Dyspareunia (painful intercourse): Causes and treatment

Dyspareunia is a persistent or recurrent pain that can happen during sexual intercourse. Causes vary widely. It can lead to distress and relationship problems.

Painful intercourse can affect both men and women, but it is more common in women. According to the American Academy of Family Physicians (AAFP), up to 20 percent of American women experience it.

A variety of factors – both physical to psychological – can contribute. Treatment normally focuses on the underlying cause.

Fast facts about exercise dyspareunia

Here are some facts about dyspareunia. More detail is in the main article.

Dyspareunia refers to pain during sexual intercourse. It mostly affects women.

Pain can range from moderate to severe.

Reasons can be physical or psychological, and they may be related to menopause.

Solutions include estrogen therapy, changing existing medications, and counseling.

Symptoms

[Dyspareunia]
There is a number of reasons why intercourse can be painful. Dyspareunia affects women more than men.

The defining symptom of dyspareunia is pain with intercourse that may occur at the vaginal opening or deep in the pelvis.

The pain may be distinct and localized, or there may be a broader sense of discomfort.

There be an aching, burning, throbbing, or ripping sensation.

Dissatisfaction with, or disinterest in, intercourse can result.

[Dyspareunia reproductive system]
Problems with the reproductive system can lead to dyspareunia.

Entry pain may be associated with vaginal dryness, vaginismus, genital injury, and others.

Vaginal dryness: During sexual arousal, glands at the entrance of the vagina secrete fluids to aid intercourse. Too little fluid can lead to painful intercourse.

Inadequate lubrication can arise from:

a lack of foreplay

a reduction in estrogen, particularly after menopause or childbirth

medications, including some antidepressants, antihistamines, and birth control pills

Vaginismus: The involuntary contraction of the pelvic floor muscles causes vaginismus, leading to painful sexual intercourse.

Women with vaginismus may also experience difficulty with gynecological examinations and tampon insertion.

There are several forms of vaginismus. Symptoms vary between individuals and range from mild to severe. It can be caused by medical factors, emotional factors, or both.

Genital injury: Any trauma to the genital region can lead to dyspareunia. Examples include female genital mutilation (FGM), pelvic surgery, or injury arising from an accident.

Painful intercourse is also common after childbirth. Some research suggests 45 percent of participants experienced postpartum dyspareunia.

Inflammation or infection: Inflammation around the vaginal opening is called vulvar vestibulitis. This can cause dyspareunia. Vaginal yeast infections, urinary tract infections, or sexually transmitted infections (STIs) can also lead to painful intercourse.

Skin disorders or irritation: Dyspareunia may arise from eczema, lichen planus, lichen sclerosus, or other skin problems in the genital area.

Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products may also cause pain.

Abnormalities at birth: Less common underlying causes of dyspareunia include vaginal agenesis, when the vagina does not develop fully, or imperforate hymen, in which the hymen blocks the vaginal opening.

Physical causes: Deep pain

If pain occurs during deep penetration or is more acute in particular positions, it may be the result of a medical treatment or a medical condition.

Medical treatments that can lead to pain include pelvic surgery, hysterectomy, and some cancer treatments.

Medical conditions include:

cystitis: An inflammation of the bladder wall, usually caused by bacterial infection

endometriosis: A condition arising from the presence of tissue from the uterus in other areas of the body

fibroids: Non-cancerous tumors that grow on the wall of the uterus

interstitial cystitis: A chronic painful bladder condition

irritable bowel syndrome (IBS): A functional disorder of the digestive tract

ovarian cysts: A build-up of fluid within an ovary

pelvic inflammatory disease (PID): Inflammation of the female reproductive organs, usually caused by infection

uterine prolapse: One or more pelvic organs extend into the vagina

Psychological causes

Some common emotional and psychological factors can play a role in painful intercourse.

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