We usually expect sex to feel good. Of course, sometimes a little pain is good, if that’s what you’re into. But unexpectedly painful sex can seriously kill the mood. It also may be a sign of an underlying health issue. “This is usually concerning to me as a gynecologist. Sex should not be painful,” Tami Rowen, M.D., an ob/gyn at UCSF Medical Center specializing in sexual health concerns, tells SELF.
Aside from some intentional kink, there are perfectly everyday reasons that sex might hurt a little. For instance, if you’re not adequately aroused, you may be too dry down there or feel your muscles are a little tight. That’s where foreplay and lube can be necessary. Every now and then, sex can have a slight ouch-factor for no identifiable reason. Rowen says this is common, and can be related to sensitivity of the skin, muscles, cervix, and uterus at any given time. “Most often it’s also positional, so trying different positions can be helpful,” she says.
If you’re feeling pain that’s not just an every once-and-a-while thing, and you’re adequately lubricated, one of these sexy-time saboteurs could be to blame.
“Deep pain [during sex] can signal endometriosis,” Rowen says. Endometriosis is a condition where the tissue that normally lines the uterus grows elsewhere in the body. One of the biggest symptoms is pain, especially during menstruation and intercourse, caused by bleeding and swelling of the endometrial growths.
2. Ruptured cyst
Oftentimes, fluid-filled cysts on the ovaries develop during ovulation, but they typically go unnoticed and resolve on their own. Sex can sometimes cause these to rupture, resulting in a sudden, sharp pain. “Pain on deep penetration that is very severe can signal a ruptured cyst,” Rowen says. “That should be evaluated before having sex again, but will usually resolve on its own.” If pain is accompanied by bloating, nausea, and bleeding that isn’t your period, see your doctor. It could be a blood-filled cyst (called an endometrioma) that burst, which can cause bleeding both internally and externally.
Uterine fibroids are benign tumors that grow in the walls of the uterus. According to the Center for Uterine Fibroids, over 70 percent of women will develop uterine fibroids at some point, although they only cause symptoms in about 25 percent of them. Symptoms include painful sex, heavy periods, constipation, and abdominal bloating.
Cervicitis, or inflammation of the cervix, can happen for many reasons. STIs like gonorrhea, chlamydia, herpes, HPV, and trichomoniasis, or a yeast infection or bacterial vaginosis can make the cervix inflamed and extra sensitive. An allergy to latex or spermicide, or any other chemical product that goes into your vagina, can also cause cervicitis. When the tissue is extra sensitive, penetration can be extremely painful.
5. Vaginal dryness
Inadequate lubrication make sex uncomfortable and can cause irritation. Dryness can be the result of numerous things, like hormonal changes that come with menopause, breastfeeding, or changing your birth control method. But some chronic health conditions that impact mucous membranes, and dermatological issues in the vagina can also be to blame. If you’re having trouble lubricating, talk with your gyn about what might be causing it.
The underdiagnosed medical condition causes involuntary spasms of the muscles surrounding the vagina, which can make it excruciatingly painful or impossible to insert anything—including a tampon. If it ever hurts to simply insert something into your vagina, see a doctor.
7. Pelvic inflammatory disease
PID is an infection of reproductive organs that usually happens when an STI goes untreated and spreads. Sometimes, it can cause pain. Depending on what causes it, PID can also be symptomless. If left untreated for too long, it can ultimately lead to infertility.
Chronic vulvar pain, or vulvodynia, is often described as a burning or stabbing pain in the inner and outer labia around the opening of the vagina. The cause is unknown, but applying pressure (read: having sex) to the area typically results in discomfort and pain. In some cases, even sitting for too long or wearing tight pants can make the area hurt. For some women, this condition can develop later in life and make sex painful when it wasn’t before.
“When the pain is getting in the way of your relationship, if there is any tearing at the entrance, bleeding that doesn’t improve quickly, or pain that persists even when sex is finished,” it’s time to see a doctor, says Rowen. Sex shouldn’t be painful, and if it is, getting to the bottom of why is the first step to make it enjoyable again.