TOPIC

Feeling sore after sex? Why your vagina hurts and what to do about it

by Emma Scott · Nov 29, 2021

Reviewed Icon

Reviewed by Dr. Melanie Davis-Hall on Nov 29, 2021

Women in bed interlocking legs
There are actually four types of pain associated with sex and vaginas: superficial, deep, primary and secondary dyspareunia. Here's the lowdown on what could be making you sore after sex.

What’s the lowdown?

Summary of points regarding soreness after sex
Summary of points regarding soreness after sex

Painful sex (dyspareunia) is way more common than you might think, affecting up to 75% of women at some point in their lives. Unsurprisingly, studies show that experiencing painful sex can be associated with poor sexual, relationial, physical and mental health. We’re about to take a closer look at what some of the causes of this super important (but much overlooked) issue are, when to seek medical advice and treatment approaches.

Is painful sex normal? 

Nope, it’s not. Sex should not be uncomfortable. 

And, because painful sex could have such a broad range of underlying causes it’s important that you pay attention to any symptoms of pain or discomfort. 

Medically speaking, the official definition of painful sex (dyspareunia) is when there’s recurrent or persistent pain before or after intercourse. But, the bottom line is, any sensation of pain is a sign that your body is telling you something is wrong and should not be ignored. Please don’t worry about checking in with your GP if it’s a pretty new symptom for you. 

Where exactly is painful sex felt?

Anatomy 101: so the vulva refers to the entirety of the external genitals including the inner and outer labia, clitoris, vestibule of the vagina (vaginal opening) and urethra (where pee comes out). Painful sex can be associated with the vulva, vagina, pelvic area and lower back. Depending on where the pain is felt, this can provide a clue to the diagnostic approach as well as treatment options. 

Types of pain

There’s a few classifications of painful sex:

  1. Superficial: Localised to vulva or vaginal entrance
  2. Deep: Inside the vagina or lower pelvis, often associated with deep penetration
  3. Primary dyspareunia:  pain during sex since the start of sexual activity
  4. Secondary dyspareunia: pain occurs after some time of pain-free sex

You might also hear the term vulvodynia which can be associated with painful sex. However, the key difference is that this refers to vulval pain that can be triggered with or without sex (with no known cause). 

BTW, give lube some love  

If you aren’t fully aroused when you attempt to have sex it can be painful. This is normal, and may be due to too little foreplay. Using lube to reduce friction can make sex more fun and comfortable

Superficial causes of painful sex

These tend to be associated with the vulva and we’re going to explore the more common causes here: 

Skin conditions

  • Irritant or allergic Contact Dermatitis can lead to itching and pain during sex, triggered by chemicals or allergens in products used for the skin. In some individuals’ chemicals cause an immune response leading to itching and redness. Common products that can trigger include baby wipes, lubricants and feminine hygiene products, topical medications and latex in condoms. 
  • Lichen Sclerosus is a condition which can cause itchy white patches on the vulva that can result in a burning sensation, tightness and scarring that leads to painful sex
  • Sperm allergy is a rare allergic reaction causing redness and burning in the vaginal area, typically 10-30 minutes after sex. This can be triggered at any point, from any sexual partner.

 

Medication

  • The contraceptive pill can also be associated with vaginal dryness and therefore painful sex. Progestogen-only pills (minipill) and other forms of progestogen only contraception are thought to cause vaginal dryness in some users because they do not contain oestrogen, the hormone responsible for blood flow to the vagina and pelvic area, particularly during arousal. This in turn affects vaginal lubrication and can cause painful sex. However vaginal dryness has also been reported by users of combined contraception.
  • Some studies suggest antidepressants can lead to persistent vulva pain and lubrication problems

Psychosexual

  • Vaginismus is an involuntary tightening of the vaginal muscles which can cause difficulty and pain with penetration. This can be caused by stress around sexual contact, sometimes due to past experiences or bad relationships.

Infections

  • The extremely common fungal infection thrush could cause painful sex, with other symptoms including the characteristic cottage cheese-like discharge and itching
  • STIs (for example chlamydia, gonorrhea and herpes)…another reason to keep on top of regular testing
  • Pelvic Inflammatory Disease (PID) is caused by infection and can lead to a deep pain due to inflammation of the pelvic organs. Untreated STIs are one of the most common causes of PID

 

Deep pain and discomfort during sex

This kind of pain inside the vagina or within the pelvis could suggest a couple of different conditions.

  • Ovarian Cysts are fluid filled sacs within the ovaries, which often cause no symptoms and are completely harmless. However, in some cases they can rupture, which can be extremely painful and requires immediate medical attention. Ovarian cysts maycause pain during sex on the side of the affected ovary. 
  • Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other parts of the body, and can cause mild to excruciating pain up to 48 hours after sex. The reason for this is inflammation and endometrial tissue that has grown behind in the pelvis, the uterus and vagina being stretched and pulled during sex. 

Should I go to see my GP? 

Yes. 100%. Pain during or after sex is not a symptom that should have to be endured. If you’re experiencing superficial pain, it’s likely that you would have a physical examination. Depending on the cause, treatment could involve antibiotics for an infection or steroid creams for skin irritation. If the root is a psychological one, this could involve therapy or counselling. 

For pelvic pain / internal deep pain, your GP would probably refer you to a gynaecologist and arrange an ultrasound scan which can detect possible causes such as ovarian cysts. 

Talk to one of our friendly doctors

Tags
  1. The American College of Obstetricians and Gynaecologists. When Sex is Painful
  2. Mitchell, K. R., Geary, R., Graham, C.A et. al. Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey BJOG, 2017
  3. Sorensen, J., Muacevic, A., Adler, J.R. Evaluation and Treatment of Female Sexual Pain: A Clinical Review Cureus, 2018
  4. Arora, V., Mukhopadhyay S., Morris, E. Painful sex (dyspareunia): a difficult symptom in gynecological practice. Obstetrics, Gynaecology and Reproductive Medicine. 2020
  5. NHS UK. Why does sex hurt?
  6. Learnskin. 4 skin issues that cause vaginal pain during sex
  7. Herbenick, D., Reece, M., Schick, V. et. al. Women’s use and perceptions of commercial lubricants: prevalence and characteristics in a nationally representative sample of American adults. J Sex Med. 2014
  8. Unity Sexual Health. Psychosexual help
  9. Clinicaltrials.gov The Female Sexual Functions With Progestogen-only Contraception
  10. International Society for Sexual Medicine. What is a sperm allergy?
  11. The Gynae Centre Why Does Sex Hurt? 8 Reasons You’re Having Painful Intercourse (Dyspareunia)
  12.  Pharmacy Times What Are Common Causes of Dysparenia?
  13.  Endometriosis.org Painful Intercourse
  14.  NHS UK Endometriosis
  15.  The American College of Obstetricians and Gynaecologists. Disorders of the Vulva: Common causes of vulvar pain, itching and burning
  16. NHS UK. Vaginal dryness. 

Emma is a Pharmacology & Physiology graduate with a huge passion for women’s health. Outside of work you’ll find her with a nose in a book, open water swimming or charging around with her standard poodle Zeki!