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When Sex Hurts in Marriage: Common Causes, When to See a Clinician, and the Products Clinicians Mention

By The BedsideBench Team · Research-based guide · Published 2026-10-26 · Updated 2026-10-26

Pain during sex is common, and it's treatable. ACOG says "nearly 3 out of 4 women have pain during intercourse at some time during their lives". For some it's temporary, and for others it's long-term.¹ This guide gathers what major health organisations say about causes, when to get help, and the products they mention: lubricants, vaginal moisturisers and dilators (also called vaginal trainers).

This is a research-based guide built from ACOG, NHS, The Menopause Society and US Office on Women's Health sources, checked on 26 October 2026. It isn't medical advice, and we haven't tested any product. See how we research.

See a clinician if pain during sex is frequent or severe, or if you have bleeding after sex, unusual discharge, or bleeding after menopause.¹³ You can ask a GP, an ob-gyn or a sexual health clinic.

First: pain is a signal, not a duty

Some couples feel they should push through discomfort. Health guidance points the other way. ACOG suggests trying "sexual activities that do not cause pain" and "nonsexual, but sensual, activities like massage" while you work out the cause.¹ The NHS notes that after childbirth, "if sex hurts, it won't be pleasurable", and that couples can "carry on being loving and close in other ways".⁵

Christian marriage researcher Sheila Wray Gregoire's survey of 22,000 Christian women linked a belief in sex as an obligation to worse outcomes. It reported vaginismus at "twice the rate of the overall population", and "as many as 1 in 5" respondents reported a condition that made penetration painful.⁸ Stopping when it hurts is always OK, and neither partner should pressure the other.

Common causes listed by health organisations

ACOG lists these among the causes of pain during sex:¹

What a clinician may do

ACOG says a clinician will take a medical and sexual history and may do a pelvic exam. Sometimes they'll arrange an ultrasound or other tests, or refer you to a physical therapist.¹ For vaginismus, the NHS says you can ask for a female doctor and bring someone for support. Treatment may include psychosexual therapy, relaxation, pelvic floor exercises, sensate focus and vaginal trainers.²

Products clinicians and health bodies mention

1. Lubricants

ACOG: "Water-soluble lubricants are a good choice if you experience vaginal irritation or sensitivity. Silicone-based lubricants last longer and tend to be more slippery." Don't use petroleum jelly, baby oil or mineral oil with condoms.¹

The Menopause Society adds that lubricants shouldn't contain flavours (sugar), warming agents, or preservatives and solvents such as propylene glycol and parabens, which may irritate some women.⁶

• Compare lubes with published pH and osmolality figures in best water-based lubes.
• For longer-lasting options, see best silicone lubes.
• If you use condoms, check lube for condoms.

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2. Vaginal moisturisers

These are different from lubricants. The Menopause Society says moisturisers are "used regularly, often several times weekly", whereas lubricants are used during sex.⁶ The NHS lists both for vaginal dryness, and suggests asking a pharmacist privately if you need help choosing.³⁴ Use only products made for vaginal use. The NHS warns that other creams and lotions "can cause more irritation or an infection".³

3. Vaginal dilators (trainers)

The NHS describes vaginal trainers as "tampon-shaped objects in different sizes" used to gradually get used to penetration. Treatment is "initially done under the guidance of specialised therapists".² The Menopause Society says dilators should be "used with the guidance of a sexual medicine specialist, physical therapist, or sex therapist".⁶ Start them with professional guidance, not on your own from a shopping list.

4. Prescription treatments

For menopause-related dryness and pain, clinicians may offer vaginal oestrogen, vaginal DHEA (prasterone) or ospemifene.⁷⁶ The US Office on Women's Health advises avoiding "energy-based vaginal treatments", saying they "have not been shown to work, and they can cause vaginal pain and scarring".⁷

5. Pelvic floor therapy

The Menopause Society says pelvic floor exercises "can help to strengthen weak pelvic floor muscles and relax tight ones". Pelvic floor physical therapy is available with trained therapists.⁶ The NHS lists pelvic floor exercises among vaginismus treatments.² Ask your GP or ob-gyn about a referral. As with dilators, a professional can tell you whether strengthening or relaxing is what you need.

Talking about it as a couple

ACOG notes that "problems with your partner may interfere with your sexual response". It says "a common relationship issue is a mismatch between partners in their level of desire for sex", and that a partner's own sexual problem can add anxiety.¹ Pain is rarely only one person's problem. Going to an appointment together, if both of you want that, can help. The NHS says you can choose to involve your partner in vaginismus treatment.²

Things couples can do together

From ACOG's self-help list:¹

• Make time. Choose a time when neither of you is tired or anxious.
• Talk. Tell your partner where and when it hurts, and what feels good.
• Widen what "intimacy" means. Massage and other non-painful touch count.
• Before sex: empty your bladder, take a warm bath, or take an over-the-counter pain reliever.
• After: for burning, a wrapped ice pack on the vulva.

The NHS adds: avoid perfumed soaps, washes and douches around the vagina.³

Frequently asked questions

Is it normal for sex to hurt after having a baby? It can happen. ACOG says pain after tears or an episiotomy may last several months, and the NHS suggests lubricant at first and a GP visit if pain continues.¹⁵ See our childbirth and menopause lube guide.

Can a vibrator help? The Menopause Society notes that regular sexual stimulation, including "with a device (such as a vibrator)", may improve vaginal health after menopause.⁶ It's not a treatment for pain, so get the cause checked first.

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