When Intimacy Hurts: Common Injuries During Sex

Sex is generally a pleasurable, bonding experience. But for many, it can result in unexpected injuries that range from mild discomfort to medical emergencies. Understanding how often and why these injuries happen helps normalize seeking care and encourages people to be more open. Often under-discussed, these matters are important to address.

1. Vaginal Tears and Abrasions

Vaginal tears and abrasions are among the most frequent injuries women report after sex. These may occur from vigorous intercourse, insufficient lubrication, or particular anatomical or physiological factors such as postpartum changes or atrophy. According to a review, among women attending examinations after consensual intercourse, over 52% had mucosal erosions, 32% experienced penetrating mucosal injuries, and 14.6% had injuries that penetrated deeper into the vaginal wall .

Most injuries in consensual sex tend to be minor, but severe tears, often linked to positions causing deep penetration or poor lubrication, can require medical attention and sometimes surgical repair .

2. Vaginal and Genito-Anal Injury After Assault

While our focus may be on consensual contexts, data from post-assault examinations helps us to understand the frequency and nature of injuries. A recent study (2023) found that among 294 women examined following sexual assault, 25.9% had genito-anal injuries . In cases with completed vaginal penetration, the rate rose to 31.1%, while anal injuries occurred in 20% of those reporting anal penetration .

3. Bruising, Swelling & Soft Tissue Damage

Friction, pressure, or awkward positioning can cause bruising or swelling of the vulva. Among women experiencing pain during sex, vaginal soreness was the most commonly reported injury—accounting for 57% of complaints . Though often self-limiting, relief measures like cold compresses or rest may be needed; if swelling doesn’t improve, medical evaluation is warranted.

4. Urethral and Bladder Concerns

Trauma to the urethral area during sex, particularly vigorous or unfamiliar activities—may lead to symptoms like burning urination or increased risk of urinary tract infections (UTIs). Survey data noted urinary tract or sexually transmitted infections accounted for 29% of injury-related ailments among women, compared to only 5% among men . Preventive tips include gentle techniques, clean habits, and hydration.

5. Penile Injuries: Fractures & More

Men can suffer serious injuries too—most notably penile fractures, which occur when the erect penis bends forcefully, rupturing its tunica albuginea. This often produces a “popping” sound, immediate pain, swelling, and loss of erection—requiring urgent surgery to avoid lasting damage .

Lifetime incidence is low (roughly 1 in 100,000 men). Certain positions are more implicated: reverse cowgirl accounts for about 50% of penile fractures, followed by doggy-style (41%) and missionary (25.5%)

6. Musculoskeletal Strains & Back Pain

Sex can be physically demanding. Across genders, people frequently report back pain, leg cramps, and muscle strains tied to positioning. Survey data show:

• Doggy-style was the riskiest for women, responsible for over 20% of injuries—ranging from bruises to vaginal tears and sprains .

• Missionary was the top cause for injuries among men, including back pain and penile fractures; it also caused 16.3% of women’s injuries, including tearing and soreness .

• Standing sex was linked to nearly 50% of men’s back injuries, while cowgirl and reverse cowgirl positions increased knee, hip, and joint strain for women .

7. Risky Practices: Choking/Strangulation

A growing concern is erotic strangulation—when consensual but risky acts lead to dizziness, seizures, stroke, or worse. In Australia, about 50% of adults under 35 reported engaging in it during sex, raising serious safety alarms . Even brief or gentle strangulation can damage the brain and neck; in women under 40, it is the second-leading cause of stroke .

When to Seek Medical Help

While many sex-related injuries are minor, immediate care is important for:

• Severe or persistent bleeding,

• Deep vaginal or genital tears,

• Hidden injuries or swelling that doesn’t resolve,

• Signs of penile fracture (e.g. popping noise, loss of erection),

• Urethral symptoms like blood or inability to urinate,

• Neurological symptoms linked to strangulation (e.g. dizziness, altered consciousness).

Early intervention ensures the best outcomes and helps ease psychological distress.

Prevention Tips: Communication & Preparation

Here’s how partners can reduce risks:

• Use adequate lubrication, especially if dryness or friction is likely.

• Engage in warm-up and take things slowly, particularly with new positions.

• Support key areas—like hips or backs—with pillows or cushions.

• Communicate boundaries clearly, and stop if discomfort occurs.

• Avoid risky practices like choking, especially without negotiation and safety planning.

• Practice hygiene, especially before exploring new contact methods, to reduce infection risk.

• Seek help confidently when injury or pain lasts beyond a day or is severe.

Injuries during sex,though embarrassing to discuss, are more common than many expect. Awareness and prevention can go a long way in preserving both physical safety and intimacy.

By Dr.Akhila C

Consultant Gynaecologist