Can Birth Control Make Sex Hurt?
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Time to read 7 min
Birth control is as important today as it ever was! It can do all sorts of things: prevent pregnancy, ease period symptoms, help treat symptoms of disorders like endometriosis or PCOS. One of the side effects of hormonal birth control that doesn’t often get discussed, however, is painful sex.
Important note: We want to be clear that this will not be a symptom experienced by everyone, but on the off chance that you are experiencing painful sex and you’ve ruled out many other possibilities (like infection or pelvic floor muscle dysfunction), it may be something worth considering.
We spoke to New York-based pelvic pain specialist Dr. Sonia Bahlani about why it happens, what you can do about it, and how to bring it up with your doctor.
Table of Contents
Why might hormonal birth control cause painful sex? Hormone receptors Sexual desire + libido Check out these painful sex faves Genetic components What should I do if I think my birth control is causing painful sex? Talk to your doctor Explore treatments or other contraceptive methods Related Articles
Why might hormonal birth control cause painful sex?
“The way hormonal oral contraceptives (OCPs) work,” Dr. Bahlani tells us, “is that they suppress estrogen and progesterone, and that prevents the natural hormonal shifts that cause ovulation. By preventing ovulation, you can’t get pregnant.”
These medications also increase something that’s called sex hormone binding globulin (SHBG). “This is a protein that binds to testosterone,” Dr. Bahlani says. “When it binds your free testosterone, you have less circulating in your system. This affects your vulvar tissue and your vestibular tissue.”
According to Dr. Bahlani, there are actually 70% more testosterone receptors in the vestibule than there are estradiol (a type of estrogen) receptors! This is something that has been studied and known for over 10 years, “but a lot of general gynecologists often don’t quote the data,” Dr. Bahlani suggests.
Science Moment: Pain at the vaginal opening may be more likely if someone...
- Began taking combined oral contraceptives (a pill with both estrogen and progesterone) at a young age
- Is taking a pill with low estrogen
- Is taking a pill containing antiandrogenic progestins (like Drospirenone)
Hormone receptors
“Hormonally-mediated vestibulodynia” is pain at the entrance of the vagina due to hormonal issues or changes—like during pregnancy, menopause, or breast/chestfeeding. If someone is experiencing this from hormonal birth control, that is often why they do not respond to estrogen treatments alone, but a combination of estrogen and testosterone.
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There are hormone-specific receptors in the vulvar area. “And if you have less testosterone and estrogen in that area,” says Dr. Bahlani, “this mimics the postmenopausal state that can cause vaginal atrophy and dryness. The tissue becomes thinner and less collagenized and there can be increased inflammation in the nerves in that area, which can cause painful penetrative intercourse.”
Dr. Bahlani notes that painful sex usually gets blamed on low estrogen levels, and while this is important (estrogen affects vaginal lubrication), the testosterone component is also incredibly relevant.
Sexual desire + libido
This is still related to hormones, but deserves its own little aside.
The sex hormone binding globulin that we mentioned earlier that lowers free testosterone is also thought to decrease libido and decrease lubrication . (The decreased libido could be due to the fact that you aren’t hormonally motivated to have sex around ovulation because you aren’t ovulating). Decreased lubrication can also lead to painful sex, though this can be helped with a little—or a lot!—of lube.
It’s also worth noting that if you don’t necessarily feel like getting it on but want to try anyway, jumping into penetration before you’re fully aroused might hurt. Some folks develop genito-pelvic pain/penetration disorder (GPPPD) because they repeatedly attempt penetration before their body is ready—and because we are sorely lacking in sex education in this country, they believe that the pain is normal. This assumption can actually lead to consistent pain with penetration and you might even develop pelvic floor dysfunction along the way.
And at the end of the day, sexual desire is a lot more complicated than just hormones. While they certainly matter, so does what's happening in the brain, relationships, environment, and the rest of the body.
Check out these painful sex faves
Genetic components
It sounds kinda wild, but Dr Bahlani says, “we believe that there might be some sort of genetic component that causes certain people to be more apt to developing these symptoms, like a gene shift on a certain chromosome.” This means that the length of time you are on OCPs has no bearing on whether or not you will experience hormonally mediated vestibulodynia. Even being on the pill for a short period of time could still cause this issue.
“Being on it for several years gives you a benefit of preventing things like ovarian cancer but does not put you at a higher risk of developing hormonally mediated vestibulodynia because if you don't have that genetic component, then you’re likely not going to develop it.”
What should I do if I think my birth control is causing painful sex?
Don’t suffer through it—there are options!
Talk to your doctor
If your birth control is affecting your quality of life, absolutely bring it up with your prescribing doctor! “Birth control, like anything in life, is not perfect,” Dr. Bahlani says. “There are pros and cons and the discussion should always involve informed consent. I think as physicians, we could improve at communicating the sexual side effects of birth control pills. And if you're experiencing painful sex and you are on some sort of hormonal contraception, it's absolutely worth a conversation with your doctor.”
Some folks may feel uncomfortable bringing this subject up with their provider and it can be even harder if you don’t feel heard. If you feel like your concerns are being brushed off or minimized, “find a new doctor,” Dr. Bahlani says. “Get a second opinion. That’s not how we should be practicing medicine at all. Everything comes with informed consent and weighing the risk/benefit ratio is really, really important.”
Explore treatments or other contraceptive methods
If you’re experiencing painful sex, but your birth control of choice is working for you otherwise, that doesn’t mean you have to come off of that form of birth control. Some options to mitigate those side effects include:
Vaginal moisturizers or topical hyaluronic acid
Topical hormones to replenish the hormones in the vulvar area
Pelvic floor therapy if the pain becomes musculoskeletal (ie from consistently bracing during painful sex)
Medication to increase libido
Experiment with different brands of OCPs or other forms of birth control (hormonal or non)
Trying different brands may seem like a daunting task, but it may be worth trying if nothing else has worked. “I think that many clinicians will try different pills first before completely eliminating the pill and suggesting another form of birth control,” Dr. Bahlani says. Different brands have different amounts of each hormone, so you may find another OCP that works better for you.
If you’re ready to explore other options, copper IUDs without any hormones are least likely to cause hormonally-mediated vestibulodynia because they can’t cause hormone fluctuations. However, they may cause cramping and abnormal bleeding, which can contribute to painful sex. While it is possible to have hormonally-mediated vestibulodynia from progesterone-only IUDs (or even the progesterone-only pill), Dr. Bahlani says it is much less likely.
If you think your birth control may be causing painful sex or contributing to it, that is a legitimate concern. There are lots of ways to mitigate this side effect so you don’t have to just live with it. Lube and vaginal moisturizers are available over the counter, and if you’re interested in topical hormones or another treatment that Dr. Bahlani shared above, see your doctor. It’s so not fair that the thing that can give you sexual freedom can also give you sexual pain. One of the main reasons why people use birth control is so that they can have safer sex! You deserve pleasurable sex without the risk of pregnancy if that’s what you desire.
Hormonal birth control may cause pain at the vaginal entrance during penetration, but it doesn't happen to everyone who takes it
The vaginal vestibule is a super hormone-sensitive area, so it makes sense that hormonal birth control (particularly those containing low estrogen) could have an effect
If you suspect your birth control is affecting your sex life, talk to your doctor about your options for either alleviating symptoms or switching to a different method
The Author || Nicole Guappone
Nicole Guappone is a writer and pelvic health nerd living in the Chicagoland area. She’s been published by Rolling Stone, Glamour, Allure, The Establishment, and more. She’s worked sex toy retail and written sex toy reviews from the perspective of someone with pelvic floor dysfunction. Ohnut helped her on her journey to pain-free sex.
Nicole has an MFA in nonfiction writing and recently completed the Mind-Body-Pelvic Health Academy training program with Dr. Brianne Grogan, DPT. Her non-human companions include two cats and four koi fish.
