Pain in Women During Sex (Dyspareunia): Causes and Care
By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by the DLHA Team.
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A young black couple looking in surprise at one another. Image credit:
Mrs. B had a vaginal delivery in which she sustained multiple injuries. The injuries were repaired, and she was discharged home a few days later. She soon began experiencing extreme pain during sex, and intercourse became almost impossible. Because of the nature of the challenge, she refrained from consulting a doctor.
Over time, this placed a significant strain on her relationship with her spouse and even made conception difficult. At that point, it became clear to her that she needed help. She presented at the hospital and was reviewed by a gynaecologist. A diagnosis of gynaetresia (vaginal stenosis or narrowed vagina) was made. She later had corrective surgery, which brought an end to her challenges.
This case of Mrs. O is a little different. She was married to a clergyman and reported experiencing extreme discomfort during sex, which placed a great strain on their relationship. She tried to discuss this with her husband, but he didn’t appreciate her symptoms. Because of the sensitive nature of the complaint and the fact that her husband was well known in the city, she had to travel to another city more than 500 km away to seek medical help.
Even in the new city, her problem did not receive the attention she desired. After seeing many doctors, they all assumed she had a mental health issue, and she did not receive any medical help. Frustrated, she returned to her city and began considering a divorce
These two case scenarios are real-life examples of the challenges women face due to painful sex.
Sexual health is a topic many people shy away from discussing, even in academic circles. One of the sexual disorders that rarely get attention is pain during sex, known as dyspareunia. This refers to persistent or recurrent pain in the reproductive organs during or after sexual intercourse.
It is not a common topic of discussion. Because of this, many women experiencing pain during sex suffer in silence, feeling too ashamed to report it. This is particularly common in the African context. In many cases, such complaints are dismissed as being due to mental health issues. In addition, healthcare practitioners often do not ask about this issue during patient visits (consultations).
So, are there issues with the reproductive system that could lead to painful sex? Can this condition be treated? This article aims to provide more insights into dyspareunia or painful sex and what can be done about it.
Beyond the physical discomfort, dyspareunia can lead to significant psychological and emotional distress for both the affected individual and their partner.
This pain may occur at the entrance of the vagina, deep within the vaginal canal, or in the pelvis. [1]
Dyspareunia or pianful sex is classified into two types:
It may also be:
The problem of dyspareunia is often confused with another condition called vulvodynia. However, while dyspareunia is always associated with sexual activity, vulvodynia may occur with or without sex.
Painful intercourse is often underreported, as its frequency varies with geographical location, cultural beliefs, and religious norms. Globally, it is documented to affect between 3%-18% of individuals. It affects women more than men.
A study conducted among women attending a gynaecological clinic in Abakaliki, Nigeria, revealed that close to 1 in 3 (36%) reported experiencing pain during sex. In another study carried out in Morocco, nearly 1 in 2 patients (40.33%) reported having painful intercourse.
Certain factors increase the risk of painful sex. These include:
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Fig. 1: Causes of painful sex (Dyspareunia). Click on image to enlarge.
Painful intercourse can result from a variety of factors. [2,3] While some causes are acquired, others are present from birth.
Some may lead to superficial pain, while others result in deep pelvic pain. In certain cases, psychological issues may also contribute (see fig. 1).
This can be caused by inborn anomalies in the reproductive organs such as imperforate hymen, vaginal atresia (closed or absent vagina), vaginal septum (a birth defect that causes a membrane or tissue to divide the vagina into two separate canals), and vaginal stenosis (narrowed and shorter vagina).
A narrow vagina can also be acquired through genital tract injuries from childbirth or female genital mutilation. In other cases, it may result from surgeries like hysterectomy( removal of the womb) or cancer treatments involving radiotherapy.
In some parts of Africa, women have been known to insert caustic substances including tobacco leaves into the vagina either as a treatment for infertility or as a means of narrowing the vagina after childbirth to enhance sexual performance.
Vaginal dryness results in pain or discomfort during sex. As a woman approaches or reaches menopause, the level of oestrogen (the female sex hormone) reduces. This results in reduced lubrication of the vagina leading to vaginal dryness (atrophy) and painful intercourse.
Other factors that can cause vaginal dryness include:
Infections in the vulva, vagina, bladder (cystitis), and urethra (urethritis) can lead to painful intercourse.
The vaginal infections include:
These infections can cause excoriations and lesions around the vulva and vagina.
Some vulvar skin diseases like lichen planus, lichen sclerosus, and psoriasis can cause wounds around the vagina and vulva, leading to irritation and painful intercourse. Lichen sclerosus affects the texture of the vulvar skin, making it more prone to tearing.
Vaginismus is the involuntary contraction of the muscles in the lower part of the vagina. This interferes with coitus and causes distress and interpersonal difficulties.
It is mainly caused by psychological factors and is often associated with emotional distress, fear, or anxiety arising from relationship problems or past experiences such as sexual abuse or rape [4].
During vaginal delivery, a woman may be given a cut to widen the vaginal outlet (episiotomy), or she may sustain a tear during childbirth. Both can result in painful intercourse.
Other causes of vaginal tears, such as those from intimate partner violence, can also lead to pain during sex.
Endometriosis occurs when tissues resembling the lining of the womb grow outside the womb. It affects 1 in 10 women worldwide. The current view from limited studies is that endometriosis is rare in African women. This may happen because of multiple childbirths or because the condition is often missed in Africa due to challenges in making a diagnosis. Women with endometriosis are two to three times more likely to avoid sex due to pain. These tissues can be found in organs such as the bladder, ovary, intestines, and other parts of the pelvis [5]. When the deposits are located in areas of the pelvis close to the vagina, they can cause painful intercourse, especially during deep penetration.
PID is the inflammation of the womb, fallopian tubes, and ovaries due to infections. It is usually linked to sexually transmitted infections that ascend from the vagina into the upper reproductive tract. PID is associated with lower abdominal pain, vaginal discharge, and pain during sex.
Uterine fibroids are non-cancerous growths in the muscle of the womb. They are more commonly seen in Black women. When present, fibroids can cause abdominal protrusion, abnormal menstrual bleeding, and pain during intercourse( [6]
Ovarian cysts are fluid-filled sacs in the ovary. When complicated by infection, rupture, or bleeding, they can lead to pelvic pain and painful intercourse.
Also known as bladder pain syndrome, this condition is associated with frequent urination, an urgent need to urinate, and pelvic pain in the absence of infection in the urine. It usually affects women of reproductive age and is associated with painful intercourse.
These structural changes can contribute to pain during sex.
Painful intercourse may also result from issues outside the reproductive organs, including:
If you experience painful intercourse, it is important to see your doctor.
Your doctor will likely do the following:
After this, the doctor will determine the best course of treatment.
Your doctor will listen to your complaints and ask detailed questions to understand the possible cause of the pain. These may include:
After explaining the structure of your pelvic organs and the nature of the checks to be done, your doctor will:
Your doctor may also take some samples for laboratory analysis:
Further tests may include:
The treatment is tailored to what the doctor finds. There are three main approaches to treatment:
Because of this, treatment often requires a team of specialists, such as:
Sex therapy may be helpful to address sexual patterns, the absence of foreplay, and sexual positions that increase the risk of pain during intercourse. These can help reduce discomfort.
Cognitive behavioural therapy (CBT) is particularly important in initiating behavioural changes that improve symptoms. It helps you understand the relationship between your thoughts, feelings, and behaviours and teaches you how to change harmful thought patterns that may increase the risk of painful sex.
Current or past emotional hurts can contribute to painful intercourse. Addressing the root of these emotional problems and finding meaningful solutions can lead to the resolution of symptoms in some cases.
Pelvic floor physiotherapy tones the muscles and relieves symptoms caused by vaginismus and prolapse of the pelvic organs. You can do this on your own through Kegel exercises or with the help of a physiotherapist. Use of vaginal dilators may also be recommended to gently increase the vaginal capacity.
Surgery may be the last resort in some cases, or the only option in others.
It may be required in:
While not immediately life-threatening, untreated painful intercourse can lead to:
Because of the sensitive nature of sexual problems, painful intercourse often goes unreported for a long time. Healthcare providers must create a safe and trusting environment where patients feel comfortable discussing such issues. A knowledgeable and empathetic practitioner can encourage disclosure and guide appropriate treatment. Managing this condition requires a multimodal and multidisciplinary approach to improve outcomes for patients. If you're experiencing painful intercourse, don’t be ashamed to speak up, doing so is the first step toward getting the care you deserve
1. Sorensen J, Bautista KE, Lamvu G, Feranec J. Evaluation and treatment of female sexual pain: a clinical review. Cureus 2018 Mar. 27;10(3):e2379. doi: 10.7759/cureus.2379. Available from here.
2. Tayyeb M, Gupta V. Dyspareunia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Last updated: June 5, 2023. [Cited 2025 Apr 3]. Available from here
3. Hrelic, Debra A. Wax, Erin M Saccomano, Scott J.. Dyspareunia: Etiology, presentation, and management. The Nurse Practitioner 2023 Mov.; 48(11):p 27-34, DOI: 10.1097/01.NPR.0000000000000111 Available from here.
4. Chalmers KJ. Clinical assessment and management of vaginismus. Aust J Gen Pract. 2024;53(1–2):37–41. doi: 10.31128/AJGP/06-23-6870. Available from here.
5. Privitera G, O’Brien K, Misajon R, Lin CY. Endometriosis symptomatology, dyspareunia, and sexual distress are related to avoidance of sex and negative impacts on the sex lives of women with endometriosis. Int J Environ Res Public Health. 2023 Feb 14;20(4):3362. doi: 10.3390/ijerph20043362. Available from here..
6. Ahmad A, Kumar M, Bhoi NR, Badruddeen null, Akhtar J, Khan MI, et al. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol. 2023 May 1;34(3):291–310. doi: 10.1515/jbcpp-2022-0219. Available from here.
Published: April 9, 2025
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