Discover what causes pain during sex in females and treatment options available.

Pain with intercourse for women is extremely common and a common symptom that patients ask about include what is the sharp pain during during sex in females. Around 1 in 4 women will experience pain with intercourse at some point in their life. 

In order to help patients overcome pain with intercourse, the first step is figuring out why the pain is there in the first place.

A couple reasons that there may be sharp pain during during sex in females includes:

1. Hormonal changes

2. Pelvic floor tension

3. Mental and emotional stress

First, hormone changes could be the result of a couple of things: hormonal birth control use, postpartum and peri/postmenopause are three reasons that your body may be producing less estrogen. 

Estrogen is a hormone that is responsible for cellular proliferation and blood flow. When there is a decrease in estrogen, the vulvar tissue thins, and becomes more sensitive. This sensitivity can result in sharp pain during during sex in females, pain upon initial insertion, or may even progress to deep penetrative pain.

If you recently changed birth control, recently had a baby, or are entering peri/postmenopause (are over the age of 40+), hormones may be playing a role in your symptoms. Be sure to chat with your OBGYN about your symptoms and ask if you could try to use a vaginal estrogen cream. 

Vaginal estrogen cream is placed on the area of the vulva that feels tender, dry, and painful (usually right at the insertion to the vaginal opening). It takes about a month to start noticing changes, but can help dramatically reduce your symptoms, especially if they are present with initial insertion.

Pelvic floor tension can also cause sharp pain during during sex in females.. The pelvic floor muscles are a group of muscles that sit in the bottom of the pelvis. When these muscles are tense, they can elicit pain. 

We always compare tension in the pelvic floor to tension int he neck. If you were to keep your shoulders shrugged all day, the muscles in the neck would become tense and painful. The same thing can happen to the pelvic floor. 

What causes pelvic floor tension?

Chronic clenching (always flinging like you are squeezing your glutes, or holding back gas), postural habits (standing with your hips thrusted forward), and mobility concerns (stiffness in the hips) are all reasons that your pelvic floor may be tense. We always say in static standing, your ribs should be stacked over the pelvis, and the butt muscles should be nice and relaxed.

It is important that we not only stretch and learn to relax the pelvic floor muscles, but that we also figure out why the muscles may be tense. We have to change some of the habits and postures that you might be doing in order to get long term changes in the pelvic floor. 

Lastly, mental and emotional distress can be causing sharp pain during sexually active female. This can come due to a number of reasons including: past trauma, fear of pain, feeling unsafe in your relationship, or even shame around sex which may be the result of values that were part of your upbringing. 

In all of these situations, the pelvic floor muscles may subconsciously tense. This tension can lead to more pain, which further drives more tension into the pelvic floor muscles. 

If you have a fear of painful penetration, or in general feel like you get into your head about pain with sex, reaching out to a certified sex therapist is the first place to start. 

Pain with sexual intercourse and sharp pain during during sex in females. often requires a multidisciplinary team of your OBGYN, mental health therapist, and pelvic floor physical therapist to help you overcome your symptoms. Relief is absolutely possible with the right care plan.  For more information, check out our podcast on painful intercourse here.