Pain during vaginal penetration or attempted vaginal penetration can feel stinging, throbbing, burning, dry or sore. It can be sharp, dull or intense and it can occur at the start, throughout or after receptive penetrative sex.

This booklet is aimed at people who experience pain or discomfort during, or when attempting, penetrative vaginal sex. Some people also experience pain when the outside of their genitals are touched. Please see our Enhancing sexual desire and enjoyment booklet if this applies to you.

The level of pain can range from mild to severe. Sometimes penetration can feel impossible, and repeated unsuccessful attempts can leave you feeling frightened and frustrated. It is understandable that having these kinds of experiences may result in wanting to avoid sex altogether. 

For many people with a vagina, any penetration may be painful including using tampons during smear tests, medical examinations and during sex.

Pain during sex is fairly common and can occur for many different reasons, but it is not something you should endure and should always be checked out by a medical professional.

What can cause or contribute to difficulties with penetration?

There are a variety of reasons that you might experience difficulties with painful sex, and is often a combination of physical or medical factors along with psychological and/or relationship influences.

A number of physical or medical factors can cause and contribute to difficulties with penetrative pain. They include:

  • Genital infections and imbalances such as thrush or bacterial vaginosis
  • A sexually transmitted infection
  • Dermatological (skin) problems (for example, lichen sclerosis or eczema)
  • Gynaecological problems (for example, endometriosis or fibroids)
  • Pelvic floor problems and dysfunction
  • Hormonal changes or endocrine disorders (like diabetes)
  • Changes associated with pregnancy, birth, or breast feeding
  • Ageing or menopause-related changes
  • Irritable bowel syndrome

It is important to have a thorough medical assessment by an appropriately trained medical professional, such as a specialist in sexual problems, to ascertain the role of any physical or medical factors contributing to penetration difficulties. Assessment of pain during penetration will usually involve an physical examination, This doesn’t have to happen at the first visit and your clinician will work with you to perform an examination in a way that you are comfortable with. It is important to note that, if you do not have an examination, then there is a chance that you are missing a treatable factor contributing to pain during sex, and therefore will be less likely to achieve your goal of reducing pain during penetration.

Difficulties with vaginal penetration can also be related to psychological factors including:

  • Beliefs about sex (for example, that it is shameful)

  • Not feeling safe with your partner

  • Unwanted, or negative, previous sexual experiences

  • Worrying about or expecting sex to be painful

  • Not being aroused by the situation, feeling sexually bored, or other feelings about your sexual practices and partners

  • Stress, depression, and anxiety

  • Tiredness

  • Relationship problems

  • Body image concerns

  • Having other things on your mind and not being able to be in the sexual moment

  • Having another sexual difficulty, or your partner experiencing sexual difficulties 

Some people might never find out what has caused their difficulties with penetration, and there might be a number of factors involved in causing and maintaining the problem.