Is It Normal for Sex to Hurt Sometimes?

If you were born with a vagina, odds are you’ve had to endure a fair amount of bodily pain over the course of your life. From period cramps to childbirth to chronic pain conditions like endometriosis…the list of common causes of pain goes on. One thing that often makes this list (but definitely doesn’t have to!) is sex. 

For some, especially those going through menopause, sex hurts every time. For others, sex hurts…but not all the time. Regardless of where you fall on this spectrum, painful sex is not something to push through or ignore. We’re here to discuss why sex hurts sometimes, all the time, or all of a sudden, how it relates to your pelvic floor, and what you can do about it. 

Is painful sex normal? 

Painful sex is common, but that doesn’t make it normal. Painful sex has real causes and real treatments, and isn’t something to put up with just because it’s common.  

10-28% of women and AFAB* folks experience dyspareunia, the clinical term for painful sex, over their lifetime. Unfortunately, here’s where things get a little heteronormative, because dyspareunia refers specifically to pain from penetrative sex. Other types of sex exist, and those types can cause pain, too.  

A new, slightly more inclusive term is on the rise: genitopelvic pain-penetration disorder (GPPPD). While “penetration” is still in the name, GPPPD includes discomfort from any form of genital contact, not just penetration. Tense, overactive pelvic floor muscles are associated with GPPPD. 

Tense pelvic floor muscles can be their own source of pain. They can be sensitive to touch even on the outside...or cause pain with no touch at all. This can happen because when you expect touch to be painful, your muscles can tense up in anticipation. This means it’s possible to feel discomfort without any physical stimulation at all.     

*AFAB: assigned female at birth

What does painful sex feel like?

Painful sex can feel like a burning, stabbing, aching, stinging, or throbbing sensation. You might feel discomfort deep inside your vagina or in your pelvis, at the opening of your vaginal canal, or externally on your vulvar skin.   

If you’re suddenly experiencing painful sex, take note of what kind of discomfort you feel and where you feel it. This information can help identify the cause of your pain and how to best move towards painful intercourse treatment. 

Painful sex can fall into a few categories depending on where you feel symptoms. It’s possible to experience just one or all of these categories at the same time:

• Deep dyspareunia: Penetration causes pain deeper in your vagina or in your pelvis. Conditions such as endometriosis or pelvic inflammatory disease can cause deep dyspareunia. However, experiencing painful sex doesn’t necessarily mean you have one of these conditions: there are other causes, too!   
• Superficial or entry dyspareunia: Sex hurts your vulva or vaginal opening, usually during initial penetration. Pelvic floor dysfunction, inadequate lubrication, and periods of low estrogen, which can cause dryness and tissue thinning, can contribute to superficial dyspareunia.
• Pain with external contact: External stimulation causes pain on your vulva, clitoris, or both. Falling under the GPPPD umbrella, this pain can come from nerve issues or structural changes such as adhesions. 

Sex hurts…but not all the time

It’s common to experience consistently painful sex after menopause or postpartum. However, it’s also possible for sex to hurt one day and not the next. Noting when you feel discomfort is as important as understanding where in your body and what type of pain you’re experiencing.  

Take note of whether your pain:

• Depends on the situation: Sex only hurts when you’re with certain partners, in certain positions, or thinking certain thoughts. 
• Shows up every time: Regardless of the situation, sex is uncomfortable or painful. 
• Has always been there: Known as primary dyspareunia, this means you’ve felt pain every time you’ve had sex.  
• Came on suddenly: Known as secondary dyspareunia, this means you’ve had pain-free sex in the past, but it now hurts either every time or only sometimes.   

Sex is mental, physical, complicated, and, above all, it’s personal. Understanding what kind of discomfort you’re experiencing can help you find a treatment plan that suits your individual needs. 

Why does sex hurt sometimes?

There are a lot of reasons why sex might be uncomfortable, and these reasons can overlap, combine, disappear, and reappear over time. Causes can be purely physical, psychological, hormonal, or a combination of each. 

Painful sex can be frustrating and cause emotional distress. Talking with a pelvic health physical therapist can help you understand what’s causing your pain and give you a treatment plan to work through it. 

Physical causes of painful sex

While not an exhaustive list of painful intercourse causes, common physical causes of painful sex include: 

• Pelvic floor muscle tension: Your pelvic floor muscles are a major player in painful sex. When these muscles are tense, overactive, or resistant to stretch, they can seize up and make sex (of all kinds!) painful.  
• Vaginal dryness: Sex involves a lot of friction, and vaginal dryness can cause burning and stinging. Dryness is common postpartum, postmenopause, and when you need more stimulation to activate the glands that make natural vaginal lubrication. 
• Pelvic pain conditions: Endometriosis, pelvic inflammatory disease, vulvodynia, and vestibulodynia can cause extreme tenderness and painful burning sensations during or after sex.  
• Infections and irritation: Bacterial vaginosis (BV), yeast infections, urinary tract infections (UTIs), and vulvar skin conditions can cause painful inflammation and irritation. 
• Hormonal changes: Low estrogen levels during menopause, childbirth, and breast/chestfeeding can all impact your sexual functioning and comfort. This happens because low estrogen can lead to vaginal dryness and tissue thinning, causing discomfort. 

Psychological and emotional causes

Sex involves your mind as much as it involves your body. If painful sex has started suddenly and won’t go away, psychological and emotional factors might be at play. Trauma, mental health conditions, relationship troubles, and body image issues can all have physical effects in your body that make sex difficult or uncomfortable. 

Depression can make it difficult to feel interested in sex, leading to less arousal, lubrication, and pleasure. Anxiety can tell your pelvic floor muscles to contract and start a cycle of persistent pain. Mental health symptoms can change day by day: on days when anxiety is lower, sex may feel better, and vice versa. For many, physical and emotional factors work together, which is why treating painful sex involves more than one type of care. 

How to make sex less painful

Remedies for painful intercourse and other types of painful sex aren’t a one-size-fits-all situation. The right approach depends on what’s causing your pain, where you feel it, and whether it happens every time or only in certain situations. A pelvic floor physical therapist, primary care provider, and sex therapist can work together to figure out what’s causing your pain and guide your treatment.   

Managing your pain may take time, but is absolutely worth it. When thinking about dyspareunia treatment, consider the following:

• Avoid pain triggers: Stick to positions that are most comfortable and don’t push through pain when it happens. Over time, you may be able to reintroduce other positions, but starting with the more comfortable ones helps your mind and body feel safer right now.
• Use lube and prioritize arousal: Using lots of lube and not skipping foreplay can help reduce friction and discomfort. 
• Address hormonal changes: Talk with a healthcare provider about treatments such as vaginal moisturizers or hormone therapy. These can help address postpartum or menopause-related vaginal dryness.    
• Myofascial release: Using a pelvic wand to release any sensitive trigger points in your muscles and connective tissue can improve blood flow, reduce muscle spasms, and help relieve painful sex.  
• Pelvic floor physical therapy: Most people with dyspareunia have pelvic floor muscles that are weak, overactive, resistant to stretch, or some combination of all three. Pelvic floor physical therapy can work to correct all of these.  
• Cognitive-behavioral therapy (CBT): Taking care of your mental health is essential for all parts of life, including your sex life. CBT can help you work through and reduce anxiety and fear related to painful sex. 

Can pelvic floor physical therapy help with painful sex?

Yes! Your pelvic floor muscles are involved in every part of sex, and pelvic floor physical therapy is an effective treatment for dyspareunia. Whether it’s your first or fiftieth time experiencing painful sex, pelvic floor physical therapy can help your pelvic floor muscles become less resistant to stretch. It can also help you strengthen weak muscles and release painful trigger points. 

Taking care of your pelvic floor muscles is a proactive way to keep sex from becoming painful, and an important way to treat pain if it’s already started. Your comfort and pleasure are worth prioritizing, and we’re here to help. Book your first visit with an Origin clinician today. 

Sources

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Krapf, J., & Pope, R. (2025). Approach to Diagnosis and Management of Clitorodynia. In O&G open (Vol. 2, Issue 1, p. e062). PubMed Central. https://doi.org/10.1097/og9.0000000000000062

Ghaderi, F., Bastani, P., Hajebrahimi, S., Jafarabadi, M. A., & Berghmans, B. (2019). Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. International Urogynecology Journal, 30(11), 1849–1855. https://doi.org/10.1007/s00192-019-04019-3

Hill, D. A., & Taylor, C. A. (2021). Dyspareunia in Women.  American Family Physician, 103(10), 597–604. https://www.aafp.org/afp/2021/0515/p597