Possible causes
- After childbirth. A 2021 meta-analysis of more than 11,000 women found pain during sex in 42% two months after birth, 43% between two and six months, and 22% between six and twelve months. So it usually gets better over time, but not for everyone. After birth, hormonal changes can make the vagina drier. The NHS suggests using lubricant and, if it still hurts at your postnatal check, talking to your doctor.
- Endometriosis. According to the WHO it can make sex painful, to the point that those affected interrupt or avoid it. More in our article on endometriosis.
- Menopause. Vaginal dryness, burning and itching are among the symptoms the NHS lists for perimenopause and menopause. More in our article on perimenopause.
- Infections and irritation. The NHS lists thrush, sexually transmitted infections, pelvic inflammatory disease and reactions to condoms, soap or shampoo.
- Vaginismus. The vaginal muscles tighten on their own as soon as something is about to be inserted, including a tampon or the speculum at a smear test. It is an automatic reaction, not a matter of willpower, and it can be treated.
- Pain at the vaginal entrance when touched. The medical term is provoked vestibulodynia.
What a physiotherapy trial shows
A randomised trial of 212 women with provoked vestibulodynia compared ten weeks of physiotherapy with an anaesthetic ointment. The physiotherapy consisted of education, pelvic floor exercises with biofeedback, manual therapy and dilation. It reduced pain during sex more, and the effect was still there after six months. 79% of women in the physiotherapy group felt much better, compared with 39% in the ointment group. The authors recommend physiotherapy as the first treatment for this form.
⚠️ If sex keeps hurting, that is a reason for an appointment with your gynaecologist. You don't have to put up with it, and there is nothing embarrassing about it. You can ask for a female doctor and bring someone you trust.