If it hurts to have sex, there are four things you need to consider.

Jessica Migala
February 22, 2018

You’ve probably heard a woman worry aloud about how her vagina will be “too stretched out” or “will never be the same” after having a baby. But some women also wonder if they have the opposite problem: that they have a vagina that’s too tight and unable to accommodate a large or even average-size penis—leading to discomfort and pain during sex that can make intercourse almost impossible.

In general, that’s largely a myth. Fact is, your vagina is very stretchable. “Any vagina has the capacity to have elasticity. After all, a baby’s head comes through there,” says Lauren Streicher, MD, medical director of the Center for Sexual Medicine and Menopause at Northwestern Memorial Hospital in Chicago.

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Of course, that doesn’t mean that the pain you might feel during sex isn’t real. If you don’t think that his penis is a match for your vagina because he can’t enter you at all or in full, and it hurts to try, an underlying issue might be going on. “If you’re having pain with intercourse, the causes are entirely fixable,” says Dr. Streicher.

Rather than assuming your vagina is too tight and there's nothing you can do, it's time to address what could really be keeping you in pain—instead of experiencing pleasure. Here are four causes to consider.

Is it hormonal?

Thanks to normal hormonal changes during perimenopause and menopause, vaginal tissue can thin out and get parched, making sex extremely uncomfortable. More surprisingly, the same problem can crop up in your 20s and 30s due to hormonal birth control, says Dr. Streicher. “While most women taking birth control pills will be fine, a small subset of women will develop thin dry vaginal tissue. Their doctor may tell them that they’re young and nothing is wrong with them, but they what they experience is excruciatingly painful,” she explains.

If you suspect your pain stems from a hormonal issue, tell your ob-gyn what you're experiencing and have her investigate. Fixing the problem could mean going on a different type of hormonal birth control or relying on a vaginal estrogen cream to rebuild elasticity in vaginal tissue.

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Is it lubrication?

So many things can leave a woman high and dry during sex, and dryness is a major cause of pain during penetration. Maybe you’re taking a lot of antihistamines; these allergy meds can dry you out down below, too. It could be that you and your guy aren’t allowing for enough foreplay, and you just need a little more kissing and touching for things to start flowing down there. Dedicate more time to the warm up before the main event, and if foreplay isn't the issue, use lube. Super-slippery silicone lubricants are best, recommends Dr. Streicher.

Is it muscular?

In the past, if sex has been painful, your vagina may be conditioned to react by clamping down during penetration. Your brain says, nope, I don’t want to feel that again. “A lot of times, it’s the fear factor,” says Dr. Streicher. She often recommends that women take the penis out of the equation completely and practice with a dildo. “That can help you figure out if it’s the guy, the size, or you,” she says.

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Is it a physical issue?

It’s rarer, but the pain could be the result of a physical problem. One woman Dr. Streicher treated "couldn’t have intercourse with her husband, and she was actually told by her doctor that his penis was too big. She had an undetected vaginal septum that had to be removed. She’s now fine,” she explains. (A vaginal septum is a wall of tissue inside the vagina.) This is why pain during sex that doesn’t get better with extra lube or foreplay needs to be evaluated by a doctor.

What should you do?

Your first step is to decode what may be causing the pain (check!). Then, see an expert, like a gynecologist specializing in sexual medicine. In major cities you can often find pelvic-floor physical therapists as well, recommends Dr. Streicher; these professionals can be especially helpful if you have a muscular issue. Otherwise, her book SexRx outlines many at-home solutions that are worth giving a shot, from lubricants to dildos. A healthy, satisfying sex life is within reach of all women.