Dyspareunia

A health condition that causes painful sexual intercourse is called dyspareunia. There are multiple causes of this condition, from structural problems to psychological ones. Furthermore, many people experience this condition at least once in their lives.

This condition causes recurrent or long-lasting genital pain that happens before, during, or after sexual activity. If you experience dyspareunia, it is advised to visit a doctor. The treatment goal is to lessen pain by treating the underlying cause.

Symptoms

Usually, people with dyspareunia experience the following symptoms. For example:

Pain only at sexual entry (also called penetration)
Deep pain during thrusting
Burning or aching pain
Throbbing pain that may last several hours after sexual intercourse
Pain with every penetration (such as when putting in a tampon)

If you experience recurrent pain before, during, or after sex, it is advised to see a doctor. If you ignore the symptoms and do not treat the condition, it may lead to emotional problems and low self-esteem.

Causes

There are multiple physical causes of dyspareunia. It depends on where the pain occurs at entry or with deep thrusting. Furthermore, there are multiple cases of painful intercourse linked with emotional factors. Check below for some dyspareunia causes according to the area where pain occurs:

Entry Pain

These include:

Little or lack of lubrication – There are multiple factors that may cause this problem. These include lack of lubrication and low Estrogen levels often caused by menopause, childbirth, or breastfeeding. In addition, certain medications may negatively affect sexual desire or arousal. For example, antidepressants, antihypertensives, sedatives, antihistamines, and some birth control pills.
Irritation, trauma, or injury – These include injuries or irritation caused by an accident, pelvic surgery, female circumcision, or a cut made during childbirth (also known as episiotomy).
Infections, inflammation, or skin conditions – Painful sexual intercourse may also occur due to urinary tract or genital infections (including eczema or others).
Vaginismus – It occurs when involuntary spasms of the vaginal muscles occur.
Congenital vaginal problems – These include vaginal agenesis (a condition in which the vagina is not fully formed), imperforate hymen (a membrane that cloaks the vaginal opening), and others.

Deep Pain

In such cases, pain occurs with deep penetration and may worsen in some positions. Check below for some causes:

Certain health conditions – For example, endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor diseases, adenomyosis, hemorrhoids, ovarian cysts, and others.
Surgery and other medical procedures – Painful intercourse may occur due to scarring from pelvic surgery (such as a hysterectomy). However, dyspareunia may also happen due to certain cancer treatments (including chemotherapy, radiation therapy, and others).

Emotional Factors

Emotional state is directly linked with sexual intercourse. There are some factors that could play a role in sexual pain. For example:

Psychological problems – These include fear of intimacy, relationship problems, physical appearance concerns, depression, anxiety, and others.
Stress – Some people may experience a tightening of the pelvic floor muscles during a stressful situation. As a result, dyspareunia may occur.
Sexual abuse – While not everyone has a history of sexual abuse, it may play a role in painful intercourse.

Sometimes, it is difficult to determine whether emotional factors are linked with dyspareunia.

Anyone may develop dyspareunia, but there are some factors that elevate the risk even more. For example:

Medical conditions (such as endometriosis)
Surgeries and other medical procedures (such as chemotherapy used to treat cancer)
Mental health conditions
Emotional distress

Diagnosis

Physicians usually ask some questions about your medical history before diagnosing dyspareunia. These include where it hurts, how it feels, how often it occurs, when the pain began, and others. Check below for other tests and procedures that help confirm the condition:

A pelvic examination – During this procedure, doctors will check for irregularities associated with painful intercourse. For example, anatomical problems, skin irritation, infections, and others. Visual examination of the vagina also can be a part of the pelvic examination. For this test, doctors use a specific tool called a speculum that separates the vaginal walls. In most cases, people who experience pain during sexual intercourse also have pain during this examination.
Other tests – If doctors identify some abnormalities after a pelvic examination, they may perform an ultrasound.

Treatment

Physicians usually prescribe different treatments for people with dyspareunia. It depends on several factors, such as the severity and cause of the condition, your age, existing health problems, and others.

Medicines

Physicians usually prescribe medicines if painful intercourse is caused by an underlying condition (including infections). Some people may experience a lack of lubrication and then painful sexual intercourse due to some medicines. In such cases, physicians may reduce the dose or even change the medication.

Dyspareunia usually occurs in postmenopausal women due to a lack of lubrication. It occurs due to reduced Estrogen levels. In such cases, the condition can be treated with topical Estrogen. This medicine is usually applied directly to the vagina.

However, the Food and Drug Administration has approved a medicine (Ospemifene) for women with moderate to severe painful intercourse. It works like Estrogen in the vaginal lining.

Another way to treat dyspareunia is a medicine called Prasterone. It is a capsule that should be placed in the vagina every day.

Other Treatment Options

Check below for some therapies that also can be used to treat painful intercourse:

Desensitization therapy – This treatment involves learning vaginal relaxation techniques.
Counseling or sex therapy – In some cases, people avoid sexual activity even after treatment because of painful intercourse. However, it is advised to improve communication with your sexual partner and restore sexual intimacy. To resolve these problems, you may consult with a counselor or sex therapist.

Home Remedies

Check below for some tips that you and your partner may try to lessen pain during sexual activity:

Position changes – If you feel pain during thrusting, you can consider other positions (such as being on top).
Communicate – Normally, you should talk with your sexual partner about what feels good and what does not.
Do not rush – In some cases, not enough foreplay may lead to little or lack of lubrication and painful intercourse.
Use lubricants – This option may help make sexual activity more comfortable, especially for postmenopausal women.

Frequently Asked Questions

What are the main causes of dyspareunia?

Endometriosis
Vaginismus
Infections (including sexually transmitted infections, urinary tract infections, and others)
Structural abnormalities of the vagina or vulva
Pelvic inflammatory disease
Some medicines (such as antidepressants, chemotherapy drugs, and others)
Mental health problems (such as depression, anxiety, and others)

What are the primary dyspareunia symptoms?