Pain during sex is surprisingly common and almost always has an identifiable, treatable cause. Roughly 75% of women experience it at some point, and it affects men too, though less frequently discussed. The reason it hurt depends on where the pain was, when it started, and what it felt like. Those details point toward very different explanations.
Where the Pain Was Matters
Sexual pain generally falls into two categories: pain near the entrance or surface, and pain felt deeper inside. This distinction is one of the most useful clues for figuring out what’s going on.
Surface-level pain, felt at or near the opening, tends to involve skin irritation, infections, dryness, or tight muscles. Deep pain, sometimes described as a dull ache or pressure during thrusting, usually points to something involving the pelvic organs, like the uterus, ovaries, bladder, or bowel. Pain that’s worse in certain positions is a hallmark of deep causes. If the pain only showed up with deeper penetration and felt like something was being bumped or pressed on, the explanation is more likely internal.
Dryness and Not Enough Lubrication
This is one of the most common and most overlooked reasons sex hurts. Without adequate lubrication, friction irritates the vaginal walls and can cause a raw, burning sensation during or after. Lubrication depends on blood flow to the vaginal tissue and on glands that produce fluid during arousal. Anything that disrupts either process can leave you dry: not enough foreplay, stress, certain medications (especially antihistamines, antidepressants, and hormonal birth control), dehydration, or simply not feeling fully aroused.
Hormonal shifts make a big difference too. During perimenopause and menopause, dropping estrogen levels thin the vaginal lining and reduce its elasticity. The tissue loses collagen, elastin, and blood supply, making it more fragile and less able to stretch or self-lubricate. But this isn’t only a menopause issue. Breastfeeding, certain cancer treatments, and some medications can create the same low-estrogen state at any age. A water-based or silicone-based lubricant solves the immediate problem, and topical estrogen treatments can address the underlying tissue changes when hormones are involved.
Infections That Cause Pain
Yeast infections are a frequent culprit. The fungal overgrowth causes inflammation, swelling, and soreness in the vaginal tissue, and sex aggravates all of it. A burning feeling during intercourse is one of the hallmark symptoms, along with itching, thick discharge, and general soreness. Bacterial vaginosis, which shifts the vaginal bacterial balance, can cause similar discomfort.
Sexually transmitted infections like chlamydia and gonorrhea can also make sex painful, particularly if the infection has spread to the cervix or deeper pelvic structures. Pelvic inflammatory disease, which happens when an untreated STI moves into the uterus or fallopian tubes, causes deep pelvic pain that often gets worse with penetration. Urinary tract infections can create a burning or pressure sensation during sex as well, since the bladder sits just in front of the vaginal wall. If pain came alongside unusual discharge, odor, burning while urinating, or fever, an infection is worth investigating.
Tight or Overactive Pelvic Floor Muscles
Your pelvic floor is a group of muscles that stretches across the base of your pelvis like a hammock. These muscles need to relax during penetration. When they can’t, or when they involuntarily clench, the result is pain, sometimes sharp, at the vaginal opening. This can make penetration feel impossible or like hitting a wall.
The condition formerly called vaginismus, now grouped under the broader term genito-pelvic pain/penetration disorder, involves an automatic tightening of these muscles triggered by the anticipation of pain. It creates a frustrating cycle: you expect pain, the muscles clamp down, penetration hurts, and the expectation of pain next time gets stronger. This can start after a painful experience, a difficult pelvic exam, or sometimes without any obvious trigger.
Pelvic floor physical therapy is the primary treatment. A specialist uses guided exercises, sometimes with biofeedback tools that show you how your muscles are responding in real time, to help you learn to consciously relax the pelvic floor. Many people see significant improvement within a few months of consistent work.
Endometriosis and Other Pelvic Conditions
Endometriosis is one of the most common causes of deep sexual pain. Tissue similar to the uterine lining grows outside the uterus, often on the fallopian tubes, ovaries, or the tissue lining the pelvis. During sex, pressure on these areas triggers pain that can range from a dull ache to a sharp, stabbing sensation. The pain is often position-dependent and may linger for hours afterward.
Other conditions that cause deep pain include ovarian cysts, uterine fibroids (noncancerous growths in the uterine wall), adenomyosis (where uterine lining tissue grows into the muscular wall of the uterus), and a retroverted uterus, which tilts backward and can be bumped more easily during deep penetration. Bowel conditions like irritable bowel syndrome, Crohn’s disease, and ulcerative colitis can also contribute, since inflamed bowel tissue sits close to the vaginal canal. Bladder conditions, including interstitial cystitis, create a similar effect from the other side.
Causes Specific to Men
Pain during sex isn’t only a concern for people with vaginas. Up to 15% of American men experience prostatitis, an inflammation of the prostate gland that causes aching pain in the lower abdomen, pelvis, lower back, or the area between the scrotum and anus. The pain often worsens during or after ejaculation. Urinary tract infections and STIs are major risk factors because bacteria can travel into the prostate.
An overly tight foreskin in uncircumcised men can also cause pain. Normally the foreskin retracts during intercourse, but when it’s too tight to pull back, the friction creates soreness, tearing, or inflammation. Steroid creams can help loosen the tissue over time.
Peyronie’s disease, where fibrous scar tissue forms inside the penis, causes a noticeable curve and painful erections. It’s more common than many people realize and can develop after minor injury to the penis, sometimes without any remembered trauma. Treatment ranges from anti-inflammatory medications to injections that break down the scar tissue.
When Pain Is New Versus Ongoing
A single episode of painful sex has different implications than pain that happens every time. If it hurt once and you can identify an obvious reason (not enough lubrication, a new position that hit an uncomfortable angle, sex after a long break), the cause is likely straightforward and situational. Trying a different approach next time, using lubricant, and allowing more time for arousal often resolves it.
Pain that repeats across multiple encounters, or that’s getting worse, suggests something that won’t resolve on its own. Persistent burning at the entrance points toward infection, skin conditions like dermatitis, or pelvic floor tension. Recurring deep pain points toward endometriosis, cysts, or other pelvic conditions that benefit from a proper evaluation. Nerve-related causes, including a pinched nerve in the lower back or pudendal nerve irritation, can also create sexual pain that comes and goes unpredictably.
What You Can Do About It
Start with the simplest explanations. Use a quality lubricant, spend more time on foreplay, and experiment with positions that give you more control over depth and angle. If dryness is a recurring issue, consider whether any medications you’re taking might be contributing.
If pain persists, a pelvic exam can rule out infections, cysts, fibroids, and visible skin conditions. For suspected pelvic floor dysfunction, a referral to a pelvic floor physical therapist is one of the most effective next steps. These specialists can assess whether your muscles are too tight, too weak, or poorly coordinated, and build a treatment plan around exercises, relaxation techniques, and sometimes biofeedback.
For hormonal causes, topical estrogen applied to the vaginal tissue can restore thickness, elasticity, and lubrication over the course of several weeks. For structural conditions like endometriosis or fibroids, treatment depends on severity and ranges from hormonal management to minimally invasive procedures. The key point is that painful sex is not something you need to accept as normal. Nearly every cause has an effective treatment once it’s correctly identified.