Common Causes
Painful intercourse can arise from a variety of factors. In some cases, the reasons are physical, such as hormonal changes or underlying medical conditions. In other cases, emotional and psychological influences play a role. Often both aspects overlap, which is why a complete evaluation is so important.
Physical Causes
- Vaginal dryness due to hormonal changes (common after menopause, postpartum, or while breastfeeding)
- Infections, such as urinary tract infections, sexually transmitted infections, or yeast infections
- Pelvic conditions including endometriosis, pelvic inflammatory disease, or ovarian cysts
- Skin disorders affecting the vulva (eczema, lichen sclerosus)
- Pelvic surgery, scarring, or radiation therapy
- Conditions such as irritable bowel syndrome, interstitial cystitis, or uterine fibroids that contribute to pelvic pain, physical pain, and sometimes chronic pain
Emotional and Psychological Causes
- Past trauma or sexual abuse
- Anxiety, depression, or other mental disorders
- Relationship stress that increases pelvic floor muscle tension and can lead to female sexual dysfunction
Other Contributing Factors
- Certain medications, such as antidepressants or birth control that reduce natural lubrication
- Inadequate arousal or lack of foreplay
- Pelvic floor dysfunction or involuntary spasms of the muscles