It is not always clear what causes pelvic floor problems.

In and after the menopause you can become just as aroused as before, and your vagina can become just as moist — it often takes longer, though. This is because your body makes less of the female hormone oestrogen during the menopause. The inside of your vagina becomes thinner and less supple, which can cause dryness, irritation and itching. If you take more time to become moist, sex remains perfectly possible.

How is pain during sex treated?

Pain at the entrance of your vagina (the vulva) can be very distressing, and treatment is possible. You can apply a soothing and protective ointment or cream. In addition, these treatments can help:

  • pelvic floor physiotherapy
  • treatment by a sexologist or psychologist

Gynaecologie Amsterdam works closely with the Minerva physiotherapy practice and with the sexologists Schade and Jansen, and will preferably refer you to them.

When should you see a doctor about pain during sex?

Sex should not hurt. If the pain continues, make an appointment with your GP; you can then think about treatment. If you come to Gynaecologie Amsterdam with this problem, we take plenty of time for your complaint, examination, explanation and treatment.

Frequently asked questions

Is pain during sex normal?

No. People sometimes think that pain is “part of it”, but that is not true — sex should not hurt. It is common, though: about 20 in 100 women sometimes have pain during sex, and about 5 in 100 women often have it.

Why does sex hurt when I am not aroused enough?

Arousal makes your vagina moist and relaxes your pelvic floor (or it is already relaxed). If you are not aroused enough yet, the vagina is not moist enough, the labia have not become fuller, and the pelvic floor muscles may be tense — sex is then often painful.

What can I do myself about painful intercourse?

Learn to feel arousal again by having sex without pain: be intimate, but without a penis or finger entering the vagina. For pain at the entrance of the vagina you can apply a soothing and protective ointment or cream. If the pain continues, see your GP.

Which treatments help against pain during sex?

Pelvic floor physiotherapy and treatment by a sexologist or psychologist can help, alongside a soothing ointment or cream. Gynaecologie Amsterdam works closely with a pelvic physiotherapy practice and with sexologists, and can refer you.

We made this page using the Dutch GP guideline on sexual problems (NHG-Standaard Seksuele klachten) and the Dutch gynaecology guideline on the diagnosis of vulvodynia (NVOG).

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