Pelvic health and pain during sex

Is it normal for sex to hurt?

It is common, but it is not something you have to endure. In the British national survey Natsal-3, with more than 6,600 sexually active women, 7.5% had had pain during sex for at least three months in the previous year. For one in four of them the pain was very frequent, lasted six months or more and caused distress. It was linked above all to vaginal dryness, anxiety about sex and low enjoyment.

It also happens to people with a penis, for example in chronic prostatitis (chronic pelvic pain syndrome), with a short frenulum or a curved penis, although it is less studied. In almost every case there is a treatable cause.

Where it hurts matters

We explain each cause in detail in Pain during sex: causes and when to see a doctor.

When to see a professional

• If the pain keeps coming back or lasts more than a few weeks.
• If it comes with unusual discharge, a bad smell, itching, sores or fever, especially after sex without a condom: it may be an infection. See how often to get tested for STIs.
• If you bleed after sex or between periods.
• If the pain is deep and your periods are very painful: endometriosis takes years to diagnose and is worth mentioning.
• If penetration is impossible or you are afraid to try.
• If pain after childbirth does not improve over the weeks.

Who to see: a gynaecologist or your GP; a urologist if you have a penis; a pelvic floor physiotherapist; a sex therapist or psychologist when there is fear, anxiety or relationship strain. Note down where it hurts, when it starts and which positions make it worse: it helps a lot with diagnosis.

What helps, according to the evidence

• Pelvic floor physiotherapy. In a trial with 212 women with provoked vestibulodynia, multimodal physiotherapy reduced pain during penetration more than topical lidocaine, and the improvement was still there six months later.
• Lubricant and more time for arousal. Dryness is the factor most linked to pain. See how to choose a lubricant and why responsive desire needs time before penetration.
• Treating the cause. An infection can be cured; in menopause there are moisturisers and local hormone treatments (see sexuality during menopause).
• Sex therapy or psychological therapy. Expecting pain tightens the muscles, and tension increases pain. Breaking that cycle, ideally as a couple, is part of treatment.
• Choosing the position. In a study of 71 patients with endometriosis, 83% had deep pain and for 68% it only hurt in certain positions; rear-entry positions, especially on all fours, were the most painful. No position works for everyone: the idea is to experiment while staying in control.

Before choosing a position: six adjustments

1. The person in pain decides depth, pace and when to stop.
2. Agree on a pause signal before you start, and always respect it.
3. More arousal and plenty of lubricant: with latex condoms, use water- or silicone-based lubricant.
4. Limit depth: legs together or straight, a smaller hip angle, or soft depth-limiting rings worn at the base of the penis or toy.
5. Rocking instead of thrusting: short, slow movements.
6. Penetration is optional. Don't push through pain: repeating it reinforces tension and fear.

Positions that help you manage pain

A selection by goal. Try them with the adjustments above and keep what works for you.

The person in pain controls depth

The CowgirlMedio

The receiving partner is on top and decides how deep, how fast and when to stop. Leaning forward reduces depth.

On a Chair (Straddling)Bajo

Sitting astride with feet on the floor, the receiving partner sets the movement with short rocking instead of thrusts.

Tantric Sex (Slow Sex)Bajo

Still penetration or just touching, with slow breathing: a gentle way back to penetration without pressure.

Side-lying and shallow

The Half Moon EncounterBajo

Side by side, face to face, with the receiving partner's legs together: shallow penetration and eye contact to communicate.

Side-by-Side Face to FaceBajo

Nobody bears weight and the angle keeps penetration shallow; it also works for rubbing only.

The Venus MirrorMedio

Side-lying and face to face with shallow penetration: easy to go slowly and stop at any moment.

The SpoonBajo

Side-lying with little range of movement; closing the legs limits depth. If the pain is deep, try it with care: rear entry bothers some people more.

Face to face with short strokes

The Cobra (Embracing Hug)Bajo

A full embrace and short rocking instead of thrusting; pubic contact stimulates without needing depth.

The MissionaryBajo

With the receiving partner's legs straight, penetration is shallower; use a cushion under the pelvis only if it eases pain.

Pleasure without penetration

Mutual Manual StimulationBajo

Pleasure without penetration during treatment or whenever penetration hurts.

Frottage (Body Rubbing)Bajo

Genital and body rubbing with full control of pressure.

Erotic MassageBajo

Lowers tension and anticipatory anxiety, which increase pain; move from neutral to erogenous areas.

The ScissorsBajo

Vulva-to-vulva rubbing without penetration, with pressure both partners can adjust.

Working with your own body

Lying Down Self-ExplorationBajo

Learn which areas and what pressure hurt, at your own pace and without a partner: the basis of many vaginismus treatments.

Pelvic Floor and KegelBajo

Learn to contract and, above all, to relax the pelvic floor. If there is pain, focus on relaxing and ask a physiotherapist for guidance: squeezing harder does not always help.

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