Among other things, painful sex may be caused by:
- A "tipped" uterus: In most women, the uterus is tipped toward the front, positioning the cervix at a deeper part of the birth canal. But for some women the uterus is tipped backward (which causes no health problems or other repercussions, it's just an anatomical variation like being left-handed) and positions the cervix closer to the opening of the vagina. During deep penetration, the penis can bump into the cervix causing serious pain. A uterus can also become retroverted after childbirth.
- Endometriosis: The lining of the uterus grows beyond the interior of the uterus.
- Interstitial cystitis: A little understood condition in which there is pain surrounding the bladder or with urination.
- Urethritis: An inflammation of the urethra caused by a number of different factors.
- Vaginusmus: An involuntary spasm of vaginal wall muscles that can make penetration painful.
- Vestibulitis: Unexplained stinging or burning around the opening of the vagina.
- Loss of lubrication: Especially after menopause when declining estrogen levels thin the lining of the vagina, creating greater friction and pain during sex. Medications, including birth control pills, antidepressants, sedatives, and antihistamines can also decrease lubrication.