Why Sex Hurts: Understanding Vaginismus, Dyspareunia & Vulvodynia

Experiencing unwanted pain during sexual activity is a serious concern and should not be treated as “normal” or something to grin and bear. Pain-free, pleasurable sexual intimacy is something that you are worthy of and is a very real possibility for you.

Painful sex is common, occurring at least occasionally for a majority of women, and recurring in roughly 15% of American women. While occasional discomfort may be normal, unwanted pain, especially re-occurring is not acceptable.

Experiencing pain during sexual intimacy can be significantly difficult and distressing. You are not alone, and you are not broken.

This blog will explore what painful sex is, clarifying specific diagnoses of vaginismus, dyspareunia, and vulvodynia, explore the underlying causes, address common myths, and outline how sex therapy and medical support can nurture satisfying sexual intimacy.

What is Painful Sex?

Dyspareunia is a general term for painful intercourse. It is a term that is used for both men and women, although it is more common in women. Pain may occur before, during, or after sexual intercourse. For women, the pain may be on the vulva, at the opening of the vagina, or deep in the vagina or pelvis. Pain can be experienced as burning, stretching, tearing, stinging, pressure or itching.

Vaginismus is the involuntary spasm and tightening of the pelvic floor muscles which obstructs vaginal penetration. Penetration is impossible, or extremely difficult. This includes penetration by even a finger or tampon. Vaginismus is often driven by a panic response in the body, linked to fear and anxiety of pain in anticipation of, during, or a result of vaginal penetration. This involuntary conditioned response can stem from negative sexual conditioning, sexual trauma, and other painful past experiences.

Vulvodynia is specific for discomfort of burning pain specific to the vulva, without explanation such as a skin condition of neurological disorder. Constant and unprovoked pain is dysesthetic vulvodynia. When pain only occurs at the area surrounding the vaginal entrance when pressure is applied, this is known as provoked vestibulodynia.

These conditions are grouped together in the DSM-5 as Genito-Pelvic Pain/Penetration Disorder (GPPPD).

Common Causes of Painful Sex

Biological: hormonal changes such as reduced estrogen levels in menopause can decrease lubrication, thin vaginal tissue, and decrease elasticity, leading to sexual pain. STIs such as herpes or infections such as yeast infections, and pelvic inflammatory disease can cause or contribute to pain. Tightness in the pelvic floor muscles is a common factor in genital pain. Other conditions include endometriosis causing deep pelvic pain, and injuries such as complications from surgery (e.g. hysterectomy).

Psychological: fear and anticipatory anxiety can activate the body’s threat system causing the pelvic floor muscles to tighten, trauma history such as sexual abuse and assault, painful or frightening past sexual experiences, and negative or rigid sexual attitudes.

Relational and Emotional: a lack of communication about sexual needs, pleasure and comfort can perpetuate poor sexual technique and pain. Misunderstanding from a partner about the pain, pressure for sexual intercourse even when it is painful, or avoidance can heighten and perpetuate pain. Shame can lead to feeling broken, amplifying distress.

Myths About Painful Sex

Pain is normal and should be expected: Many women tolerate pain unnecessarily because they believe it is normal. This belief can lead to enduring pain and not seeking support or treatment. Pain during sex can be managed and treated. Sex can be pleasurable, and unwanted pain should not be tolerated.

If my doctor finds nothing wrong, the pain must be “all in my head”: Your vulva or vaginal pain is very real and not imaginary. If a doctor finds no biological reason, it just means that the origin of the pain is not yet clear. While not imaginary, their may be psychological and relational factors that play a major factor in your pain, but this does not mean the pain is imaginary or not real physically.

I just need to relax and push through the pain: forcing penetration can reinforce the negative association of penetration and pain, and worsen the pain in the long run! While relaxation is important, trying to “relax” without first understanding the very valid reasons your body may be experiencing pain can dismiss and invalidate your experience. This dismissal can inadvertently feed the fear and anxiety.

Practical Steps You Can Try Now

Prioritise lubrication: Use a water-based lubricant, incorporating it into sexual play prior to intercourse.

Expand sexual intimacy: Sex is more than penetration. Engage in and focus on pleasurable touch such as cuddling, kissing, manual, oral, or vibrator stimulation. Treat these as valid and fulfilling acts of sexual intimacy in and of themselves, without the pressure or “goal” for these activities to lead to penetration.

Take charge of penetration: if and when penetration is desired, the person experiencing pain needs to be supported to initiate and guide penetration, such as the speed, depth, and position. This minimises discomfort and enhances a sense of control.

Communicate needs proactively: Share what you value in sex, what brings you pleasure, what amplifies desire and arousal. Share what makes you anxious or causes you pain. Work as a team to explore shared pleasure.

When to Seek Professional Support

-            If your pain is persistent and not alleviated by simple measures such as lubrication

-            If pain is causing significant distress or sexual avoidance

-            If there is the inability to experience vaginal penetration during intercourse, tampons, or gynaecological exams

-            If there is relational strain surrounding or resulting from the sexual pain

Due to the complex relationship between the biological, psychological, and relational factors it is essential to address sexual pain holistically. Consult a GP as a first step to explore the biological components. Pelvic floor physiotherapy is considered an essential treatment to manage the muscular components of sexual pain with a hands on, practical approach. Sex therapy can address the psychological and relational components at play.

How Sex Therapy Can Help

Sex therapy is part of an integrated, multidisciplinary approach to treating sexual pain. It helps you understand fear and anxiety, reframe catastrophic thoughts, challenge negative sexual scripts, establish realistic goals, and validate both the psychological and physical experience of pain.

In therapy, I invite couples to explore the pain together as a team — fostering empathy, understanding, and connection. We work on understanding each other’s sexual expectations and views, improving the overall relationship communication and emotional intimacy, and practical tools for enhancing sensuality and pleasure.

Painful sex is not something to be ignored or endured. With the right support, compassion, and guidance, it is possible to heal, reclaim safety in your body, and experience intimacy that feels connected and pleasurable again.

If you’re struggling with sexual pain, I’d be honoured to support you through this journey. I offer online sex therapy across Australia — providing a safe, confidential, and understanding space to explore and work toward sexual wellbeing.

Written by Justine

References

1. Gambescia N, Weeks GR, Hertlein KM. A Clinician’s Guide to Systemic Sex Therapy. 3rd ed. New York, NY: Routledge; 2021.

2. Bolin A, Whelehan P, Vernon M, Antoine K. Human sexuality: biological, psychological, and cultural perspectives. 2nd ed. New York, NY: Routledge; 2021.

3. Crooks R, Baur K, Widman L. Our Sexuality Enhanced Fourteenth Edition. Mason, OH: Cengage Learning, Inc.; 2025.

4. Leech P. Overcoming Anxiety in Sex and Relationships: A Comprehensive Guide to Intimate and Emotional Freedom. New York, NY: Routledge; 2025. doi: 10.4324/9781003369080.