Pregnancy is a very crucial time marked by significant changes — both emotional and physical. Many couples continue to enjoy sex, but for some women, intercourse becomes painful. This is called dyspareunia (medical term for painful sex). If you are pregnant and sex hurts, you are not alone. Research shows sexual problems, including pain, are very common during pregnancy and after childbirth.
The purpose of this article is to keep couples informed and updated about dyspareunia (painful sex during pregnancy). It will cover the leading causes and simple tips for relief, so that both partners can better understand and manage this condition:
- Why sex may hurt in pregnancy.
- The simple tips for relief from pain.
- When it is time to seek medical advice.
How common is painful sex in pregnancy?
A large number of studies confirm that painful intercourse is a common experience. Canadian research observed women from pregnancy up to 24 months postpartum and found that dyspareunia increased during pregnancy and remained high after delivery.
Some other reviews also show that sexual desire, comfort, and frequency often decline, especially in the second and third trimesters. This is due to both physical changes (belly growth, hormonal shifts) and emotional concerns (fear of hurting the baby, fatigue).
Causes of painful sex in pregnancy
Here are the main reasons why sex may hurt while expecting:
1. Pelvic joint and muscle changes
Pregnancy hormones (like relaxin) make the pelvic joints looser to prepare for birth. This can cause pelvic girdle pain (PGP) or pain in the pubic bone area, hips, or lower back. Certain sexual positions may make this pain worse.
2. Vaginal dryness or reduced lubrication
Hormonal changes sometimes reduce natural lubrication. Less lubrication means more friction, which can lead to burning or pain during penetration. Some sources indicate that it can be normal, while others suggest high progesterone levels may cause it. Some medicines, such as excessive use of antidepressants, can enhance vaginal dryness.
3. Vaginal or urinary infections
Yeast infections, bacterial vaginosis, or urinary tract infections are prevalent in pregnancy. They can cause itching, burning, or sharp pain during sex.
4. Cervical Sensitivity During Pregnancy
During pregnancy, the cervix becomes softer, more swollen, and highly sensitive due to increased hormone levels and greater blood flow to the reproductive organs. This sensitivity means that deep penetration during sex can sometimes cause cramping or light spotting afterwards.
Light spotting is usually normal, but if bleeding becomes heavy or persistent, it is essential to consult a doctor immediately.
In many cases, cervical sensitivity is harmless. However, certain conditions may also lead to spotting or pain during intercourse, including:
- Cervical polyps
- Vaginal or cervical infections
- Early pregnancy complications, such as an ectopic pregnancy
Because the cervix and uterine tissues are more delicate during this period, some women may experience temporary discomfort or minor bleeding after sex or even after a routine pelvic examination.
5. Emotional and psychological factors
Worries about hurting the baby, changes in body image, or relationship stress can all lead to pain or reduced arousal. Research shows that psychological factors play a significant role in pregnancy-related dyspareunia.
6. Medical complications (less common but important)
Mostly, sex during pregnancy is safe and does not cause any complications. However, in some high-risk pregnancies, complications may occur. These include an increased risk of vaginal infections, preterm labor, or unexplained vaginal bleeding.
Doctors usually recommend avoiding sex in pregnancy if you:
- Have a history of preterm labor
- Have a low-lying placenta (placenta previa)
- Have experienced ruptured membranes (your water has broken)
If you notice heavy bleeding, severe abdominal cramping, fluid leakage, or any signs of infection after sex, contact your healthcare provider right away. Early medical attention can prevent further complications.
What Doctors Do When You Report Painful Sex in Pregnancy
If you tell your OB-GYN, midwife, or family doctor about painful sex during pregnancy, they will try to find the safest and most likely cause. The evaluation usually includes:
- Detailed Questions About Pain
Your doctor will ask when the pain occurs, where it is felt, and what type of discomfort you experience (sharp, dull, cramping, or deep pressure). - Assessment of Pelvic Congestion
Sometimes, enlarged veins in the pelvis cause heavy pressure or deep aching pain, which can worsen after sex. - Checking Uterine Ligaments
As the uterus grows, the supporting ligaments stretch, leading to sharp or stabbing pain that may be triggered during intercourse. - Gentle Pelvic Examination
If considered safe in your pregnancy, your doctor may do a light pelvic exam to rule out physical causes. - Testing for Infections
A swab or urine sample may be collected to check for vaginal or urinary tract infections that can make sex painful. - Screening for Pelvic Joint Issues
Pelvic girdle pain or joint problems may also contribute to discomfort during intimacy. - Discussion of Emotional Factors
Stress, anxiety, or relationship concerns can sometimes make painful sex worse, and your doctor may gently explore these aspects.
In many cases, a thorough history and a basic examination are enough to identify the cause. Extra tests are usually not needed unless something unusual is found.
Safe treatments and self-help strategies
Most cases of dyspareunia in pregnancy are manageable at home with simple changes:
- Try different positions
- Side-lying (“spooning”) or woman-on-top often reduces pressure on the belly and pelvis.
- Avoid deep penetration if the cervix feels sore.
- Use lubrication
- Water-based lubricants are safe in pregnancy and can reduce friction.
- Go slow and communicate
- Longer foreplay and slower movements can help relax muscles and reduce pain.
- Pelvic floor physiotherapy
- Evidence shows that physiotherapy reduces pelvic girdle pain and sexual pain. A physiotherapist can also teach safe exercises and relaxation techniques.
- Treat infections promptly
- If a swab or urine test shows infection, proper treatment usually solves the problem quickly.
- Counselling or sex therapy
If fear, anxiety, or relationship stress is the main issue, talking to a counsellor or sex therapist can help. Studies have shown that these approaches improve comfort and satisfaction.
When to Worry: Red Flag Signs After Sex in Pregnancy
Sex during pregnancy is usually safe, but there are times when you should seek medical help immediately. Call your doctor, midwife, or go straight to the hospital if you experience:
- Heavy vaginal bleeding after intercourse
- Severe cramping or contractions that do not settle with rest
- Leaking fluid from the vagina, which may be a sign of ruptured membranes (water breaking)
- Fever or foul-smelling vaginal discharge, which could indicate an infection
- Sudden, severe pelvic pain, with or without other symptoms
These are considered red flag warning signs and may point to pregnancy complications that need urgent medical care. Getting help quickly can protect both you and your baby.
What research says about long-term outlook
The good news for most women is that sexual pain improves after delivery. However, some may continue to have pain up to a year or more postpartum, especially if they had perineal tears, cesarean scars, or untreated pelvic floor dysfunction. Early treatment — especially physiotherapy and open communication with healthcare providers — improves outcomes.
Practical tips for couples
- Talk openly about what feels comfortable or painful.
- Focus on intimacy beyond penetration (touch, massage, oral sex if comfortable).
- Use pillows to support the back or hips.
- Take breaks if pain starts — don’t push through discomfort.
- Remember: sex cannot hurt the baby if the pregnancy is healthy. The amniotic sac and uterus protect the baby.
Key takeaway
Painful sex during pregnancy is very common and usually not dangerous. Most cases are due to pelvic changes, reduced lubrication, or infections, and can be improved with simple adjustments, such as position changes, increasing lubrication, or undergoing physiotherapy. But if you have bleeding, severe pain, or signs of infection, always contact your healthcare provider.
Being open with your partner and your doctor helps ensure that intimacy during pregnancy remains safe, comfortable, and enjoyable.
References
- Rosen N.O., et al. Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum. Am J Obstet Gynecol. 2022.
- Morris C., Briggs C., et al. Dyspareunia: Review and Clinical Guidance. 2021.
- Robinson H.S., et al. Pelvic Girdle Pain in Pregnancy and Early Postpartum. BMC Musculoskeletal Disorders. 2024.
- Fernández-Carrasco F.J., et al. Influence of Pregnancy on Sexual Desire in Pregnant Women. 2024.
- ACOG Guidance. Sexual Activity and Pelvic Rest in Pregnancy. Reviewed 2023.
