Dyspareunia (Painful Intercourse)
What is dyspareunia?
Pain during sex, or dyspareunia, is persistent or recurring pain just before, during or after sex. The pain is felt in the genital region. Women can have pain externally in the vulvar region — to the labia (lips of the vagina) or at the opening to the vagina. Some feel the pain internally—in the cervix, uterus or lower abdomen.
It's a common condition that can have negative emotional and psychological effects. In addition to the physical pain, couples may suffer from loss of intimacy or experience strain in their relationship.
Your healthcare provider can recommend the appropriate treatment based on your symptoms and determine the underlying cause of your pain.
Who is most likely to have dyspareunia?
Pain during sex is more common in women. It can affect both men (male dyspareunia) and women (female dyspareunia) of all ages. The pain is often due to physical factors or medical conditions, but it can also be psychological.
How common is dyspareunia?
Pain during sex is one of the more common gynecologic problems healthcare providers treat. It affects 10% to 20% of people in the United States at some point in their lives.
Are there different types of dyspareunia?
The location of the pain can help determine what type of dyspareunia you are experiencing:
- Entry pain (intraorbital or superficial dyspareunia): This pain is felt at the entrance to the vagina during initial penetration. Some factors associated with entry pain can be lack of lubrication, injury or infection.
- Deep pain (collision dyspareunia): This is pain that occurs in deep penetration and can feel worse in certain sexual positions. You will feel this pain in the cervix or lower abdomen. A medical condition or prior surgery usually causes sexual pain that occurs deeper.
Pain during intercourse can also be described as primary, secondary, complete or situational:
- Primary pain is pain you've had since becoming sexually active.
- Secondary pain develops after experiencing pain-free sex.
- Complete pain means you feel pain every time you have sex.
- Situational pain is when the pain only happens at certain times.
Symptoms and Causes
What causes dyspareunia?
In many cases, you can experience pain during sex if there is not sufficient vaginal lubrication. In these cases, the pain can be resolved if you become more relaxed, increase foreplay or if you use a sexual lubricant.
In some cases, you have painful intercourse if one of the following conditions is present:
- Vaginal atrophy: The vaginal lining can lose its normal moisture and thickness and become dry, thin and inflamed. This can be caused by medication, menopause or other hormonal changes.
- Vaginismus: The fear of being hurt or prior trauma causes a spasm of the vaginal muscles.
- Vaginal infections: These conditions are common and include yeast infections.
- Problems with the cervix (opening to the uterus): The penis can reach the cervix at maximum penetration. Therefore, problems with the cervix (such as infections) can cause pain during deep penetration.
- Problems with the uterus: These may include fibroids that can cause deep intercourse pain.
- Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
- Problems with the ovaries: Such problems might include ovarian cysts.
- Pelvic inflammatory disease: The tissues deep inside become badly inflamed, and the pressure of intercourse causes deep pain.
- Ectopic pregnancy: A pregnancy in which a fertilized egg develops outside of the uterus.
- Intercourse too soon after surgery or childbirth.
- Sexually transmitted infections (STIs): These may include genital warts, herpes sores or other STIs.
- Vulvodynia: Causes chronic pain in the vulvar area.
- Injury to the vulva or vagina: These injuries may include a tear from childbirth or from a cut (episiotomy) in the perineum (area of skin between the vagina and the anus) that is made during labor.
- Skin disorders affecting the genitalia.
- Psychological issues: Anxiety, depression and low self-esteem can prevent sexual arousal. If you have been a victim of sexual abuse, it can also contribute to your pain during sex.
Like women, men can also feel pain if there is not enough vaginal lubrication during sex. This can be solved by using a sexual lubricant. In men, painful sex can be caused by certain penile disorders:
- Foreskin damage: Damage to the foreskin (skin that covers the head of the penis) caused by rubbing or tearing can lead to pain.
- Sexually transmitted infections (STIs): Yeast infections or infections under the foreskin, as well as common STIs like genital herpes or gonorrhea, can make sex painful.
- Penis deformities: Peyronie’s disease or other deformities of the penis can cause painful intercourse.
- Painful erections: A condition such as priapism can lead to persistent, painful erections.
What are the symptoms of dyspareunia?
If you have pain during sex, you may feel:
- Sharp pain during penetration or at entry.
- Deep pain during thrusting.
- Throbbing or aching after intercourse.
- Burning pains.
- Pelvic cramping.
- Muscle tightness or spasms.
What does dyspareunia feel like?
The most common symptom is pain with intercourse that occurs at the vaginal opening or deep in the pelvis. It can be a distinct pain in one area or it may affect the entire genital region. There can be feelings of discomfort, burning or throbbing.
Does dyspareunia cause bleeding?
Dyspareunia doesn't necessarily cause bleeding. Any bleeding that occurs during sexual intercourse is likely caused by the underlying medical issue. The bleeding could be caused by the same issue that is causing the painful sex.
How do I talk to my doctor about painful sex?
Talk openly with your healthcare provider about any pain during sexual intercourse. Some questions your healthcare provider may ask you are:
- Where is the pain occurring?
- How often does the pain occur?
- How long have you been having painful intercourse?
- What does the pain feel like?
- What medications are you taking?
- Have you had any prior surgeries in the area?
- Have you been treated for any conditions of the vagina?
Diagnosis and Tests
How is dyspareunia diagnosed?
Your healthcare provider can diagnose the underlying cause of pain during sex with a thorough health history and physical examination. The physical exam could include checking your pelvis, abdomen, vagina and uterus.
What tests are done to diagnose dyspareunia?
To locate the source of the pain and diagnose any medical conditions, healthcare providers may perform the following:
- Physical exam: This examination could include a pelvic exam, rectal exam and Pap test. Your healthcare provider may also collect a sample of vaginal fluid and urine to test for signs of infection.
- Ultrasounds: Transvaginal ultrasound can get a better view of the female reproductive system.
- Laparoscopy: In rare cases, laparoscopy is used if other tests are inconclusive.
Management and Treatment
How is dyspareunia treated?
Some treatments for sexual pain do not require medical intervention. For example, in the case of painful intercourse after pregnancy, wait at least six weeks after childbirth before attempting intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants.
Some treatments for sexual pain do require prescription medication. If vaginal dryness is due to menopause, ask your healthcare provider about estrogen creams, tablets, rings or other medications. Other causes of painful intercourse also may require prescription medications.
For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve guilt, inner conflicts regarding sex or feelings regarding past abuse.
How can you treat dyspareunia naturally?
Applying a water-based lubricant to your vagina, vulva and labia is helpful to some women when dryness is the main cause. Those who have pain during sex often stop using vaginal perfumes, bubble baths or scented sanitary pads or toilet paper.
Are there medications to take for dyspareunia?
Yes, there is a medicine available to treat pain during sex. If vaginal dryness due to low estrogen is the cause of your painful sex, topical estrogens can be applied to the vagina. The Food and Drug Administration (FDA) approved a drug called ospemifene for dyspareunia due to menopause. It can be taken orally. Medication can also be prescribed to treat pain due to infection or underlying medical conditions.
How do I manage symptoms of dyspareunia?
There are some things you can do on your own to manage the pain you feel during or after sex:
- Use a water- or silicone-based lubricant to help with vaginal dryness.
- Try sexual activities or positions that do not cause pain.
- Take over-the-counter pain reliever before sex.
- Find time to relax and de-stress before having sex.
- Apply ice packs to the vulva after sexual intercourse.
How long does it take to recover from dyspareunia?
The recovery time for dyspareunia varies depending on the underlying cause for the pain you feel during sex. The good news is that you can find relief and recover from painful sex. Whether it is medication, counseling, surgery or using lubrication—your healthcare provider can find a treatment that can improve or eliminate dyspareunia.
Is there anything I can do to reduce my risk of dyspareunia?
There is usually not much you can do to reduce your risk of dyspareunia. It's often something you have no control over. Some of the factors within your control are having safe and protected sex and maintaining good hygiene.
When should I contact my doctor?
Contact your healthcare provider if there are symptoms such as new or worsening pain during sex, bleeding, genital lesions, irregular periods, vaginal discharge or involuntary vaginal muscle contractions. For pain with no underlying medical cause, ask for a referral to a certified sex counselor or therapist.
What questions should I ask my doctor?
Painful sexual intercourse can be physically and emotionally difficult. Some questions you may ask your healthcare provider are:
- What is causing my pain?
- What treatments are available?
- Is there anything I can do to decrease my pain?
- How long will it take to feel better?
A note from Cleveland Clinic:
Pain during sex can lead to physical discomfort, emotional distress and loss of intimacy. If having sex hurts you, contact your healthcare provider. Do not feel embarrassed to discuss your symptoms. Treating the problem can help your sex life, intimacy and confidence.
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