Understanding Painful Sex
Why it happens, why it’s common, and why you don’t have to live with it
Pain during sex is more common than most people think — but it’s also more overlooked. Many people feel alone or even ashamed when they experience it. Others are told it’s “just part of getting older,” or something they simply need to tolerate after breast cancer treatment, testosterone treatment, perimenopause, or menopause.
At Corla Health, we’re here to tell you something different:
Painful sex isn’t something you have to tolerate. It’s real, and it’s treatable.
What Is Painful Sex?
Pain during or after sex is known medically as dyspareunia. It can feel like burning, stinging, tightness, or irritation — sometimes right at the vaginal opening, sometimes deeper inside.
Why Does It Happen — and What Can Be Done?
There are many possible causes of painful sex, and often more than one is involved. Below are some of the most common reasons, along with evidence-based treatment options that can help.
Genitourinary Syndrome of Menopause (GSM)
Lower estrogen levels during or after menopause can cause vaginal dryness, thinning tissue, and reduced elasticity. This often leads to discomfort, tearing, or burning during intimacy.
What can help:
Vaginal moisturizers (used regularly)
Lubricants (used during sex)
Breast Cancer Treatment Effects
Hormonal therapies (like tamoxifen or aromatase inhibitors) lower the levels of estrogen in your body. These lower estrogen levels can cause vaginal dryness, thinning tissue, and reduced elasticity - just like in menopause or perimenopause. Many patients were never told about these side effects or were told there just aren’t options for treatment. We’re here to tell you - there are safe, effective options.
What can help:
Non-hormonal vaginal moisturizers and lubricants
Low dose vaginal estrogen (Safe and effective even with a breast cancer history!)
Targeted support from providers trained in cancer-related sexual health
Testosterone Treatment in Transmasculine Care
Testosterone medications - while increasing your level of testosterone - also inhibit estrogen levels in the body. This drop in estrogen levels acts similarly to menopause or perimenopause and can cause genital dryness, thinning tissue, and reduced elasticity. These changes may lead to burning, tightness, or pain with sex or exams.
What can help:
Non-hormonal vaginal moisturizers and lubricants
Low dose vaginal estrogen (it doesn’t increase the levels of estrogen in your blood stream or act against gender-affirming care)
Support from providers who can help you look at all the factors affecting your symptoms.
Pelvic Floor Dysfunction
Tight or overactive pelvic muscles can contribute to pain during penetration or even during routine activities. This can be caused by trauma, chronic stress, or prolonged hormone changes.
What can help:
Pelvic floor physical therapy with trained specialists
Mindfulness techniques or sex therapy to help retrain muscle response and reduce anticipatory pain
Emotional or Psychological Factors
Pain can create a cycle of fear, avoidance, and tension. Past trauma and/or anxiety can contribute to pain during intimacy.
What can help:
Sex therapy or counseling
Communication tools for partners
Addressing any underlying medical or emotional factors contributing to pain
You’re Not Alone - And You’re Not Without Options
Too often, patients bring up painful sex in a medical appointment only to have it brushed aside — or they don’t bring it up at all, because they fear they won’t be taken seriously. At Corla Health, we want to change that.
We believe sexual health deserves to be taken seriously. It’s about quality of life and your relationship with your own body — and that matters.
You don’t have to accept discomfort or put intimacy on hold. You deserve thoughtful, personalized care from someone who understands the full picture — and will treat it like the priority it is.
If painful sex is affecting your life, we’re here to help.
Because you deserve to thrive.