Sex Hurts, Desire Is Gone, or You Can't Orgasm? Start Here.

Start with the problem you're actually having

More than one can happen at the same time, and one can make another worse.

If penetration burns, stings or feels like your body is fighting it

Pain during sex is common. You still do not have to put up with it.

Where the pain happens matters.

Burning or pain right around the vaginal entrance can come from friction, dryness, irritated tissue or a skin condition, vulvodynia or vestibulodynia, or pelvic floor muscles that tighten to protect against pain.

Deeper pain inside the pelvis can have different causes, such as endometriosis or other gynecological conditions. So if the pain keeps coming back, get it checked instead of trying one home fix after another.

Frequent or severe pain should be checked by a gynecologist or another qualified doctor. If you keep being told that painful sex is just part of being a woman, look for a doctor or physiotherapist who treats vulvar pain or pelvic floor problems.

A painful pelvic floor can be too tight

Mention "pelvic floor" and the internet immediately recommends Kegels.

Some women with pain during penetration have pelvic floor muscles that are already too tense, or hard to relax. The muscles can tighten before penetration even starts.

It can turn into a loop:

Sex hurts → you expect it to hurt next time → your body tightens → penetration becomes harder → it hurts again.

Being told to "just relax" does not stop it.

Pelvic floor physiotherapy has good evidence for one specific condition: provoked vestibulodynia, which is pain at the vaginal entrance when it is touched or pressed. In a trial of 212 women, a 10-week physiotherapy program did better than a numbing ointment (lidocaine) for pain during sex, and the difference held six months later. Asked how they felt, 79% of the physiotherapy group said they were much or very much improved, compared with 39% of the lidocaine group. The program combined education, pelvic floor exercises with biofeedback, hands-on therapy and dilators.

If the pain keeps happening, or your muscles tighten on their own, see a pelvic floor physiotherapist. They check what your muscles are actually doing before giving you exercises.

You may be waiting for desire to arrive in the wrong order

One of the most influential ideas in female sexual medicine came from physician and researcher Dr. Rosemary Basson.

The older model of sexual response assumed this order:

Desire → arousal → sex → orgasm

Basson proposed a different model. In it, desire does not always come first, especially in long-term relationships.

Sometimes desire is responsive.

You begin feeling fairly neutral. Affection, flirting, touch or enjoyable stimulation starts. You become aroused. Then desire appears.

So "I wasn't horny before we started" doesn't automatically mean something is wrong.

It also doesn't mean anyone should force themselves into sex hoping they'll eventually enjoy it.

Responsive desire only applies when you actually want to start, and what follows feels comfortable and good. Dread, pressure or pain mean something else, and they are worth paying attention to.

Psychologist Dr. Lori Brotto has led randomized trials with women who have low desire and arousal problems. Women who did mindfulness-based or cognitive behavioral programs, including one run online, reported real benefits. These programs do not rule out physical causes such as pain, medication or hormones.

If low desire has lasted for months and is more than a short phase, our article on losing sexual desire in a long-term relationship goes deeper.

Sometimes the desire is still there, and something else is getting in the way of it.

Dryness has more than one cause

Dryness during sex can simply mean there was not enough arousal, or not enough time. It can also come from lower estrogen, which happens around menopause, while breastfeeding and during some medical treatments.

How turned on you feel and what your body does also do not always line up. A review of 132 lab studies found that in women, genital response and reported arousal matched only weakly.

So being dry says nothing, on its own, about how attracted you are to your partner. It works the other way too: a body reacting is not the same as wanting sex.

Our guide to vaginal dryness explains how to tell the causes apart and what helps with each.

Dryness that keeps coming back, burning, irritation, repeated urinary infections or pain during penetration can come from hormonal changes or vulvar conditions. Sexual medicine specialist Dr. Rachel Rubin argues that these conditions are often missed, or brushed off as a foreplay problem.

Sometimes the "orgasm problem" is actually a stimulation problem

Most talk about sex treats penetration as the main event. Survey data from women says otherwise.

In a nationally representative survey of 1,055 women in the United States, only 18.4% said intercourse alone was enough for them to orgasm. Another 36.6% said they needed clitoral stimulation during intercourse, and 36% said it made orgasm feel better. It is one survey from one country. Still, it shows penetration alone works for a minority of women.

For many women, clitoral stimulation is a central part of sex.

If you can orgasm alone and struggle with a partner, your body can do it. The question is what changes when your partner is there, such as the kind of touch, or how easy it feels to ask for what you want.

One problem often leads to another

Pain makes the body tense. Tension makes arousal harder, less arousal means more friction, and more friction means more pain. After a while, sex stops being something you want.

Eventually the problem sounds like:

"I just don't have a sex drive anymore."

Maybe.

Or her body has learned to expect sex to hurt, or to feel like nothing.

Before assuming something is wrong with you

Sources & experts worth knowing