Pain during sex is common, but it's also one of the most under-discussed sexual health concerns — many people quietly avoid intimacy for months or years before ever mentioning it to a doctor or therapist. Painful sex has a real medical name (dyspareunia) and a range of identifiable causes, and it's treatable in most cases. It is not something to just "push through."
What Counts as Pain During Sex?
Pain during sex can show up in different ways: sharp or burning pain on penetration, deep pain during thrusting, pain that lingers after sex ends, or pain specific to certain positions or types of touch. It can be constant or situational, lifelong or new. All of these patterns are worth paying attention to — pain is information, not something to override.
Common Causes of Painful Sex
Painful sex usually has a physical component, a psychological component, or both, and the two frequently interact:
Physical causes can include:
Vaginismus — involuntary tightening of the pelvic floor muscles that makes penetration painful or impossible
Vulvodynia — chronic pain in the vulvar area without an identifiable cause
Hormonal changes — including menopause, postpartum, or breastfeeding, which can affect lubrication and tissue sensitivity
Infections or skin conditions affecting the genital area
Endometriosis or pelvic floor dysfunction
Insufficient arousal or lubrication before penetration
Scar tissue, including from childbirth or surgery
Psychological and relational factors can include:
Anxiety about sex, which can cause the pelvic floor to involuntarily tense
A history of sexual trauma
Anticipatory fear after previous painful experiences, which can create a cycle where fear of pain increases the likelihood of pain
Relationship stress or communication issues around sex
Body image or shame related to sex
Because physical and psychological causes often reinforce each other — pain causes fear, fear causes tension, tension causes more pain — effective treatment frequently needs to address both.
When to See a Doctor
Pain during sex should always be evaluated by a medical provider first, especially if it's new, sudden, or accompanied by other symptoms like unusual discharge, bleeding, or fever. A doctor — often a gynecologist or urologist — can rule out or treat underlying physical causes such as infections, hormonal issues, or structural conditions.
How Sex Therapy Fits Into Treatment
Sex therapy is not a substitute for medical evaluation, but it plays an important role, especially when anxiety, fear, or trauma are part of the picture. A sex therapist can help with:
Breaking the fear-tension-pain cycle through education and gradual, paced approaches
Processing trauma that may be contributing to pain or muscle guarding
Communication strategies for talking with a partner about pain without shame or pressure
Coordinating care alongside a pelvic floor physical therapist or physician, since this concern often benefits from a multidisciplinary approach
Rebuilding a sense of safety and pleasure in the body, separate from the goal of penetration
Many people find real relief once physical and psychological treatment happen together, rather than assuming the issue is "all physical" or "all in your head" — it's rarely only one or the other.
Frequently Asked Questions
Is pain during sex always a sign of a serious medical problem? Not necessarily, but it should always be evaluated. Causes range from minor and easily treated (like insufficient lubrication) to more complex conditions requiring ongoing care, and a medical provider can help identify which applies.
Can pain during sex be fixed, or is it something to just live with? Most causes of painful sex are treatable, especially with a combination of medical and therapeutic support. It is not something you have to permanently accept.
Does pain during sex mean something is wrong with my relationship? No. Pain during sex is very often physical or trauma-related, not a sign of relationship dysfunction — though avoiding the topic with a partner can create relational strain, which is part of why open communication and therapy support both matter.
Do I need a referral to see a sex therapist for this? No referral is typically required to start sex therapy, though many sex therapists coordinate with a client's medical providers, such as a gynecologist or pelvic floor physical therapist, as part of care.
Getting Support in Ann Arbor
Sarah Cissell, LMSW and AASECT-Certified Sex Therapist, works with clients on sexual pain, anxiety around intimacy, and trauma-informed approaches to rebuilding comfort and pleasure, in Ann Arbor and via telehealth across Michigan and Florida. For pain that's connected to a broader chronic pain picture, Kristy Correll, LMSW, works specifically with chronic pain through a compassionate, mind-body lens, including somatic integration and breathwork. Sarah also co-leads an 8-week virtual pelvic pain support group for people navigating conditions like vulvodynia, vaginismus, and endometriosis. Schedule a free consultation or learn more on Sarah Cissell's profile or Kristy Correll's profile.
Related reading: Low Sexual Desire in Relationships · What to Expect in Your First Sex Therapy Session
This article is educational and not a substitute for medical advice. If you're experiencing pain during sex, please consult a physician or pelvic health specialist for evaluation.
