Pain during sex isn’t totally uncommon—we’ve all felt the cringe that follows not using enough lube. Around 12 to 16 percent of women report consistently painful sex, says Deborah Coady, M.D., a New York City ob-gyn and author of Healing Painful Sex, and there are many more who experience periodic pain.
If you do have any pain during the action, it’s important to pay attention. First things first: Determine whether the pain is transient (an occasional occurrence) or consistent (a regular problem you’ve had more than two or three times in a row), says Dr. Coady. Next, analyze the situation when the pain occurs: What’s going on in your body in that moment? Are you in an uncomfortable position? What is your emotional comfort like? Do you have any infections? Where are you in your cycle? That will help your ob-gyn figure out for sure what’s going on.
Here are the most common reasons you might feel pain during sex—and when to talk to your doctor.
Having sex when you’re not fully lubed up can be seriously uncomfortable. “The tissues are not engorged and lubricated and ready,” says Dr. Coady. Luckily, there’s a pretty easy fix. If you’re not getting naturally aroused, spend more time on foreplay. But even with foreplay, some women need a little extra help (and that’s totally OK). Look for a lube that’s water-based (i.e., formulated without oil) if you’re using condoms.
Another major culprit of transient pain is certain personal care products, says Dr. Coady. These include “creams and douches and contact irritants such as soaps,” she says. These products are often full of chemicals that can be irritating to the super-sensitive skin on your vulva and inside your vagina. If you have any sort of issue, ask for a recommendation from your gyno, and if you have any sort of irritation or, worse, an allergic reaction after trying a new product, stop using it immediately and call your doctor.
Yeast infections and urinary tract infections can make sex really uncomfortable. While these things are generally easy to treat on their own, Dr. Coady says they can be exacerbated (or first made evident) by sex. Your doctor will likely advise you to forgo sex while you’re being treated for the infection. If the pain doesn’t resolve, don’t be afraid to head back to your doctor for a follow-up. “If there’s pain in the bladder and it’s consistent and antibiotics don’t work, that should really be evaluated,” Dr. Coady says.
Both of these issues—especially bloat—can cause pelvic pain during sex. But, as Dr. Coady points out, they should be short-lived. If it’s a consistent problem, let your doctor know.
In some cases, the pain is more constant than situational, which could be a sign of a chronic issue like vestibulodynia—”an inflammatory disorder or process that occurs in the tissue at the vaginal opening,” says Dr. Coady. Eighty percent of consistent sexual pain in women (premenopause) is caused by vestibulodynia, she adds. The condition causes pain when the sensitive area is provoked in any way, sexual or not—even by a tampon. If you’re having pain at the opening of your vagina on a regular basis, get it checked out to know for sure whether this is the case, and to get treatment.
The muscles in your vagina might tense up due to vestibulodynia, but it can also be a sign of more serious conditions like interstitial cystitis or painful bladder syndrome. These conditions can cause the muscles to become shortened or overactive, Dr. Coady says, because they’re reacting to another issue in your body. Your doctor may refer you to a pelvic floor physical therapist.
Whether there’s an ongoing issue or not, it’s important to “know your anatomy,” Dr. Coady says. “Know how you look and know your baseline of feeling fine,” she says. If you feel something outside of that baseline, always get it checked out. “Never ignore pain,” Dr. Coady says.
More important, don’t let anyone tell you it’s just in your head. “The most important thing is self-advocacy,” Dr. Coady says. “If your doctor says they don’t see anything and it must be in your head, the mistake would be to not change doctors. Anyone who says they can’t help you, or that there’s nothing there, is not the right doctor.”