Painful sex (dyspareunia) affects about 1 in 5 women in a given year. Common causes include vaginismus, vulvodynia, vaginal atrophy from menopause, endometriosis, infections, postpartum scar tissue, and lack of arousal. Most painful sex is treatable — through pelvic floor physical therapy, medical evaluation, lubricant, and addressing underlying causes. Suffering in silence damages both the body and the relationship.
Painful Sex Is Treatable — and Underdiagnosed
Per ACOG (American College of Obstetricians and Gynecologists) 2024 data, dyspareunia (painful sex) affects roughly 1 in 5 women in a given year, and roughly 30% of women at some point in their lives. About 1 in 20 men experience painful sex.
Most painful sex is treatable. The reason it persists is not because it can't be helped — it's because the silence around it keeps people from seeking help. Many women have been told the pain is "in their head" or that they should just push through. Both are wrong.
The Most Common Causes
Vaginismus
Involuntary tightening of the pelvic floor muscles, often making penetration impossible or extremely painful. Affects 1-7% of women globally. Highly treatable with pelvic floor physical therapy and (sometimes) graded dilator therapy.
Vulvodynia
Chronic pain or discomfort at the vulva, often without an obvious cause. Affects roughly 8% of women at some point. Treatment usually involves pelvic floor PT, topical medications, and specialized care.
Vaginal atrophy (genitourinary syndrome of menopause)
Thinning and drying of vaginal tissue due to estrogen decline at perimenopause and after. Affects 50-70% of postmenopausal women. Highly treatable with topical estrogen, vaginal moisturizers, and lubricant.
Endometriosis
Affects roughly 1 in 10 women. Causes painful sex, especially with deep penetration, due to lesions outside the uterus. Often takes years to diagnose. Treatment ranges from medical management to surgery.
Infections
Yeast infections, bacterial vaginosis, UTIs, and STIs all cause painful sex. Treatable with appropriate medical care.
Postpartum scar tissue
From perineal tearing, episiotomy, or C-section. Often resolves with pelvic floor PT and time.
Lack of arousal or insufficient lubrication
The most common single cause and often overlooked. Sex when not aroused enough leads to friction and pain. Lubrication declines with hormonal birth control, certain medications, and lower estrogen states.
Trauma and anxiety
Past sexual trauma, anxiety about sex, or fear of pain can all create body-level responses that lead to pain. Often combines with one of the physical causes above.
Why Couples Suffer in Silence
Painful sex is often the most-hidden sexual issue in relationships. The reasons:
- Shame. The partner experiencing pain often feels broken or feels they're failing their partner.
- Fear of partner's reaction. Worried the partner will feel rejected or take it personally.
- Medical dismissal. Many women have been told by doctors the pain is normal, in their head, or unsolvable. After 1-2 dismissals, many stop seeking help.
- Pushing through. The cultural script of "just power through" leads many couples to keep having painful sex, which often makes it worse.
- Disappearance of sex altogether. Many couples eventually stop having sex rather than address the pain — which becomes its own problem.
The Medical Pathway
If sex has been painful for more than a few episodes, or for any sustained period, the medical workup is essential.
1. OB-GYN evaluation
Should rule out infections, endometriosis, vaginal atrophy, fibroids, scar tissue, or other anatomical causes. If your OB-GYN dismisses the pain or doesn't take it seriously, get a second opinion. The International Society for the Study of Women's Sexual Health maintains a directory of specialists.
2. Pelvic floor physical therapy
One of the most underused interventions for painful sex. Pelvic floor PTs can treat vaginismus, scar tissue, and many other muscular causes. Often covered by insurance. The American Physical Therapy Association maintains a directory.
3. AASECT-certified sex therapist
For the psychological and relational layers — performance anxiety, fear of pain, communication with the partner. Often combined with medical and PT treatment.
4. Specialized centers
For complex cases, vulvodynia and pelvic pain specialty centers exist (often at academic medical centers).
How to Talk About It With Your Partner
The conversation often feels harder than it is. Most partners are deeply relieved to know what's actually happening — they've usually been worried they did something wrong or that their partner doesn't want them.
Lead with what's real, not with apology
"Sex has been painful for me for the past several months. It's nothing about you — it's a physical issue I want us to address together." Direct is better than minimizing.
Make it a shared project
"I want to see an OB-GYN about it. Will you support me through that process?" Inviting your partner into the work shifts the dynamic from "her problem" to "our problem."
Don't suffer through sex while you figure it out
Continuing to have painful sex while seeking treatment usually makes the pain worse — and damages the body's response to the partner over time. Pause penetrative sex while addressing the cause.
Maintain non-painful intimacy
Other forms of physical and sexual connection are still available. Maintaining them keeps the couple connected during the medical work.
What Partners Can Do
If your partner is experiencing painful sex, what helps:
- Believe them. The single most important thing.
- Don't take it personally. The pain is not about you.
- Don't pressure them to "push through." This makes everything worse.
- Support the medical work. Drive them to appointments if possible. Listen when they tell you what the doctor said.
- Maintain non-sexual affection. Don't withdraw touch — keep the connection alive while the sexual layer is being addressed.
- Manage your own frustration with someone other than your partner. A friend, therapist, or journal — not them.
Frequently Asked Questions
Reconnection happens through small daily acts
Connected helps couples build the daily rituals — check-ins, appreciation, intentional conversation — that support intimacy in long-term relationships.
Try Connected free →Frequently Asked Questions
How common is painful sex?
Painful sex (dyspareunia) affects about 1 in 5 women in a given year, and roughly 30% of women at some point in their lives (ACOG 2024). About 1 in 20 men experience painful sex. Most cases are treatable.
What causes painful sex?
Common causes include vaginismus, vulvodynia, vaginal atrophy from menopause, endometriosis, infections, postpartum scar tissue, insufficient arousal/lubrication, and past trauma or anxiety. Most have specific treatments. The first step is a thorough OB-GYN evaluation.
Is painful sex normal?
Some discomfort during specific sexual acts can be normal (and addressable with lubricant or position changes). Recurring pain, sharp pain, deep pain, or pain that interferes with intimacy is not normal and warrants medical evaluation. Most painful sex is treatable.
What should I do if my doctor dismisses my painful sex?
Get a second opinion. Many women have been told their pain is "normal" or "in their head" by physicians not specialized in sexual medicine. The International Society for the Study of Women's Sexual Health (ISSWSH) maintains a directory of specialists. Pelvic floor physical therapists are also excellent first-line specialists.
Can painful sex damage a relationship?
Yes — but mostly through silence rather than the pain itself. Couples who openly address painful sex (medical workup, pause penetrative sex during treatment, maintain non-painful intimacy) typically navigate it well. Couples who suffer through it without naming it often see growing resentment, sexual avoidance, and emotional distance.
How do I talk to my partner about painful sex?
Lead with what's real, not apology: "Sex has been painful for me for the past several months. It's nothing about you — it's a physical issue I want us to address together." Make it a shared project. Pause penetrative sex while seeking treatment. Maintain other forms of intimacy. Most partners are deeply relieved to finally understand.
Related Reading
- Sex After Baby
- Intimacy Exercises for Couples
- Mismatched Libidos
- Low Libido in a Relationship
- How to Support Your Partner
Last updated: April 27, 2026. This article is reviewed by Kayla Crane, LMFT. The information above is for educational purposes and not a substitute for medical advice or licensed therapy.