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What are the most common causes of painful intercourse in women?
Executive summary
Painful intercourse (dyspareunia) is common and usually has identifiable causes; vaginal dryness/low lubrication and pelvic or gynecologic conditions such as infections, endometriosis, or ovarian/cervical problems are repeatedly listed as leading contributors (see Johns Hopkins, Cleveland Clinic, ACOG) [1][2][3]. Psychological/emotional factors and pelvic floor muscle problems—including vaginismus—also appear across major sources as important causes and modifiers of pain [4][5].
1. Vaginal dryness and low lubrication: the most frequently cited proximal cause
Many clinical and academic sources identify insufficient lubrication—often from low estrogen (menopause, breastfeeding, surgical menopause), certain medications, or inadequate arousal—as the most common immediate reason penetration feels painful; providers routinely recommend lubricants or local estrogen therapies when appropriate (Cleveland Clinic, Cedars-Sinai, Henry Ford) [2][6][7].
2. Infections and inflammatory conditions: sharp or burning pain linked to treatable causes
Vaginal or vulvar infections (yeast, bacterial vaginosis) and sexually transmitted infections such as chlamydia, gonorrhea, and herpes cause local irritation, sores, discharge or inflammation that commonly produces painful intercourse; clinicians emphasize testing and targeted treatment because these are often reversible causes (Johns Hopkins, WebMD, Rush) [1][8][5].
3. Deep pelvic pain from gynecologic problems: endometriosis, fibroids, ovarian issues
Deep dyspareunia—pain during thrusting or with deep penetration—is commonly linked to internal pelvic conditions such as endometriosis, uterine fibroids, ovarian cysts, or adhesions/scar tissue from surgery or childbirth. Multiple specialty sources note these conditions may require gynecologic evaluation and specific medical or surgical management (ACOG, Mayo Clinic, Cedars-Sinai) [3][9][6].
4. Pelvic floor muscle dysfunction and vaginismus: when muscles tighten instead of relax
Involuntary pelvic floor muscle spasm (vaginismus) and other myofascial pelvic pain syndromes can cause severe entry pain even when no visible disease is present. Guidance from gynecology clinics and reviews notes physical therapy, desensitization, and psychological therapies as common, effective approaches (Princeton Gyn, StatPearls, Rush) [4][10][5].
5. Skin and dermatologic disorders, trauma and scarring: look at the vulva, too
Dermatologic diseases (lichen sclerosus/planus, contact dermatitis), episiotomy scars, female genital mutilation, or tearing from childbirth can create ulcers, cracks or scar tissue that make intercourse painful; these causes are highlighted across hospital and specialist sites as requiring dermatologic or surgical review (UT Health Austin, Patient.info, StatPearls) [11][12][10].
6. Urological and bladder disorders: when pain is not purely “gynecologic”
Chronic bladder conditions such as interstitial cystitis / painful bladder syndrome are associated with deep dyspareunia and pelvic floor tenderness; some reviews emphasize cross-talk between bladder, pelvic floor and reproductive organs as an under-recognized contributor to sexual pain (StatPearls, Rush) [10][5].
7. Psychological and relational factors: how mind and context shape pain
Anxiety, prior sexual trauma, shame, low arousal or relationship stress can reduce lubrication and produce muscle tension that magnifies or even generates pain; major health organizations recommend assessing psychological and relational contributors alongside physical causes (Princeton Gyn, ACOG, Rush) [4][3][5].
8. How common is this—and why prevalence estimates vary
Estimates vary widely: some professional bodies say up to three in four women report pain at some time, while epidemiologic reviews put point prevalence lower (3–18%); differences reflect whether surveys ask lifetime experience vs. persistent, clinically significant pain and whether people seek care (Princeton Gyn, ACOG, StatPearls) [4][3][10].
9. Diagnostic approach and treatment themes: treat the cause, and address contributors
Sources consistently advise clinicians to take a nonjudgmental history, examine for infections/dermatologic disease, consider pelvic imaging for suspected endometriosis or masses, and evaluate pelvic floor function; treatments span topical lubricants and hormones, antibiotics/antifungals, pelvic floor therapy, psychotherapy, and surgery when indicated (Johns Hopkins, Cleveland Clinic, Mayo Clinic, Henry Ford) [1][2][9][7].
10. Caveats, disagreements and gaps in reporting
Available sources emphasize multiple overlapping causes and treatments but differ in prevalence figures and in how prominently they rank specific causes (e.g., dryness vs. pelvic pathology) [4][10]. Sources do not provide a single, definitive ranking of “most common causes” by percentage; available sources do not mention a universal numeric breakdown that applies across populations [2][10].
If you want, I can summarize likely next steps for someone experiencing pain (what to tell a clinician, immediate self-care measures to try, and red flags that require prompt evaluation) with citations from these same sources.