Painful intercourse, called dyspareunia, is common. Many women experience painful intercourse at some point in their lives. For some, experiencing pain during sex is only a temporary problem, however, for others it can be a life-long condition. Similar to other sexual dysfunctions, dyspareunia may be caused by emotional and physical problems. Dyspareunia can significantly challenge a woman’s ability to have a healthy sex life and can negatively impact mental health, self-esteem, and relationships. Dyspareunia can be classified in two ways: vaginal entry pain and deep pain inside the vagina or lower pelvis. Entry pain occurs when initial or attempted penetration of the vagina is painful. Deep pain refers to pain that occurs during deep vaginal penetration.

What causes entry pain?

The most common problems contributing to entry pain include not having enough lubrication, medications that reduce sexual desire, injury or trauma, and vagnismus. A lack of lubrication can be the result of little to no foreplay, drops in estrogen levels and breast-feeding. Some high blood pressure medications, antidepressants, and birth control can also contribute to a reduction in sexual desire. Injury or trauma, such as pelvic surgery or having an episiotomy during childbirth can also cause entry pain. Some women experience involuntary spasms in the muscles around the vagina. This condition is called vaginismus and can also cause pain during intercourse.

What causes deep pain?

The most common problems contributing to deep pain include gynecological illness and conditions such as endometriosis, pelvic inflammatory disease, uterine fibroids, irritable bowel syndrome, and ovarian cysts. Surgical and medical treatments commonly cause deep pain during intercourse as well. These include scarring from pelvic surgery and cancer treatments such as chemotherapy and radiation therapy.

What are some emotional factors that can contribute to painful intercourse?

Studies have shown a significant connection between sexual pain and psychiatric problems such as depression, anxiety, and self-esteem issues. For some women, a fear of intimacy or relationship problems contribute to painful intercourse. During times of stress, the pelvic floor muscles tend to tighten and can make it difficult or painful for penetration to occur. Having a history of sexual abuse can also play a significant role in sexual dysfunction.


Vaginismus is involuntary spasms of the muscles around the opening of the vagina. Despite the desire for penetration, entry of a penis, finger, or even tampon use, tight muscle contractions makes this difficult. It is possible for vaginismus to be limited to sexual activity and not experienced during a pelvic examination. The opposite is also true: vaginismus may occur during a pelvic examination and not during sexual activity. Treating vaginismus is based on a combination of cognitive and behavioral therapeutic approaches in order to help a woman achieve a sense of control over a sexual encounter or pelvic examination. The goal of treatment is to lower the anxiety/panic associated with penetration and encourage an understanding that she is no longer in danger of experiencing pain. Treatment options might include:

How can Balance help?

Balance providers understand the challenges of sexual pain and the importance of determining if emotional factors are associated. Because treatments for sexual pain can vary, a thorough evaluation is conducted to review sexual history and symptoms. We know that the idea of a sexual assessment appointment may make you nervous. We are truly committed to making the process as comforting and pleasant as possible.


Please remember this information is intended for educational purposes only and should not substitute medical advice from a healthcare provider.