Can Birth Control Lead to Painful Sex?

If sex has been a little more than uncomfy—as in downright painful—you may attribute it to not being wet enough, vaginismus or another condition. While there may be some validity to those guesses, there's another potential reason to consider: birth control.

A few months ago on Reddit, an online messaging board, some users explained they'd been on birth control since before they started having sex and they've had only painful sex since. Other users said birth control led to the same predicament, citing its contribution to vestibulodynia—pain in the tissue between your vulva and vagina—as well as decreased sex drive, less lubrication and chronic yeast infections.

We found some connections between birth control and painful sex that experts can address, plus their tips for helpful next steps.

How birth control can lead to painful sex

First, it's important to note that not everyone experiences this connection, so don't be deterred from birth control if you need it. Second, multiple types of birth control—not just the pill—can cause someone to feel pain. According to Suzannah Weiss, a Los Angeles-based sex educator and resident sexologist for the erotic pleasure platform FrolicMe, we're looking at forms of hormonal birth control, whether that's the pill, hormonal IUDs, implants, the NuvaRing, the patch or the Depo-Provera shot.

With that cleared up, here are the plausible explanations:

Less testosterone equals less protective tissue

Hormonal birth control can decrease the amount of testosterone your body produces, according to Weiss. Some of that testosterone is needed to build up the vulvar vestibule tissue, the tissue between your labia and vaginal opening.

"If this tissue is too thin, someone can experience pain or burning upon penetration or even other symptoms, such as itchiness in the labia," Weiss said.

Hana Patel, M.Sc., M.B.B.S., a clinical general practitioner in the United Kingdom, added that in some women, the changes in hormones and testosterone can cause a condition called vulvodynia, which is chronic and unexplained pain in the vulva.

Dryness can be a side effect of birth control  

Another possible reason is the fact that vaginal dryness, or not being able to get wet, is a common side effect of birth control.

"[Birth control] can change our hormone levels so that we produce less lubrication that leads to painful intercourse," Patel said.

And as you probably know, not being wet enough leads to more friction during penetrative sex, which isn't super-comfortable. If you notice pain in other areas or additional symptoms—headaches, breast tenderness, nausea, bloating—that can be due to birth control too, Patel added.

How to make sex less painful 

So, the dreaded question: Does it come down to giving up birth control or enjoyable sex? Potentially, but not necessarily. You do have choices:

Figure out if birth control is the cause of your pain

As mentioned previously, pain during sex can have several other causes, such as round ligament pain, a urinary tract infection (UTI), vaginismus and so on. It may help to talk to a professional about all of your symptoms and experiences to distinguish the problem. Patel encouraged people to specifically ask about polycystic ovary syndrome (PCOS), endometriosis, UTIs, yeast infections and latex allergies, all of which can cause pain during or after sex.

"Also, some patients have recurrent UTIs or yeast infections after sexual intercourse, and this may not be related to the BC [birth control] pill but something else," Patel added.

Patel recommended talking to your doctor about different forms of birth control, too, as some can worsen painful intercourse or endometriosis or PCOS symptoms more than others.

Make small changes to your sex life

You may need to add lube to your bedside table to make intercourse more comfortable. Patel explained hormonal changes can affect your lubrication and pain level, too, meaning you may need to make adjustments occasionally but not always.

Consider nonhormonal forms of birth control

For some people, birth control is necessary for various reasons. In this case, keep nonhormonal options in mind if they would address your concerns. Some of these options include condoms, sterilization, pulling out and nonhormonal IUDs.

"Many of these methods, besides vasectomy and female sterilization, tend to be less effective at preventing pregnancy than highly effective hormonal birth control methods like IUDs, but they can work very well if you combine them," Weiss said.

Try pelvic floor therapy to decrease pain 

A more general approach to resolving painful sex is seeing a pelvic floor therapist.

"Any kind of pain during sex can lead to a tightening of the pelvic floor muscles, and this becomes a self-perpetuating cycle," Weiss explained.

If you've experienced sexual trauma or shame around sex, seeing a trauma-informed pelvic floor therapist specifically is an especially good idea.

Don't feel guilty or at fault during sex

For some of us, having sexual boundaries, such as only feeling comfortable with oral sex or requiring a condom, can lead to feelings of anxiety and shame. You may wonder if your partner(s) will still be interested in you and enjoy sex as much as usual. But hey, it's OK to have needs—we all do—and to enforce boundaries around them. While it's understandable you might feel bad, you don't need to feel that way. And if someone makes you feel bad, they simply aren't worth your time.

"People with vulvas should not have to endure pain so that their partners can have more pleasure," Weiss said.

Before kicking birth control cold turkey, make an appointment with your OB-GYN and discuss possible solutions when weighing the pros and cons of a healthy, satisfying sex life and your birth control.