Pain During Sex: Why It Happens to Women, What Causes It, and What You Can Do About It

Because nobody ever told them it was okay to talk about it.

In India, sexual health is wrapped in so many layers of silence that most women do not even have a vocabulary for what they are experiencing. You grow up hearing that sex is something you endure, not enjoy. That pain is expected. That asking questions about it means something is wrong with you rather than something is wrong medically.

That Delhi hospital study found that 64 percent of women with sexual health problems had never discussed them with anyone - not a friend, not a family member, and certainly not a doctor. They just carried it silently.

Then there is the misinformation. Google “pain during sex” in Hindi and you will find everything from dubious home remedies to spiritual explanations. Women try coconut oil, ashwagandha, “Kegel exercises for six months” - all before considering that a ten-minute conversation with a gynaecologist could actually tell them what is going on.

I am not blaming anyone for this. The healthcare system has not exactly made it easy. Many doctors themselves skip over sexual health in consultations. But the result is that women suffer in silence for years over something that could often be fixed in weeks.

This is one of the most searched queries I see, and it is surrounded by more myths than almost any other topic in women’s health.

Let me be direct: mild discomfort during the first time is common. It happens because of nervousness, muscle tension, and unfamiliarity - not because something is “supposed to break.” The idea that first-time sex must hurt or must cause bleeding is simply not true for many women.

The hymen is not a seal that needs to be torn. It is a thin, stretchy membrane that has an opening already. In many women, it stretches gradually over time from normal activity - exercise, tampon use, regular movement. Some women experience a little discomfort the first time, some do not notice anything at all.

What does cause first-time pain in most cases is anxiety. Your pelvic floor muscles tense up because you are nervous, which makes penetration harder and more painful. This is a completely normal response.

What is not normal: severe pain that makes penetration impossible, bleeding that does not stop, or pain that persists every single time beyond the first few attempts. If that is happening, see a doctor. It could be vaginismus, a thick hymen, or an infection that was already there.

This depends entirely on the cause. But the good news is that treatment works. A multidisciplinary treatment study found that over half of women with chronic dyspareunia reported significant improvement, and for specific causes like vaginismus, success rates reach 79 to 86 percent. Here are the practical steps that help across most situations.

Use a water-based lubricant. This is the simplest first step. Many women feel embarrassed about needing lubricant, as if it means their body is not working properly. It does not. Lubrication varies with stress, sleep, hydration, hormones, and even the time of the month. A good water-based lubricant (avoid oil-based ones with condoms) reduces friction and makes a significant difference for many women.

Ensure adequate arousal before penetration. This is not just about foreplay as a concept - the body needs time to prepare physically. Blood flow to the pelvic area increases, the vaginal walls produce natural lubrication, and the cervix lifts. Rushing this process is one of the most common reasons sex is painful.

Treat active infections first. If you have a yeast infection, bacterial vaginosis, or any other gynaecological infection, sex is going to hurt. Treat it, wait for it to clear, and then try again.

Experiment with positions. Positions where the woman controls the depth and pace of penetration (such as being on top) tend to be less painful for women with deep dyspareunia. Avoid deep-thrust positions if deep pain is your issue.

Manage stress and fatigue. Chronic stress tightens pelvic floor muscles without you realising it. Poor sleep reduces arousal and lubrication. These are not “soft” causes - they have real physiological effects.

Pelvic floor physiotherapy. For vaginismus and muscle-related pain, this is one of the most effective treatments available. Research shows pelvic floor therapy achieves success rates of around 85 percent for vaginismus. A trained physiotherapist teaches you to identify, relax, and retrain the pelvic muscles. It is not a quick fix - it typically takes 8 to 12 weeks - but it works.

Address hormonal issues. If dryness is related to menopause, breastfeeding, or hormonal contraception, your doctor may recommend local oestrogen therapy or adjust your medication.

“The most common pattern I see is a woman who has been enduring painful sex for years, and her only strategy has been to avoid it. By the time she comes in, it has affected her relationship, her confidence, and sometimes her mental health. The fix is often surprisingly straightforward once we know the cause.”
- Dr. Pallavi Kulkarni

I know this is the part that stops most women. The thought of describing something so personal to a doctor feels overwhelming. So let me tell you exactly what happens, step by step, so you know what to expect.

First, we talk. I will ask you when the pain started, where exactly it hurts, whether it happens every time or only sometimes, whether it has changed over time, and what other symptoms you have noticed. I may ask about your periods, about any changes in discharge, about your general health and medications. This conversation is private and confidential.

Then, if needed, a physical examination. This is always done with your consent, gently, and with explanation at each step. I am looking for signs of infection, inflammation, skin changes, muscle tightness, or tenderness in specific areas.

Depending on what I find, I may recommend an ultrasound, a vaginal swab for infection testing, or blood tests for hormones. Often, the cause is identified in the first visit itself.

Nobody is judging you. Whether you are married or unmarried, whether you have been sexually active for ten years or ten days, it makes no difference to me. I am a gynaecologist. My only concern is your health, not your personal life. Nobody is going to lecture you. And nobody is going to make you do anything you are not comfortable with. A good gynaecologist creates a space where you can speak freely, and that is exactly what we aim for.

Pain during sex is one of the most under-reported, under-discussed, and under-treated problems in women’s health - especially in India. But it does not have to stay that way.

You do not need to “just relax.” You do not need to endure it. You do not need to wait until it gets unbearable. You need a proper diagnosis and a treatment plan that actually addresses the cause.

If you have read this far, you already know something is not right. The next step is a conversation with someone who can help. That is all it takes to start.