Painful intercourse (dyspareunia)
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Dyspareunia, commonly referred to as pain during sexual intercourse, is the experience of persistent or recurring discomfort occurring just before, during, or after sex, primarily in the genital region. This is a common condition that can have negative emotional and psychological effects, potentially straining relationships and diminishing intimacy.
The location of the pain can indicate the type of dyspareunia:
- Entry pain: This type of pain is felt at the entrance of the vagina during initial penetration and may be attributed to factors such as insufficient lubrication, injury, or infection.
- Deep pain: Deep penetration can cause discomfort, which may be exacerbated by specific sexual positions. This kind of pain is typically experienced in the cervix or lower abdomen and is often linked to an underlying medical condition or prior surgery.
Your healthcare provider can suggest the suitable treatment by assessing your symptoms and identifying the root cause of your discomfort.
Symptoms
If you experience painful intercourse, you may notice:
- Pain solely during sexual entry (penetration).
- Discomfort during any form of penetration, even when using a tampon.
- Deep pain during thrusting.
- Sensations of burning pain or aching discomfort.
- Muscle tightness or spasms.
- A lingering throbbing pain that persists for hours after intercourse.
If you frequently encounter pain during sexual activity, it’s advisable to have a discussion with your healthcare provider. Addressing this issue can positively impact your sexual well–being, emotional intimacy, and self–image.
Causes
The causes of painful intercourse can vary depending on whether the pain occurs at the entry or with deep thrusting. Emotional factors may also be associated with various types of painful intercourse.
Entry pain
There are many potential causes of pain during penetration, including:
- Injury, trauma or irritation. This includes wounds or rashes brought on by accidents, pelvic surgery, female circumcision, or an episiotomy—a cut done during childbirth to widen the birth canal.
- Inadequate lubrication. Painful intercourse can often result from insufficient foreplay, as well as a decrease in estrogen levels that can occur after menopause, childbirth, or during breast–feeding. Additionally, some medications, such as antidepressants, high blood pressure medications, sedatives, antihistamines, and certain birth control pills, are known to impact sexual desire and arousal, potentially leading to reduced lubrication and painful sexual experiences.
- A problem present at birth. Dyspareunia may result from the absence of a completely formed vagina (vaginal agenesis) or the growth of a membrane that closes the vaginal opening (imperforate hymen).
- Inflammation, infection or skin disorder. A painful genital infection or urinary tract infection might affect how you sex. Your vaginal area’s eczema or other skin conditions may possibly be the issue.
- Vaginismus. These uncontrollable contractions of the vaginal wall’s muscles can make penetration uncomfortable.
Deep pain
Deep pain typically accompanies deep penetration during sexual intercourse and may intensify in specific positions. The causes of this type of pain include:
- Some diseases and conditions. Endometriosis, pelvic inflammatory disease, retroverted uterus, uterine prolapse, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor dysfunction, adenomyosis, hemorrhoids, and ovarian cysts are among the conditions on the list.
- Surgical or medical intervention. Hysterectomy scarring and other pelvic surgery scarring can make sexual activity uncomfortable. Chemotherapy and radiation therapy for cancer can alter the body in ways that make sex difficult.
Emotional factors
Emotions may contribute to sexual pain since they are intricately linked to sexual behavior. Emotional factors consist of:
- History of sexual abuse. Although not every person with dyspareunia has experienced sexual abuse, it can be a factor.
- Psychological issues. Anxiety, depression, body image concerns, fear of intimacy, or relationship issues can all contribute to reduced arousal levels and subsequently lead to discomfort or pain during sexual activity.
- Stress. Pelvic floor muscles often tighten in response to life stress, potentially leading to discomfort during intercourse.
It can be challenging to determine whether emotional factors contribute to dyspareunia. Initial discomfort might cause dread of future discomfort, which makes it challenging to relax, which can result in further discomfort. If you start to equate sex with pain, you can begin to avoid it.
Diagnosis
A medical assessment for dyspareunia typically involves the following steps:
- Detailed Medical History: Your healthcare provider will conduct a comprehensive review of your medical history. They will inquire about when your pain started, its location, nature, and whether it occurs with different sexual partners or positions. Questions about your sexual history, surgical history, and childbirth experiences may also be asked. It’s essential to answer truthfully, as these details provide important clues about the underlying causes of your pain.
- Pelvic Examination: A pelvic examination will be performed to look for indications of skin irritation, infections, or anatomical abnormalities. Your healthcare provider may gently apply pressure to your genital and pelvic muscles to pinpoint the source of your discomfort. In some cases, a visual examination of your vagina may be conducted using a speculum to separate the vaginal walls. If this causes discomfort similar to what you experience during intercourse, you can request to stop the exam.
- Ultrasounds: Transvaginal ultrasound may be used to obtain a more detailed view of the female reproductive system.
- Laparoscopy (Rarely): In exceptional cases, if other diagnostic tests yield inconclusive results, a laparoscopy may be recommended as a further investigative procedure.
Treatment
Depending on the cause of the discomfort, various treatments are available.
Medications
Treating the underlying cause of pain, such as infections or medical conditions, can often resolve the issue. Switching medications known to cause lubrication problems may also alleviate symptoms.
Dyspareunia, a common issue in postmenopausal women due to low estrogen levels, can be addressed with topical estrogen directly applied to the vagina. The Food and Drug Administration (FDA) has approved ospemifene to treat moderate to severe dyspareunia by mimicking estrogen’s effects on the vaginal lining. However, it comes with potential drawbacks, including hot flashes and risks of stroke, blood clots, and endometrial cancer.
Another option to ease painful intercourse is prasterone, a daily vaginal capsule placement.
Other treatments
Some non–pharmacological treatments can be beneficial for dyspareunia:
- Desensitization therapy: This approach involves learning exercises to relax the vaginal muscles, reducing pain during intercourse.
- Counseling or sex therapy: When painful sexual experiences continue over an extended period, they can trigger adverse emotional responses to sexual stimulation. Furthermore, couples who have abstained from intimacy due to this pain may require support to enhance communication and restore their sexual connection. Seeking guidance from a counselor or a sex therapist can be beneficial in addressing these concerns. Additionally, cognitive–behavioral therapy can prove effective in changing detrimental thought patterns and behaviors linked to dyspareunia.
