Pain during sexual intercourse, medically termed dyspareunia, can be a distressing symptom. This discomfort may present as superficial pain at the entrance of the vagina or deeper pain during penetration. While often attributed to other causes, hormonal birth control methods can be a contributing factor for some individuals. The hormonal changes induced by these contraceptives can alter the physiological environment of the genital tissues.
How Hormonal Contraception Causes Painful Sex
Hormonal contraceptives, particularly combined methods containing both synthetic estrogen and progestin, work by suppressing the body’s natural hormone production. This suppression reduces the normal levels of sex hormones, including estrogen and free testosterone. The synthetic estrogen component in these medications also triggers the liver to produce more Sex Hormone-Binding Globulin (SHBG). This SHBG then binds to the body’s naturally produced testosterone, effectively lowering the amount of biologically active free testosterone.
This reduction in circulating sex hormones can directly impact the genital tissues, which are highly sensitive to these hormonal fluctuations. Low hormone levels can lead to a condition known as vulvovaginal atrophy, where the delicate tissue of the vulva and vagina becomes thinner and less elastic. This thinning makes the tissue more vulnerable to friction, irritation, and micro-tears during intercourse.
Furthermore, these hormonal changes reduce the natural blood flow to the genital area. The resulting hypolubrication, or vaginal dryness, forces friction during penetration, which can cause burning, stinging, and pain at the vaginal opening. This mechanism mimics the symptoms of a lower estrogen state, similar to those experienced during menopause.
Contraceptive Methods and Associated Pain Risks
Combined hormonal contraceptives, which include the pill, patch, and vaginal ring, carry the highest potential risk for dyspareunia related to dryness and atrophy. These methods are the most effective at suppressing ovarian hormone production and increasing SHBG, leading to the most significant drop in free testosterone. Some studies suggest that lower-dose estrogen pills (20 micrograms or less) may be more likely to cause these symptoms due to their minimal estrogenic activity.
Progestin-only methods, such as the mini-pill, hormonal implant, or the contraceptive injection, can also lead to vaginal dryness and decreased libido. While they do not contain the estrogen that increases SHBG, the high dose of progestin can still suppress ovarian activity and may have androgen-blocking effects that contribute to dryness. However, the severity of dryness is sometimes less pronounced than with combined methods.
Intrauterine Devices (IUDs) present a different set of pain risks. The copper IUD (non-hormonal) is not associated with hormonal side effects like dryness or atrophy. However, both hormonal and copper IUDs can cause mechanical pain, such as temporary discomfort during insertion or deeper pain during intercourse if the IUD has shifted position or if the strings are too long. Pain specifically related to dryness is generally not an issue with the copper IUD, but it remains a possible side effect of the hormonal IUD due to its localized progestin release.
Practical Steps for Managing Pain and Seeking Help
If birth control is contributing to painful sex, immediate steps can be taken to manage the discomfort at home. The most effective first measure is to use high-quality, long-lasting personal lubricants before and during sexual activity. Water-based or silicone-based lubricants are generally recommended, but if using latex condoms, avoid oil-based products as they can compromise the integrity of the latex.
Increasing the duration of foreplay can also help, as extended arousal time naturally increases vaginal blood flow and lubrication. Open communication with your partner about the pain and the need for slower, more gentle penetration is important. Using vaginal moisturizers on a regular, non-sexual basis can help restore moisture and elasticity to the tissues over time, unlike lubricants which are only used during sex.
If at-home management does not resolve the discomfort, consult a healthcare provider for a medical evaluation. Persistent pain requires ruling out other potential causes, such as infections, skin conditions, or pelvic floor muscle dysfunction, which can co-exist with hormone-related pain. Treatment options include switching to a combined oral contraceptive with a higher estrogen dose to counteract the atrophic effects. Alternatively, switching to a non-hormonal method entirely, such as the copper IUD or barrier methods, often reverses the tissue changes and resolves the pain.