What is painful intercourse (dyspareunia)?
Painful intercourse can occur for a variety of reasons — ranging from structural problems to psychological concerns. Many women experience painful intercourse at some point in their lives.
The medical term for painful intercourse is dyspareunia — which is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you’re experiencing painful intercourse. Treatments focus on the underlying cause, and can help eliminate or reduce this common problem.
How common is painful intercourse (dyspareunia)?
Although this problem can affect men, it is more common in women. Please discuss with your doctor for further information.
What are the symptoms of painful intercourse (dyspareunia)?
The common symptoms of painful intercourse (dyspareunia) are:
- Pain only at sexual penetration (entry)
- Pain with every penetration, even while putting in a tampon
- New pain after previously pain-free intercourse
- Deep pain during thrusting
- Burning pain or aching pain
- Throbbing pain, lasting hours after intercourse
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes painful intercourse (dyspareunia)?
Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.
Pain during penetration may be associated with a range of factors, including:
- Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding.
- Certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
- Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).
- Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.
- Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.
- Congenital abnormality. A problem present at birth, such as the absence of a fully-formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could be the underlying cause of dyspareunia.
Deep pain usually occurs with deep penetration and may be more pronounced with certain positions. Causes include:
- Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.
- Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy, can sometimes cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.
Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Emotional factors include:
- Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
- Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
- History of sexual abuse. Most women with dyspareunia don’t have a history of sexual abuse, but if you have been abused, it may play a role.
Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.
What increases my risk for painful intercourse (dyspareunia)?
There are many risk factors for painful intercourse (dyspareunia), such as:
- Those who are sexually inexperienced (particularly if their partners are also inexperienced).
- Those who are peri- or post-menopausal.
- Hysterectomy might be expected to increase the risk but the opposite is observed.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is painful intercourse (dyspareunia) diagnosed?
A medical evaluation for dyspareunia usually consists of:
- A thorough medical history. Your doctor may ask when your pain began, exactly where it hurts, how it feels, and if it happens with every sexual partner and every sexual position. Your doctor may also inquire about your sexual history, surgical history and previous childbirth experiences. Don’t let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your pain.
- A pelvic exam. During a pelvic exam, your doctor can check for signs of skin irritation, infection or anatomical problems. He or she may also try to identify the location of your pain by applying gentle pressure to your genitals and pelvic muscles. A visual exam of your vagina, using an instrument called a speculum to separate the vaginal walls, may be performed as well. Some women who experience painful intercourse are also uncomfortable during a pelvic exam, no matter how gentle the doctor is. You can ask to stop the exam at any time if it’s too painful.
- Other tests. If your doctor suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound.
How is painful intercourse (dyspareunia) treated?
Treatment aims to relieve the underlying cause of the condition. Options include medication and counseling.
Medication can treat pain due to an infection or medical condition.
If existing medications are causing vaginal dryness, a doctor may recommend alternatives.
Topical estrogen may help women who experience vaginal dryness due to low estrogen levels.
In 2013, the United States (U.S.) Food and Drug Administration (FDA) approved a drug called ospemifene for women with moderate to severe dyspareunia due to menopause, at a dosage of 60 mg once a day.
Adverse effects include that mild to moderate hot flashes.
Learning some techniques can help relax the vaginal muscles and decrease pain levels.
If sexual abuse, trauma, or other emotional issues are the root cause of the dyspareunia, counseling may help.
Women whose dyspareunia does not have a psychological cause may also wish to attend counseling to cope with the emotional consequences of painful or difficult intercourse.
Couples may attend counseling together if painful intercourse is leading to communication or intimacy issues.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage painful intercourse (dyspareunia)?
The following lifestyles and home remedies might help you cope with painful intercourse (dyspareunia):
- Switch positions. If you experience sharp pain during thrusting, the penis may be striking your cervix or stressing the pelvic floor muscles, causing aching or cramping pain. Changing positions may help. You can try being on top of your partner during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels good to you.
- Talk about what feels good and what doesn’t. If you need your partner to go slow, say so.
- Don’t rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused.
- Use lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one you like.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Painful intercourse (dyspareunia). http://www.mayoclinic.org/diseases-conditions/painful-intercourse/basics/definition/con-20033293. Accessed July 19, 2017.
Dyspareunia. https://patient.info/doctor/dyspareunia. Accessed July 19, 2017.
Dyspareunia: Causes and treatment of painful intercourse. http://www.medicalnewstoday.com/articles/192590.php. Accessed July 19, 2017.
Review Date: July 20, 2017 | Last Modified: September 13, 2019