PCOS And Painful Sex: What’s The Connection? Tbh, We’re Not Really Sure…
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Time to read 9 min
If you’ve heard of Polycystic Ovarian Syndrome (PCOS) , you’ve probably heard it described as a “reproductive disorder” that causes cysts to form on the ovaries. While that’s technically a correct definition, PCOS is so much more than that. It’s a complex condition that impacts not just the reproductive system, but also hormone production and metabolic function.
And ovarian cysts aren’t even close to the only major symptom of PCOS. Other symptoms include:
Missed or painful periods
Pain during sex
Acne
Weight gain
Insulin resistance
Glucose intolerance
Metabolic syndrome
Diabetes
Infertility
Newer research has also linked PCOS to chronic, systemic inflammation, which can contribute to a whole host of additional symptoms.
PCOS is a relatively common condition for people with ovaries. According to one review of the current research , between 4% and 20% of women (only cis women were included in the studies) of reproductive age have PCOS, making it more common than other chronic reproductive disorders like endometriosis (6% to 18%).
Table of Contents
The Impact of PCOS on Quality of Life PCOS, Pain, and Sexual Dysfunction – The Elephants in the Room What’s the Link Between PCOS, Pain, and Painful Sex? PCOS and Chronic Inflammation PCOS, Pain, and Pelvic Floor Tension Your Pelvic Floor’s Relief Team PCOS and Oxidative Stress PCOS and Hormonal Changes Related Reading
The Impact of PCOS on Quality of Life
Even though it’s one of the most common conditions affecting people with ovaries, PCOS still hasn’t been studied enough for doctors and researchers to fully understand what causes the condition or all the ways it affects people’s lives. In fact, the first studies aimed at investigating the quality of life for people with PCOS were only developed in the late 1990s and early 2000s! Since then, quality of life surveys have been used to study how PCOS impacts the physical, mental, and emotional health of people who live with the condition.
The findings are remarkably consistent. A 2024 analysis of the research on PCOS and quality of life found that women with PCOS were more than twice as likely to experience symptoms of depression than women without PCOS. The same analysis found that 76% of women with PCOS reported symptoms of moderate to severe generalized anxiety disorder. Additionally, women with PCOS consistently scored lower on quality of life assessments, especially in the sections related to body image, self-esteem, and sexual function.
For other people with pelvic floor dysfunction, the tension can also feel like:
Stabbing or tearing sensations at the entrance during sex — which Kiwi can help with, too!
Issues with bowel movements
A perpetual UTI that may or may not be a UTI
“The quality of their pain can vary from a burning sensation to sharp, shooting, achy, cramping, ripping, or sometimes they will describe it as sitting on a rock or golf ball,“ said Rachel Gelman, PT, DPT, CSC.
PCOS, Pain, and Sexual Dysfunction – The Elephants in the Room
In the vast majority of studies on how PCOS impacts quality of life, information about one particular symptom is glaringly absent. The quality of life surveys specific to PCOS don’t include questions about chronic pain. Wild, right?
In the past decade or so, researchers finally started asking people with PCOS whether the condition caused them chronic pain. They also started including more comprehensive questionnaires about quality of life and sexual function.
The results were not surprising… to anyone with ovaries.
Preliminary results of a 2024 analysis of the current research on chronic pain in people with PCOS revealed that 19% of women with PCOS also had a formal pain-related diagnosis, like dysmenorrhea, the medical term for painful periods.
In a 2025 survey of more than 250 women with PCOS 65% of participants reported experiences with chronic pain, suggesting far more women experience chronic pain without receiving an official diagnosis.
Even less explored in the research is people’s experiences with sexual pain. Few studies have investigated PCOS and sexual dysfunction, and the results have been wildly inconsistent. So inconsistent, that the authors of a 2023 analysis of the research stated “this issue remains controversial.”
That analysis, as well as two others - a 2020 analysis of 28 studies of and a 2024 analysis of 27 studies found mixed results:
Some studies showed no difference in sexual function between women with and without PCOS.
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Others showed significant differences, with women with PCOS more likely to experience:
Pain during sex
Issues with lubrication
Difficulties with arousal
Inability to orgasm
Some clarity on these widely varying results came with the July 2025 publication of the largest review of the research on polycystic ovary syndrome and sexual function ever conducted. The article’s authors examined the results of 40 studies, aggregated the data, and analyzed all the results to see if they could glean any new information about PCOS and sexual function.
Their extensive work revealed that one of the issues with identifying a connection between PCOS and sexual dysfunction lies in the ways the research is conducted and data is collected. The researchers concluded that different research methodologies – specifically using different quality of life and sexual function questionnaires – likely explained studies that found PCOS had little to no effect on sexual function. Because of this, the authors concluded that, according to their review of the research, there is a clear link between PCOS and sexual dysfunction.
Past studies of PCOS and sexual function have also been rife with fatphobia, often linking higher body weight and BMI to higher rates of sexual dysfunction and assuming weight and body image played a major role in sexual dysfunction.
However, the 2025 review uncovered data that suggests this may not be the case. Or at least it’s not the full story.
The aggregated data from the studies included in the review actually showed that larger bodied women with PCOS experienced sexual dysfunction at similar rates as larger bodied women without PCOS and thinner women with PCOS. The data also showed that larger bodied women with PCOS actually experienced fewer issues with lubrication than thinner women with PCOS. Since lubrication can be a significant factor in painful sex, this could suggest larger bodied women are less likely to experience painful sex. Of course, much more research is needed.
Though the research still isn’t clear enough to show a definitive link between PCOS and painful sex, the studies that support this finding are way more in line with what women are telling their doctors about their experiences with PCOS. A 2024 study included detailed interviews with 17 women about their experiences with PCOS, and the majority of the women interviewed said sex was painful and they had trouble with lubrication and getting aroused.
What’s the Link Between PCOS, Pain, and Painful Sex?
As with so many aspects of PCOS, the infuriating answer to this question is, we just don’t know. There’s just not enough research to draw any conclusions yet.
But researchers do have some theories they’re exploring. A group of researchers in Taiwan dug into the data about PCOS and pain, and their investigation revealed some interesting connections that might explain why so many people with PCOS experience chronic pain and pain during sex.
PCOS, Pain, and Pelvic Floor Tension
The body’s natural response to pain is to flex the surrounding muscles to protect them from damage. So, when sex is painful, a cycle occurs:
- The body’s natural reaction is to flex the muscles in the pelvic floor.
- The muscles in the pelvic floor basically forget how to relax and stay tense all the time.
- Tense pelvic floor muscles can make sex even more painful, which creates this nasty cycle.
Though there isn’t a ton of research on pelvic floor dysfunction and PCOS, a 2023 study of 368 women found that 37% of the women with PCOS had some sort of pelvic floor dysfunction and that pelvic floor dysfunction was far more common in people with PCOS than those without. So, pelvic floor dysfunction could be another factor contributing to painful sex in people with PCOS.
PCOS and Chronic Inflammation
Several studies have found that people with PCOS have higher levels of systemic inflammation than healthy folks. One of the reasons for this is that many people with PCOS develop insulin resistance, which is a known cause of chronic inflammation. Over time, chronic inflammation can both cause pain and change the way the brain perceives pain, making painful stimuli even more painful. So, chronic, low-grade inflammation could be one cause of pain in people with PCOS.
Your Pelvic Floor’s Relief Team
PCOS and Oxidative Stress
What is oxidative stress?
Because we breathe air, our bodies naturally make something called "reactive oxygen species" (you may have also heard them called free radicals). This is just a fancy way to describe molecules that contain oxygen and react readily with other stuff inside our bodies. These are totally healthy and normal and useful, until you get too many of them. Then you've got a situation known as oxidative distress, which can potentially lead to cell and tissue damage.
Newer research is exploring the connection between oxidative stress and chronic pain . Oxidative stress happens when free radicals build up in the body because antioxidants can’t get rid of them. If that sounds like something from a woo-woo supplement commercial, we get it. But free radicals are real, and they can build up and cause oxidative stress. But that woo-woo antioxidant supplement won’t solve the problem.
Anyway, like chronic inflammation, oxidative stress can cause pain and change the way the brain perceives pain. And research has found that people with PCOS have higher levels of oxidative stress than healthy folks, so that could be another contributing factor to their chronic pain.
While chronic inflammation and oxidative stress may contribute to overall experiences of pain in people with PCOS, when it comes to sexual pain, there’s likely a more straightforward answer.
PCOS and Hormonal Changes
One of the many contributing factors to PCOS is the overproduction of “male” hormones called androgens. When the body of a person with ovaries overproduces androgens, it produces less estrogen. Estrogen plays a crucial role in arousal and lubrication. so lower levels of estrogen can lead to:
Difficulty with natural lubrication
Lessened physical response to arousal
Vaginal atrophy over time
So, people with PCOS, who likely have lower levels of estrogen, may experience pain during sex because their bodies don’t respond to sex the way they used to. Penetrative sex without enough natural lubrication is definitely painful, and so is penetrative sex when the vaginal tissue is damaged in any way.
When it comes to painful sex and PCOS, the only definitive answer is “it’s complicated.” If you have PCOS and you’re experiencing pain during sex, the absolute best thing you can do is work with a doctor who really understands the systemic nature of PCOS and how many factors contribute to the myriad symptoms the condition causes.
Getting an evaluation from a pelvic floor physical therapist is also worth it. Though identifying and treating pelvic floor dysfunction won’t be the magic solution, at the very least it will give you more information about the factors contributing to your pain. At best, it can help you work toward sexual pleasure without pain. Want more information? Check out our resources on pelvic floor PT !
Many people with PCOS report pain during sex, but research on the connection is still limited and inconsistent.
Hormonal changes, especially lower estrogen, can reduce lubrication and make sex uncomfortable or painful.
Chronic inflammation, oxidative stress, and pelvic floor dysfunction may also play a role in sexual pain with PCOS.
More research is needed, but pelvic floor PT and supportive care can help manage pain and improve sexual comfort.
The Author || Robin Zabiegalski
Robin Zabiegalski (they/them) is a queer, non-binary writer and editor with several years of experience in digital media. Their specialties include: sexual health, mental health, LGBTQIA+ issues, and wellness. Robin's work has been published in Insider, Health Digest, GameRant, Heavy.com, and several other digital publications.
When they're not working, Robin can be found teaching or practicing yoga and Brazilian Jiu Jitsu, hiking, playing Fortnite with their husband, or chasing their rambunctious kiddo.
