Hurts so good? Not so much. Lovemaking is supposed to be more pleasurable than painful. So if you’re feeling discomfort on a regular basis, it’s time to get a tune-up and see just what’s going on down there.   

The medical term for pain during sex is dyspareunia, and a number of factors can contribute to the ache.  When moaning turns to groaning, it’s time to get to the root of the problem. 

The underlying issues may be physical, structural or psychological in nature. It’s important to address the issue because avoiding the topic and neglecting your symptoms could cause problems in your sexual relationship, as well as your emotional health. 

Below we discuss some of the most common causes of dyspareunia, the general symptoms of each and what you can do to ease the pain. 

Endometriosis 

Endometriosis is a condition in which the lining of the uterus – the endometrium – grows outside of the uterus. It often affects other structures in the pelvic region. Unfortunately, these growths can cause intense pain during intercourse. 

According to Everyday Health, more than half the women afflicted with endometriosis experience significant discomfort. Talk to your doctor about possible medical treatments, which may include hormone therapy to reduce the growths, and in some cases, surgery. 

Vaginusmus 

Another cause of pain during sex is vaginusmus, an odd-sounding medical term that simply means involuntary spasms or contractions of the vaginal muscles. Women frequently describe the sensation as burning, tearing or having “hit a wall,” explains The Society of Obstetricians and Gynecologists of Canada. The tightening itself doesn’t hurt; it’s only with penetration when pain occurs. 

For those with vaginusmus, pain can occur during: 

• sex;
• medical exams; or
• tampon insertion. 

The reflex may be the result of fear of pain from a previous trauma. There are certain exercises that can help patients overcome the condition. Discuss the issue with your doctor. 

Uterine Fibroids 

Uterine fibroids are benign growths than many women develop but do not know they have. 

There are a number of symptoms that indicate the presence of uterine fibroids, including: 

• back pain;
• heavy menstrual bleeding;
• pelvic pain; and
• bladder problems. 

Fibroids can make sex very uncomfortable or painful. It may worsen during certain parts of the menstrual cycle. If fibroids develop on the cervix near the cervical opening, this intensifies the pain. Fibroids also may begin to affect the libido because they can throw the hormones out of whack. 

Generally, fibroids are a non-life-threatening condition. If fibroids cause uncomfortable symptoms, speak to your doctor about treatment options. 

Emotional Issues 

Sometimes pain during sex can be attributed to emotional or psychological issues. Negative emotions often cause an array of problems in terms of intimacy and sex. For instance, fears, memories or angst can prevent a person from relaxing. Guilt factors or a history of sexual abuse may stifle a woman’s ability to enjoy intercourse. 

Emotional disturbances can prevent a woman from becoming aroused and creating natural lubrication, which inevitably leads to pain during sex, explains the Rubino OB/GYN Group in New Jersey. If you suspect that pain during sex is psychological in nature, consider therapy with a qualified sex therapist. The American Association of Sexuality Educators, Counselors, and Therapists is a good starting point for referrals, Rubino notes. 

Inadequate Lubrication 

You may be hurting during sex because of a lubrication issue. Lack of adequate natural lubrication and vaginal dryness can be very painful during intercourse.  There are a number of possible causes of inadequate lubrication, including hormonal imbalances (childbirth and menopause) and certain health conditions. 

Also, there are a number of commonly used medications that may reduce lubrication, according to the Mayo Clinic, including: 

• antidepressants;
• high blood pressure medications;
• sedatives;
• antihistamines; and
• certain birth control pills. 

In most cases, a simple, over-the-counter water-based lubricant does the job. 

Other Reasons for Pain during Sex 

WebMD cites several other possibilities for pain during intercourse, including: 

• vaginal infections;
• issues with the cervix;
• ovarian cysts;
• inflammatory diseases;
• ectopic pregnancy;
• sexually transmitted diseases; and
• injury to the vagina, such as tearing during childbirth. 

Ways to Treat the Pain 

Treatment options depend on the condition causing the pain. For example, menopause-induced lubrication issues may be remedied with hormone replacement or artificial lubricants. More serious conditions, such as severe endometriosis, may require surgery.  

According to Everyday Health, John C. Petrozza, MD, board-certified obstetrician-gynecologist at Massachusetts General Hospital Fertility Center offers these tips for easing the pain during sex. Although they are geared toward endometriosis-related pain, they also may relieve symptoms in other situations: 

• try side-to-side or "doggy style" positions in lieu of missionary, which is the most uncomfortable position because of the tilt of the pelvis;
• pick the least painful times of your menstrual cycle to have sex. Most women experience more endometrial pain mid-cycle, so you might want to forgo sex during those few days;
• talk to your partner about the pain to keep communication open. Having him or her involved in what you’re going through can make you feel understood and avoid misconstruing your physical pain as a relationship issue; and
• consider kissing, fondling and massage as alternatives when there’s discomfort. 
  

When It’s Time to See the Doctor 

If sex is becoming a pain, your best bet is to visit a doctor and determine the root cause. It the problem persists, it could be something more serious. Your physician will examine your medical history, perform an exam, and may or may not order additional tests. 

The Cleveland Clinic makes it clear when to see a physician: “Contact your doctor if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions.” It also recommends seeing a certified sex counselor if you experience pain that has no underlying medical explanation. 

Remaining mum on intimacy issues won’t help resolve the issue. It’s important to be proactive and take the necessary steps to get to the bottom of your issues. The health of your relationship may depend on it.