Sexual Health Q&A

What are some causes of sexual pain for women?

Sexual pain affects almost three in four women at some point in their lives, according to the American College of Obstetricians and Gynecologists. The causes can be physical, psychological, or both. Here is a list of some of the most common causes:

Childbirth and breastfeeding. The genital area takes time to heal after childbirth. Stitches, lacerations, episiotomies, and infections can make the area tender. Hormonal changes associated with breastfeeding can lead to vaginal dryness and breasts may be more tender.

• Emotional and psychological issues. Depression, anxiety, stress, and fatigue can all affect a woman’s sexual response system. Some women are afraid of sex, feel guilty or ashamed about wanting intimacy, or embarrassed about their lack of experience. Past sexual abuse, problems in relationships and lack of trust can also take their toll. In these situations, it can be difficult for a woman to relax and become fully aroused. Physical tension may lead to pain.

Endometriosis. A woman’s uterus is lined with tissue called the endometrium. Sometimes, this tissue grows in areas outside of the uterus, like the ovaries or other parts of the pelvis.

• Medical conditions. Arthritis, diabetes, and cancer are some of the medical conditions that can contribute to painful sex.

• Ovarian cysts. These cysts are small sacs of fluid that form on the ovary. Usually, they are not cancerous, but they can still make sex painful.

• Pelvic inflammatory disease (PID). PID refers to inflammation of a woman’s reproductive organs, such as the uterus, fallopian tubes, or ovaries. Common causes of PID are gonorrhea, chlamydia, and bacterial vaginosis.

Provoked vestibulodynia (PVD). PVD affects the vestibule area, located where the vulva and the vagina meet. Women with PVD feel pain when the area is touched. This can occur during sex, but it might also happen when a woman inserts a tampon or has a gynecological exam.

Uterine fibroids. These tumors can grow inside or outside the uterus or in the uterine lining.

Vaginismus. Penetration is difficult – and sometimes impossible – for a woman with vaginismus, as pelvic muscles spasm and tighten, almost shutting the vagina.

• Vaginitis. It’s normal for women to have forms of yeast and bacteria in the vagina. When yeast and bacteria fall out of balance, however, the vagina can become inflamed, a condition called vaginitis.

Vulvar and vaginal atrophy. When a woman goes through menopause, her body produces less estrogen, a hormone important for vaginal health. Estrogen keeps the vagina moist and flexible. It also stimulates lubrication of the vagina when she becomes sexually aroused. When estrogen levels decline, the vagina may become dry and less elastic, making intercourse uncomfortable.

• Vulvodynia. This condition is marked by chronic pain in the vulva – the area surrounding the entrance to the vagina.

Women who are experiencing any kind of sexual pain are encouraged to see their healthcare provider. Some women feel awkward about discussing their sexual health with a doctor, but in many cases, the pain can be treated. Lubricants, medications, counseling, and pelvic floor physical therapy are all possible options. A physician can help a woman decide which treatment is right for her.