Talking With a Partner About Painful Sex

Understanding Dyspareunia, Communicating Without Blame, Finding the Cause and Restoring Comfortable Intimacy

By Dr. Nizamuddin Qasmi
Founder & Chief Physician, Saira Health Care
Focused Practice in Sexual Disorders & Infertility

BUMS – Hamdard University, Delhi
MD, CGO
Certificate in Infertility – MGBIMS, Delhi
Certificate in Urology – London, UK
Masters in Male Infertility – MasterHealthPro (HealthPro)
Integrated Sexual and Reproductive Health – ISRH, UNFPA

Introduction

When sexual intercourse becomes painful, many people do not know how to explain it to their partner.

A woman may think:

“If I ask him to stop, will he think I do not love him?”

Another may worry:

“Maybe pain during sex is normal and I simply need to tolerate it.”

A man may experience pain during erection or ejaculation but remain silent because he feels embarrassed.

The partner may then misunderstand the situation and think:

“Why is my husband or wife avoiding intimacy?”

This is where a medical problem can gradually become a relationship problem.

In my clinical practice in sexual disorders and infertility, I consider communication about painful sex to be just as important as identifying the physical cause.

The medical term commonly used for painful intercourse is dyspareunia. It refers to pain that occurs before, during or after sexual activity or penetration. Pain may occur near the vaginal opening, deeper within the pelvis, in the penis, testicles, prostate or pelvic floor, or around the time of orgasm and ejaculation.

Painful sex is particularly common in women, but men can experience it as well. Importantly, painful sex is not a diagnosis by itself. It is a symptom that can arise from many different physical, hormonal, muscular, neurological, infectious, psychological or relationship-related conditions.

My first message to patients is therefore simple:

Sex should not repeatedly hurt, and pain should not be ignored merely because the subject is private or embarrassing.

In many patients, identifying and treating the underlying cause can substantially improve or resolve the problem.

Painful Sex Is Not Something You Should Be Forced to “Adjust To”

Some patients have been told:

“It happens to everyone.”

“You will get used to it.”

“Just relax.”

“You have to tolerate some pain.”

These statements can delay diagnosis.

A brief sensation of mild discomfort may occasionally occur, particularly during inadequate lubrication or a new sexual experience, but recurrent, significant or persistent pain should not simply be accepted as normal.

WHO’s sexual-health framework emphasises that sexual wellbeing should involve safety, respect and freedom from coercion. Healthy sexual activity should be mutually acceptable rather than something one person is pressured to endure.

If penetration hurts, it is appropriate to say:

“Please stop.”

Consent is not given once and then permanently fixed.

A person can slow down, change activity or stop at any point.

A caring partner should treat pain as information—not as rejection.

Talking About Pain Does Not Mean Rejecting Your Partner

This is one of the most important misunderstandings I see.

A person experiencing pain may begin avoiding intercourse without explaining why.

The partner may then think:

“She does not want me anymore.”

or:

“He has lost interest in me.”

But the reality may simply be:

“I am afraid it will hurt again.”

When pain is not discussed, both people start making assumptions.

Good communication removes those assumptions.

You might say:

“I still want closeness with you, but penetration has recently become painful for me. I don't want us to ignore it. I would like us to slow down and find out why it is happening.”

This communicates three things immediately:

There is still affection.

The pain is real.

The partner is being invited to help rather than blamed.

What Does Painful Sex Feel Like?

Painful sex does not feel the same for everyone.

Some patients describe:

burning,

stinging,

sharp pain,

tearing,

pressure,

cramping,

aching,

or deep pelvic discomfort.

Mayo Clinic’s current 2026 review describes dyspareunia as pain that may occur with vaginal entry, with insertion of another object such as a tampon, deeper within the vagina or pelvis, or before, during or after sexual activity.

The location of the pain can give important clues about the cause.

Entry Pain Versus Deep Pain

Doctors often distinguish between superficial or entry pain and deep pelvic pain.

Entry pain

This occurs around the vulva or vaginal opening as penetration begins.

A patient may say:

“It burns as soon as penetration starts.”

or:

“The muscles seem to close automatically.”

Possible causes include vaginal dryness, inadequate lubrication, infection, vulvar skin disorders, vulvodynia, childbirth injury, pelvic-floor muscle overactivity or vaginismus-type symptoms.

Deep pain

This is felt farther inside the pelvis, often during deeper penetration.

A woman may describe:

“The entrance is not the problem, but I feel a sharp pain deep inside.”

Possible causes can include endometriosis, pelvic inflammatory disease, adenomyosis, uterine fibroids, ovarian cysts, pelvic organ prolapse, bladder pain disorders, pelvic-floor problems and other pelvic conditions.

The distinction matters because the treatment can be completely different.

Vaginal Dryness Is a Common Cause

Adequate lubrication reduces friction during sexual activity.

When lubrication is insufficient, vaginal tissues may become irritated and penetration may burn or feel as though the tissues are being stretched painfully.

Dryness may occur because of inadequate arousal, stress or hormonal changes.

It is particularly common after menopause because estrogen levels fall and vaginal tissues can become thinner, less elastic and more easily irritated.

It can also occur during breastfeeding and after childbirth.

Certain medicines may contribute to dryness or reduced arousal as well.

This is one reason couples should not rush penetration.

More time for arousal may increase natural lubrication in some patients, and an appropriate lubricant can substantially reduce friction.

Painful Sex Around Menopause

After menopause, some women experience what is now commonly called genitourinary syndrome of menopause.

Lower estrogen levels can cause:

vaginal dryness,

thinning of vaginal tissues,

burning,

irritation,

urinary symptoms,

and pain during penetration.

This is a genuine biological condition.

It should not be dismissed as:

“You are getting older, so nothing can be done.”

Depending upon the individual patient, treatment may include vaginal moisturizers, lubricants and appropriately prescribed local vaginal estrogen or other therapies.

Medical history matters because hormonal treatment is not suitable for every patient and should be discussed with an appropriate clinician.

Pain After Childbirth

Painful intercourse after childbirth is another situation that couples sometimes misunderstand.

The woman may have experienced:

vaginal tearing,

an episiotomy,

scar formation,

pelvic-floor injury,

hormonal changes,

breastfeeding-related dryness,

fatigue,

fear after a difficult delivery.

Sexual recovery after childbirth is therefore not simply a matter of waiting for a calendar date.

The tissues, hormones, pelvic floor, emotions and relationship all need time.

If pain persists, an appropriate examination can help determine whether the cause is dryness, scar sensitivity, pelvic-floor dysfunction or another condition.

Infections Can Make Sex Painful

Pain may also be caused by infection or inflammation.

Possible examples include:

vaginal infection,

urinary infection,

sexually transmitted infection,

pelvic inflammatory disease,

or inflammation of genital tissues.

Associated symptoms might include abnormal discharge, unpleasant odour, genital itching, burning during urination, sores, fever or pelvic pain.

If an infection is suspected, simply applying lubricant will not solve the underlying problem.

The infection needs proper diagnosis and treatment.

Patients should also understand that not all vaginal discharge represents infection and that treatment should ideally be based upon clinical evaluation rather than repeatedly purchasing antifungal or antibiotic medicines without testing.

Endometriosis and Painful Intercourse

Endometriosis is an important cause of deep sexual pain.

The discomfort may be worse with deeper penetration and may occur together with:

painful menstruation,

chronic pelvic pain,

pain during bowel movements,

or fertility difficulties.

Not every woman with endometriosis has the same symptoms.

And not every woman with painful sex has endometriosis.

But persistent deep pain, particularly when accompanied by menstrual or fertility symptoms, deserves proper gynaecological assessment.

This is particularly relevant to my practice because endometriosis may involve both sexual pain and infertility, and these two concerns should be evaluated together when they coexist.

Pelvic Inflammatory Disease

Pelvic inflammatory disease, or PID, is infection and inflammation involving the upper female reproductive tract.

It may cause pelvic pain and pain during intercourse.

Untreated PID can also damage the fallopian tubes and contribute to infertility.

Therefore, pain accompanied by fever, abnormal discharge, pelvic tenderness or STI risk should not be ignored.

The objective is not only to improve sexual comfort but also to protect reproductive health.

Vulvodynia

Some women experience persistent vulvar pain or burning even when no obvious infection or visible lesion explains the symptoms.

This may represent a vulvar pain syndrome such as vulvodynia.

The discomfort may be triggered by penetration, tight clothing, prolonged sitting or light touch.

These patients may see several doctors before receiving an explanation because externally the tissue can appear relatively normal.

The pain is still real.

Chronic vulvar pain often requires multidisciplinary management rather than repeated empiric treatment for presumed infection.

Vaginismus and Genito-Pelvic Pain/Penetration Difficulties

Some women tell me:

“I want intercourse, but as soon as penetration is attempted my muscles tighten automatically.”

Another says:

“Even inserting a finger or undergoing a pelvic examination is very difficult.”

These symptoms may be associated with involuntary pelvic-floor tightening and what contemporary diagnostic frameworks describe within genito-pelvic pain/penetration disorder.

Pain, fear and muscle contraction often reinforce one another.

The sequence can become:

pain → fear of the next attempt → pelvic-floor tightening → more pain → stronger fear.

This is not intentional.

The woman is not “refusing to cooperate.”

Her body may be responding protectively to anticipated pain.

Treatment may involve education, gradual desensitisation, pelvic-floor physiotherapy, psychological or psychosexual support and treatment of any physical cause.

Importantly:

forcing penetration generally makes this cycle worse rather than treating it.

The Pelvic Floor Can Be an Important Part of the Problem

The pelvic floor is a group of muscles supporting the pelvic organs.

These muscles must be capable not only of contracting, but also of relaxing.

If they remain excessively tight or contain painful trigger points, penetration can become uncomfortable.

The 2026 EAU chronic-pelvic-pain guideline recognises pelvic-floor overactivity as an important contributor to pelvic pain and recommends specialised pelvic-floor therapy as part of treatment when dysfunction is present.

The guideline describes a familiar cycle:

pain causes muscle tightening,

tight muscles increase pain,

pain causes further tightening.

Learning to relax the pelvic floor can help interrupt this pain–spasm–pain cycle.

This is why simply telling someone to “do Kegel exercises” is not always correct.

If the pelvic floor is already overactive, repeatedly strengthening it without learning relaxation can be inappropriate.

Evaluation should determine what the muscles actually need.

Pelvic-Floor Physiotherapy

Specialised pelvic-floor physiotherapy may include education, relaxation training, breathing work, stretching, myofascial treatment, biofeedback and appropriately selected home exercises.

It should be performed by a clinician trained specifically in pelvic health.

The latest EAU chronic-pelvic-pain guideline states that pelvic-floor muscle physical therapy may reduce pain and sexual complaints and recommends including pelvic-floor therapy in the treatment plan when appropriate.

A 2025 randomized trial also continues the investigation of manual therapy and vaginal dilator strategies for genito-pelvic pain/penetration disorder, reflecting the growing evidence base for rehabilitation approaches.

Psychological Factors Do Not Mean the Pain Is Imaginary

This distinction is extremely important.

Fear, anxiety, depression, relationship tension, previous painful experiences or sexual trauma can influence sexual pain.

But saying that psychological factors contribute does not mean:

“The patient is imagining it.”

Current EAU guidance specifically states that there is no evidence that psychological distress means pelvic pain is unreal. It recommends assessing pain-related fear, anxiety and depressive symptoms because they can influence the patient's experience and recovery.

Chronic pain changes how the nervous system responds.

Repeated pain can make the body increasingly protective.

A person may begin tightening muscles before penetration even starts.

This is why good treatment sometimes includes:

medical care,

pelvic-floor treatment,

psychological support,

and couple communication.

Previous Sexual Trauma or Coercion

Not every patient with painful sex has experienced trauma.

But for some, previous coercion, abuse or a frightening sexual experience can contribute.

A medical professional should approach this carefully rather than automatically assuming that trauma exists.

WHO's definition of sexual health emphasises safe, respectful sexual experiences free from coercion and violence.

If trauma is relevant, forcing sexual activity or repeatedly attempting penetration despite fear can worsen symptoms.

Trauma-informed psychological support may be an important part of recovery.

Painful Sex Can Affect Men Too

Dyspareunia is more commonly discussed in relation to women, but men can also experience sexual pain.

A man may have pain:

during erection,

during penetration,

in the penis,

in the testicles,

in the pelvis or perineum,

during ejaculation,

or after orgasm.

Possible causes include inflammation or infection of the prostate, chronic pelvic pain syndrome, urinary or sexually transmitted infections, pelvic-floor dysfunction, nerve pain, phimosis, inflammation of the foreskin or glans, Peyronie's disease, and effects of pelvic surgery or radiation.

Men should not hide sexual pain merely because they assume they are expected to tolerate it.

Painful Ejaculation

Pain during or after ejaculation is sometimes called odynorgasmia, dysejaculation or painful ejaculation.

The discomfort may occur in:

the penis,

urethra,

testicles,

perineum,

pelvis,

rectum,

bladder area.

Current Cleveland Clinic guidance lists possible causes including prostatitis, chronic pelvic pain syndrome, urinary or sexually transmitted infection, ejaculatory-duct obstruction, pelvic-floor dysfunction, nerve problems, certain medicines and previous prostate surgery or radiation.

Repeated or severe painful ejaculation should be medically evaluated.

Prostatitis and Chronic Pelvic Pain

Men with prostatitis or chronic pelvic pain syndrome may experience:

pelvic discomfort,

painful urination,

painful ejaculation,

erectile difficulty,

or discomfort during intercourse.

Sex does not automatically worsen prostatitis in every patient, but some men experience significant pain with ejaculation.

If pain is accompanied by urinary symptoms, genital discharge, fever or other concerning symptoms, medical evaluation is required.

Peyronie's Disease

Peyronie's disease causes scar tissue within the penis and can lead to:

curvature,

painful erection,

narrowing or indentation,

reduced penile length,

difficulty with intercourse.

In some men the curvature itself makes penetration painful for the patient or partner.

If new penile curvature or painful erections appear, the problem should not simply be treated with analgesics.

A proper urological evaluation is appropriate.

Phimosis and Pain During Intercourse

In uncircumcised men, a tight foreskin may sometimes cause pain during erection or intercourse.

Attempting forceful penetration may cause small tears, inflammation or worsening discomfort.

Cleveland Clinic notes that symptomatic phimosis may cause pain with erection or sexual intercourse and can be associated with infection or scarring.

If this is the problem, treating anxiety or taking sexual-performance medication will not address the underlying cause.

How Pain Changes a Couple's Sexual Relationship

Once sex hurts repeatedly, the problem often extends beyond the original medical cause.

The person in pain becomes afraid.

The partner becomes cautious.

The next intimate encounter begins with tension.

The patient thinks:

“Will it hurt again?”

The partner thinks:

“Am I going to cause pain?”

Arousal decreases.

Muscles tighten.

Lubrication may decrease.

The next experience becomes even more uncomfortable.

Eventually both people may stop initiating affection because they worry that touching will automatically lead to painful intercourse.

This is how a physical symptom can create a relationship pattern.

The aim of treatment is therefore not simply:

“Make penetration possible.”

It should also help the couple restore safety, affection and confidence.

How to Start the Conversation With Your Partner

Choose a calm moment rather than waiting until intercourse is already painful.

You might say:

“I want to talk about something because our intimacy is important to me. I have been experiencing pain during sex. It is not because I don't want to be close to you. I think we should slow down and understand what is causing it rather than forcing ourselves through it.”

That statement removes blame.

It also reassures the partner that affection remains.

Another useful sentence is:

“If I ask you to stop, it means I am in pain—not that I am rejecting you.”

This distinction can prevent considerable misunderstanding.

What the Partner Should Say

A supportive response may be:

“Thank you for telling me. We don't have to continue anything that hurts. We can go slowly and get it checked.”

This response immediately reduces pressure.

It communicates:

safety,

respect,

and partnership.

A damaging response would be:

“You always make excuses.”

or:

“You just need to relax.”

or:

“You should tolerate it for me.”

Pain should never become a test of love.

Never Use Force to “Overcome” Painful Penetration

This is especially important in vaginismus-like or genito-pelvic pain conditions.

Repeated forced penetration can reinforce fear and pelvic-floor contraction.

The patient learns:

“Sex equals pain.”

The nervous system becomes even more protective.

Treatment should move in the opposite direction:

safety → relaxation → confidence → gradual comfortable activity.

Pressure and force damage this process.

Intimacy Does Not Have to Stop Completely

When penetration is painful, many couples mistakenly stop all affection.

But intimacy can temporarily be redefined.

The 2026 EAU chronic-pelvic-pain guideline specifically recommends behavioural strategies for couples, including exploring sexual activities that do not reproduce pain and pacing intimacy below the level that triggers symptoms.

Kissing, affectionate touch, massage and other mutually comfortable forms of closeness can help maintain connection while the cause is being evaluated and treated.

The objective is not to ignore the problem.

It is to prevent painful penetration from becoming the only definition of intimacy.

More Foreplay Can Matter

Adequate arousal is not simply an emotional issue.

It produces physical changes.

In women, arousal helps increase lubrication and genital blood flow.

If penetration begins before adequate arousal, friction can increase discomfort.

Therefore, some couples benefit simply from slowing down and allowing more time.

However, persistent pain should not automatically be blamed on insufficient foreplay.

Endometriosis, infection, pelvic-floor dysfunction and other medical conditions still require proper assessment.

Lubricants Can Be Helpful

Appropriate lubricant can reduce friction and may be particularly useful when dryness contributes.

Mayo Clinic recommends lubricants among simple supportive measures for painful sex and also distinguishes them from vaginal moisturizers used more regularly for dryness.

But lubricant is not a universal treatment.

If pain is caused by:

infection,

deep endometriosis,

pelvic-floor spasm,

Peyronie's disease,

prostatitis,

or another medical condition,

lubrication alone is unlikely to solve it.

Sexual Position Can Make a Difference

If pain occurs mainly with deeper penetration, changing position can sometimes reduce depth and pressure.

Allowing the person experiencing pain to control depth and movement may help.

Current EAU pelvic-pain guidance includes adapting sexual positions and pacing activity according to pain as part of behavioural management.

Again, these adjustments are supportive measures.

They should not be used to hide persistent unexplained pain.

When Should You See a Doctor?

I advise professional evaluation when pain is recurrent, moderate or severe, when it continues over time or when the patient is worried by it.

Mayo Clinic’s September 2026 review similarly recommends medical assessment when painful intercourse occurs frequently, persists or is moderate to severe, and particularly when accompanied by other symptoms such as bleeding or abnormal vaginal discharge.

You should seek evaluation sooner if there is significant bleeding, unusual discharge, genital sores, fever, severe pelvic pain, painful urination, a new penile curvature, testicular pain, painful ejaculation, difficulty urinating, suspected STI, symptoms after surgery or cancer treatment, or pain that is rapidly worsening.

Sudden severe pelvic or testicular pain should not be treated as a routine sexual problem; urgent assessment may sometimes be required.

What Happens During Medical Evaluation?

A good assessment begins with listening.

I may ask:

Where exactly is the pain?

Does it occur at entry or deeper inside?

Did it begin with the first attempts at intercourse or after years of comfortable sex?

Does pain occur every time?

Is there dryness?

Is there discharge, itching or burning?

Does menstruation affect the pain?

Was there recent childbirth?

Has there been surgery?

Are there urinary symptoms?

Is there pelvic pain outside sexual activity?

Is there difficulty with penetration even with a finger or examination?

For men, important questions may include painful erections, penile curvature, foreskin problems, urinary symptoms, pelvic pain and painful ejaculation.

These details can guide the next step.

Examination Should Be Respectful and With Consent

Some patients with painful sex are frightened of examination because they expect it to hurt.

The purpose of examination is not to prove how much discomfort the patient can tolerate.

It should be explained beforehand.

The patient should understand what is being done.

If an examination becomes too painful, the patient can ask the clinician to stop.

Mayo Clinic specifically notes that some patients with painful sex also experience discomfort during pelvic examination and should tell the healthcare professional when the examination is too painful.

Depending upon the suspected cause, evaluation may include visual examination, gentle pelvic-floor assessment, vaginal swabs, STI testing, urine testing, ultrasound or other investigations.

Not every patient requires every test.

Treatment Depends on the Cause

There is no single medicine called “the treatment for painful sex.”

That is because dyspareunia is a symptom with many possible causes.

If an infection is present, treat the infection.

If vaginal dryness is the major factor, improve lubrication and address the hormonal or medication-related cause where appropriate.

If menopausal tissue changes are responsible, local hormonal or other approved treatment may be considered.

If pelvic-floor overactivity is present, pelvic-floor physiotherapy may be useful.

If endometriosis is responsible, gynaecological treatment is required.

If chronic pelvic pain is present, treatment may need to be multidisciplinary.

If fear and pain have developed into a strong psychological cycle, counselling or sex therapy may be valuable.

This is why self-treatment without diagnosis often fails.

Counseling and Sex Therapy

Pain can remain emotionally influential even after the original physical problem improves.

A woman who experienced painful penetration for six months may still tense automatically when sex is attempted after treatment.

A man who had months of painful ejaculation may become anxious before orgasm.

The pain may have disappeared medically, but the fear remains.

Mayo Clinic recognises counselling, cognitive-behavioural therapy and sex therapy as useful approaches when painful sexual experiences have created fear, avoidance or communication problems.

Current EAU guidance also states that couples dealing with pelvic pain may benefit from early relationship and sexual counselling.

Seeking therapy does not mean the pain was imaginary.

It means the pain affected the mind as well as the body.

Painful Sex and Infertility

Painful sex and infertility are different diagnoses, but they can sometimes occur together.

For example:

endometriosis may contribute to pain and fertility difficulty.

Pelvic inflammatory disease can cause sexual pain and damage the fallopian tubes.

Severe vaginismus or penetration difficulty can prevent regular vaginal intercourse.

Male pelvic pain or painful ejaculation can reduce the frequency of intercourse.

When a couple is experiencing both painful intercourse and delayed conception, both concerns should therefore be evaluated.

At Saira Health Care, this connection is particularly important because my focused practice includes both sexual disorders and infertility.

However, it is important not to assume that every patient with dyspareunia is infertile.

Many people with painful intercourse have completely normal fertility.

The Unani Perspective on Painful Sex

As a physician trained in the Unani system of medicine, I believe one of its strengths is the traditional emphasis on evaluating the person as a whole rather than considering sexual symptoms in isolation.

Traditional Unani descriptions have discussed painful intercourse within concepts sometimes described as Waja-ul-Jima or Usr-e-Jima, while related symptoms may be considered in the context of reproductive and genital disorders.

The traditional framework also considers:

Mizaj, or temperament;

general health and vitality;

diet and digestion;

sleep;

physical activity;

psychological condition;

menstrual and reproductive health.

These concepts belong to the traditional Unani medical framework and should not be confused with modern laboratory concepts such as estrogen concentration, microbial culture, vaginal pH, pelvic ultrasound findings or endometriotic lesions.

Both systems should be understood in their proper context.

Asbab-e-Sitta Zarooriya

An important Unani concept is Asbab-e-Sitta Zarooriya, the six essential factors traditionally considered important for preservation of health.

The Ministry of Ayush describes them broadly as:

air and environment,

food and drink,

physical movement and rest,

psychological movement and rest,

sleep and wakefulness,

and retention and evacuation.

For patients with sexual-health problems, these principles can help provide a structured lifestyle framework around:

sleep,

nutrition,

physical wellbeing,

stress,

bowel and urinary habits,

and general health.

However, lifestyle advice must always be connected with the actual diagnosis.

A woman with bilateral endometriotic lesions, for example, should not simply be told to improve sleep and digestion.

A man with phimosis needs treatment for phimosis.

A patient with an STI needs appropriate infection treatment.

How Unani Care May Be Useful

In properly selected patients, individualized Unani care may be useful as a supportive part of a broader treatment plan.

Depending upon the patient's condition, attention may be given to:

general vitality,

nutrition,

sleep,

digestive health,

psychological wellbeing,

menstrual and reproductive health,

coexisting sexual symptoms,

and individualized traditional pharmacotherapy.

My approach is not to give every patient the same medicine merely because they report painful intercourse.

The first responsibility is to identify the cause.

What Does Scientific Research Say?

Modern clinical evidence specifically evaluating Unani treatment for dyspareunia remains limited.

Some Unani clinical research has examined conditions that may themselves cause painful intercourse.

For example, a randomized study involving women with vulvovaginal candidiasis evaluated a Unani preparation containing Boswellia serrata and included dyspareunia among its measured symptoms.

This kind of research is useful because it begins to scientifically evaluate traditional interventions.

However, it would be incorrect to use one small, condition-specific trial to claim that a particular Unani medicine cures all painful intercourse.

Dyspareunia caused by infection is different from dyspareunia caused by endometriosis.

Endometriosis is different from menopausal dryness.

Menopausal dryness is different from pelvic-floor hypertonicity.

Pelvic-floor pain is different from Peyronie's disease or prostatitis in a male patient.

Therefore, treatment must be cause-specific.

My Approach at Saira Health Care

At Saira Health Care, when a patient reports painful intercourse, my approach is to first determine what type of pain is present rather than simply prescribing a sexual medicine.

I want to understand:

Is the pain superficial or deep?

Is it primarily vaginal, vulvar, pelvic or male genital pain?

Is there dryness?

Is an infection possible?

Is there pelvic-floor tightening?

Is menstruation painful?

Could endometriosis be present?

Was there childbirth trauma or surgery?

Are there urinary symptoms?

Does the male partner have painful ejaculation or prostatitis symptoms?

Are psychological fear and relationship tension now contributing?

Is infertility also present?

These questions determine whether the patient may benefit primarily from medical treatment, Unani supportive care, gynaecological evaluation, urological treatment, pelvic-floor physiotherapy, psychological therapy or a combination.

Saira Health Care's Contribution to Sexual Disorders and Infertility

Sexual pain is an important part of sexual medicine because patients often remain silent for years.

Some couples do not seek help until the problem begins affecting their marriage.

Others present because they are trying to conceive but intercourse itself has become difficult.

Through Saira Health Care, my objective is to provide an environment where patients can discuss these problems professionally and without embarrassment.

My clinical focus includes sexual disorders and infertility, which allows sexual pain to be considered alongside related concerns such as:

erectile function,

ejaculation,

sexual desire,

pelvic symptoms,

semen and fertility issues,

menstrual and reproductive health,

and the psychological effects of sexual difficulties.

Where another specialist is required, referral should form part of responsible care.

When I Refer to Other Specialists

There are situations where good treatment requires collaboration.

A patient may need a gynaecologist for endometriosis or another pelvic condition.

A male patient may need a urologist for Peyronie's disease, prostatitis, phimosis or persistent painful ejaculation.

Pelvic-floor dysfunction may require a trained pelvic-health physiotherapist.

Pain associated with trauma or severe anxiety may benefit from a psychologist or qualified psychosexual therapist.

Suspected sexually transmitted infection requires appropriate testing and treatment.

Complex chronic pelvic pain may require multidisciplinary pain management.

This is not a failure of one medical system.

It is good clinical medicine.

What Should a Partner Never Do?

A partner should never respond to pain by pressuring, threatening, humiliating or forcing sexual activity.

Statements such as:

“If you loved me, you would continue.”

or:

“Your pain is only in your mind.”

or:

“You have to get used to it.”

are harmful.

WHO’s sexual-health principles emphasise respect, safety and freedom from coercion and violence.

Healthy intimacy requires mutual willingness.

How a Partner Can Help

The most helpful partner is not necessarily the person who gives the most advice.

Often it is the person who listens.

If your partner tells you:

“Sex is painful,”

respond first with:

“Tell me what hurts and what makes you comfortable.”

Do not immediately ask:

“When can we try again?”

Let the patient recover emotionally as well as physically.

The couple can then approach treatment together.

A Conversation I Often Recommend

If you are finding it difficult to explain the problem, you can say:

“I want to tell you something because our relationship and intimacy are important to me. Recently sex has been painful. I do not want you to think that I am avoiding you or that I have lost attraction to you. I would like us to slow down, stop whenever it hurts and find out what is causing the pain. I want us to deal with this together rather than allowing it to create distance between us.”

This type of conversation replaces blame with partnership.

Frequently Asked Questions

Is pain during first intercourse normal?

Some people experience mild temporary discomfort during early sexual experiences, particularly if there is anxiety or inadequate lubrication.

However, severe pain, significant bleeding or repeated inability to tolerate penetration should not simply be accepted as normal.

Persistent symptoms deserve evaluation.

Should I continue intercourse if it hurts?

No one should feel obligated to continue painful sexual activity.

Slow down or stop.

Repeated forced penetration may worsen irritation, fear and pelvic-floor tightening.

Can lack of lubrication cause painful intercourse?

Yes.

Insufficient lubrication increases friction and can cause burning or soreness.

More time for arousal and appropriate lubricant may help when dryness is the main cause.

Can menopause cause painful sex?

Yes.

Reduced estrogen after menopause can cause vaginal dryness and tissue changes that make intercourse painful.

Effective treatments are available and should be individualized.

Can breastfeeding cause dryness?

Yes.

Hormonal changes during breastfeeding may reduce vaginal lubrication in some women and contribute to discomfort.

Can endometriosis cause pain during intercourse?

Yes.

Endometriosis is one of the recognised causes of deep pelvic pain during sexual activity.

Can pelvic-floor muscles cause painful sex?

Yes.

Overactive or painful pelvic-floor muscles can contribute to dyspareunia.

Current EAU guidance supports specialised pelvic-floor therapy as part of treatment when dysfunction is present.

Can anxiety cause painful intercourse?

Anxiety can contribute by increasing muscle tension, reducing arousal and strengthening anticipation of pain.

However, the presence of anxiety does not mean that the pain is imaginary or that physical causes should be ignored.

Can painful sex affect fertility?

Painful sex itself does not automatically cause infertility.

However, some underlying causes—such as endometriosis or PID—may also affect fertility, and severe pain may reduce the ability to have intercourse regularly.

Can men experience painful sex?

Yes.

Men may experience pain from prostatitis, chronic pelvic pain syndrome, painful ejaculation, infection, pelvic-floor dysfunction, phimosis, Peyronie's disease or other conditions.

Can prostatitis cause painful ejaculation?

Yes.

Pain during ejaculation is a recognised symptom in some men with prostatitis and chronic pelvic pain.

Should both partners attend the consultation?

Not always.

Some patients prefer a confidential individual consultation first.

However, partner involvement may sometimes improve understanding and communication when the patient is comfortable with it.

Current pelvic-pain guidance recognises the value of early relationship and sexual counselling for couples.

Can sex therapy help?

Yes, particularly when repeated painful experiences have produced fear, avoidance, performance anxiety or relationship difficulties.

Sex therapy does not replace treatment of physical disease; it can complement it.

Can Unani medicine help painful intercourse?

In appropriately selected patients, Unani care may provide supportive benefits through individualized attention to lifestyle, general health, reproductive health, psychological wellbeing and condition-specific traditional therapy.

However, dyspareunia has many different causes.

No responsible clinician should promise that one Unani medicine will cure all painful intercourse.

Proper diagnosis comes first.

About Dr. Nizamuddin Qasmi

Dr. Nizamuddin Qasmi
Founder & Chief Physician – Saira Health Care
Focused Practice in Sexual Disorders & Infertility

My professional qualifications and training include:

BUMS – Hamdard University, Delhi
MD
CGO
Certificate in Infertility – MGBIMS, Delhi
Certificate in Urology – London, UK
Masters in Male Infertility – MasterHealthPro (HealthPro)
Integrated Sexual and Reproductive Health – ISRH, UNFPA

My focused clinical work involves sexual disorders, reproductive-health concerns and infertility, where physical symptoms frequently overlap with psychological, relationship and fertility issues.

At Saira Health Care, I believe that sexual-health complaints deserve the same professionalism and dignity as any other medical problem.

A patient should be able to say:

“Sex hurts.”

without shame.

My Message to Couples

If intercourse has become painful, please do not let silence turn the problem into resentment.

Do not assume:

“My partner should already understand.”

Explain what you are feeling.

If you are the partner, listen before reacting.

Pain does not necessarily mean lack of love.

It does not necessarily mean lack of attraction.

And it certainly should not be interpreted as permission to force someone to continue.

Try to think of the problem as:

“Something we need to understand together.”

not:

“Something wrong with you.”

Final Words From Dr. Nizamuddin Qasmi

During my work with sexual disorders and infertility, I have seen that painful sex can become much larger than the original physical problem.

At first there may be dryness.

Then there is pain.

Then comes fear.

Then avoidance.

Then misunderstanding.

Then the couple begins losing emotional closeness.

This is why early communication matters.

The right approach is not to keep repeating painful intercourse in the hope that the body will eventually surrender.

The right approach is:

stop when it hurts,

communicate openly,

identify the cause,

treat the underlying condition,

restore comfort gradually,

and protect the relationship while treatment is taking place.

Modern medicine gives us valuable tools for diagnosing infections, hormonal changes, endometriosis, pelvic-floor dysfunction, chronic pelvic pain and male genital conditions.

Pelvic-floor physiotherapy can be extremely useful in appropriately selected patients.

Psychosexual and psychological treatment can help break the fear–pain cycle.

And responsible Unani care can contribute an individualized perspective addressing lifestyle, general health, reproductive wellbeing, sleep, diet, psychological balance and selected condition-specific symptoms.

At Saira Health Care, my aim is to combine these considerations around the needs of the individual patient.

Because the real objective is not simply:

“Make intercourse possible.”

The objective is:

comfortable, consensual, respectful and healthy intimacy.

And that begins with one very important sentence:

“Please tell me when something hurts.”

Medical Disclaimer

This article is intended for general health education and patient awareness. It does not replace an individual medical consultation, gynaecological or urological examination, laboratory testing or treatment plan.

Painful intercourse may result from hormonal, infectious, dermatological, gynaecological, urological, muscular, neurological, psychological or relationship-related conditions.

Persistent or significant pain should therefore be properly evaluated.

Do not force penetration as a treatment for painful sex or vaginismus-type symptoms.

Do not repeatedly self-treat suspected infections without proper evaluation.

Herbal and Unani medicines should also be used under appropriately qualified supervision. Natural origin does not automatically mean that a preparation is suitable for every patient or free from adverse effects.

Seek prompt medical evaluation for significant unexplained bleeding, fever, abnormal genital discharge, genital sores, severe or sudden pelvic or testicular pain, difficulty urinating, severe painful ejaculation, rapidly developing penile curvature, persistent postmenopausal bleeding or another concerning symptom.