“Burning Love” may be a good song to get you in the mood, but if your sex life is accompanied by a burning feeling of any kind, you’re probably more likely to strap on a chastity belt than opt for any kind of sexual encounter. In fact, almost 30 percent of women experience pain during sex (medically called dyspareunia), but many are too embarrassed to report it to a doctor—opting instead to either resign themselves to the hurt or to a sexless existence. The good news? There are other (better) options for coping with painful sex.

Whether it’s mild discomfort or excruciating pain, a variety of conditions can take sex from pleasurable to I’d-rather-be-doing-anything-else. Many of these conditions happen upon penetration (whether with a penis, a finger, or a toy). In some cases, the pain comes merely when the outside of the vagina is touched. Regardless of where it happens, painful sex can affect not only a person’s relationship, but also overall quality of life Dyspareunia in postmenopausal women: A critical review. Kao, A., Binik, Y., Khalife, S., et al. Pain Research and Mangement, 2008 May-Jun;13(3):243-254.

To help understand what’s happening “down there,” check out this breakdown of the 10 most common reasons that sex could be uncomfortable or even excruciating—and how to handle them. Then, talk with your doctor about what’s going on. Educating yourself and reaching out for help are two of the most important steps toward getting your amazing sex life back (or having one to begin with).

Why Sex Might Be Painful—and What to Do About It

Why Sex Might Be Painful – Burning Sensation

1. The Problem: Speaking of “burning love”… That burning sensation comes with a side of severe itching and a cottage-cheese-like discharge.

Possible Causes: Yeast infections (or vaginal candidiasis) are extremely common; as many as three out of four women will get (at least) one in her lifetime. The swelling and pain associated with these infections pretty much takes sex off the table. Plus, having sex before you’re completely healed can mean passing the infection to a partner’s genitals or mouth. These symptoms could also be a sign of bacterial vaginosis (which is often accompanied by a fishy odor, but can cause no symptoms at all) or sexually transmitted infections like chlamydia or gonorrhea.

Potential Solutions: Be wary of self-diagnosing and treating yourself for a yeast infection, especially if you’ve never had one before. Your best bet is to see a doctor to get the issue properly diagnosed. For a yeast infection, you may be prescribed an antifungal medication; for bacterial vaginosis or a sexually transmitted infection, you may need an antibiotic Vulvovaginal candidiasis as a chronic disease: diagnostic criteria and definition. Hong, E., Dixit, S., Fidel, PL, et al. Journal of Lower Genital Tract Disease, 2014 Jan;18(1):31-9.

2. The Problem: You feel deep pain during penetration (with anything long enough to hit your cervix) in the lower abdomen and pelvis.

Possible Causes: Pelvic Inflammatory Disease (PID), an infection of the reproductive organs, will cause this type of pain in addition to discharge. Other symptoms include irregular bleeding, fever, or painful urination (though symptoms may be more mild). PID is caused by the introduction of bacteria into the reproductive organs through the cervix, usually as a result of chlamydia or gonorrhea. It can also happen from an infection after IUD insertion or childbirth.

Potential Solutions: See a doctor for proper diagnosis. If it is PID, the doctor will most likely prescribe a combination of antibiotics. If PID is caused by an STI, your partner should see a doctor for treatment as well.

3. The Problem: You feel a pain deep inside you during thrusting with a penis, fingers, or toy, but it goes away when you switch positions.

Possible Causes: Your partner may have just poked your cervix. It’s most likely an issue of position and angle.

Potential Solutions: This isn’t medically harmful, but it can make sex a whole lot less fun. If you find that this always happens in a certain position, switch things up until you find a position that’s more comfortable for you.

Why Sex Might Be Painful – Vaginal Dryness

4. The Problem: The walls of your vagina feel like sandpaper every time you attempt penetration (whether with a penis, finger, or toy).

Possible Causes: Vaginal dryness is often associated with menopause, but there are reasons younger women will also feel a dry, tearing sensation when something is inside of them. In a small percentage of women, birth control pills cause dryness. Decongestants, the job of which is to clear up moisture in other parts of the body, can also be the culprit. Dryness can also occur from time to time if you’re not in the mood, you’re distracted, or you’re just not that into your partner.

Potential Solutions: In many cases, something as simple as a lubricant can be a lifesaver. But if dryness is more than just the occasional inconvenience, you may want to see a doctor for treatment. If your doctor determines that medications are the cause, ask about other options that may not cause this side effect. For chronic cases, it may also be helpful to try long-acting vaginal moisturizers, which relieve dryness for up to three days by imitating the body’s natural lubrication.

Painful Sex Symptoms Treatments

5. The problem: You’re experiencing sharp, localized pain on the outside of the vagina.

Possible Causes: Take a look at your nether regions in a mirror, because chances are the pain is coming from a skin irritation such as a pimple or ingrown hair. Rubbing up against these bumps during sex can only make the irritation worse.

Potential Solutions: Treat these suckers the same way you would on any other part of your body—try to keep the area clean and dry, and don’t pop them. A warm compress may help bring the pimple or ingrown hair to a head. If it doesn’t go away on its own in a few days, a dermatologist can tell you if further steps need to be taken. They can also help determine if that lump is actually a deeper problem, like a wart.

6. The Problem: You feel a deep pelvic throbbing and cramping during sex.

Possible Cause: This could be a symptom of endometriosis, a disorder that causes uterus-lining tissue (the endometrium) to grow somewhere outside your uterus, like the ovaries, bowel, or pelvis. In addition to making sex painful, endometriosis may cause periods to be a lot heavier and come with the same deep, throbbing pain.

Potential Solutions: See a doctor, who may prescribe you pain relievers and hormone therapy medications. Extreme cases may require surgery like a hysterectomy.

Why Sex Might Be Painful – Vaginismus

7. The Problem: Your vagina painfully clamps shut like a Venus flytrap whenever you attempt penetration.

Possible Cause: Vaginismus is a complex condition characterized by involuntary spasms of the pelvic floor muscles. This condition’s roots can be both physical and mental—it can happen after sexual trauma or in women who’ve grown up with a background that frowns upon premarital sex. Vaginismus can also be an anxiety response caused by a fear of pain or intimacy.

Potential Solutions: Since vaginismus is often primarily psychological, your doctor may prescribe psychotherapy. Recovery will also probably take retraining of the vaginal muscles (to help them learn how to relax) with a pelvic floor physical therapist Understanding and treating vaginismus: a multimodal approach. Pacik, PT. International Urogynecology Journal, 2014 Jun 4..

8. The Problem: You feel horrible, stabbing pain on the outside and opening of your vagina when touched.

Possible Cause: Vulvodynia is a condition that affects the tissues surrounding the entrance to the vagina, making them excruciatingly sensitive. It can be short-lived or last for years, and it can make not just sex, but also exercise or even wearing tight pants painful.

Potential Solutions: Since doctors aren’t sure of the cause of vulvodynia, treatment is complex. You may be prescribed a combination of medication, local anesthetics, and physical therapy.

9. The Problem: You’ve never been able to insert anything into your vagina because of excruciating pain.

Possible Cause: You may have a hymen that’s partially or completely intact. Of course, in this situation, sex would be extremely painful since there’s an actual physical barrier that’s preventing penetration. An imperforate hymen is one that’s completely intact with no holes, while a septate hymen is one that is broken, but still has a band of membrane running through the center, making penetration impossible.

Potential Solutions: See a doctor. If your doctor determines that your hymen is the cause of your pain, you may have to have minor surgery (hymenectomy) to remove the remainder Imperforate hymen: Can it be treated without damaging the hymenal structure? Chelli D, Kehila M, Sfar E, Zouaoui B, Chelli H, Chanoufi B. Sante, 2008 Apr-Jun;18(2):83-7.

Why Sex Might Be Painful – Interstitial cystitis

10. The Problem: Pain in the pelvis during intercourse accompanied by the constant feeling of having to urinate.

Possible Cause: Interstitial cystitis, or painful bladder syndrome, is a chronic condition (not an infection) that causes pressure on the bladder that can be painful.

Potential Solutions: There’s no treatment that completely eliminates interstitial cystitis, but your doctor can suggest methods to find relief from the pain and discomfort, including pelvic physical therapy and medication.

The Takeaway

In the end, the best bet is always to consult a medical professional if sex is proving to be painful or uncomfortable. You—and your body—are worth the minor awkwardness of fessing up if you’re feeling pain.

Note: The information in this article is not intended to replace medical advice. If you are concerned about pain or discomfort during sex, consult a medical professional.

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