Dyspareunia

Painful Sex Causes

Dyspareunia (Painful Intercourse)

Overview

What is Dyspareunia? Dyspareunia, commonly called painful intercourse, is genital pain that happens during or after sexual activity. This pain can be felt on the outside of the vulva or inside the vagina, uterus, or pelvic area. Often, things like medical conditions or infections can cause this pain. Therefore, treatment mainly involves finding and addressing the root cause of discomfort.

Understanding Dyspareunia

Pain during intercourse, or dyspareunia, is when pain keeps happening either right before, during, or soon after sex. Although this condition is more common in people assigned female at birth (AFAB), anyone can experience it. Dyspareunia can cause pain on the outer vulva, including the labia or at the entrance of the vagina, or deeper in areas like the:

• Pelvic floor muscles.
• Skin inside the vaginal canal.
• Uterus.
• Ligaments that support the uterus.
• Lower abdomen.

People assigned male at birth (AMAB) may feel pain on the penis’s head or shaft, in the testicles, or in the pelvis. Dyspareunia doesn’t only cause physical pain, but it can also lead to emotional strain. For instance, couples may have intimacy problems or relationship stress due to ongoing pain.

Seeing a Specialist

Your healthcare provider may refer you to a gynecologist or urologist who focuses on sexual health. A specialist will evaluate your symptoms to find the best treatment options, helping with both the physical and emotional effects of painful sex.

Types of Dyspareunia

Dyspareunia can show up in different ways based on where and how the pain happens:

• Entry Pain (Introital or Superficial Dyspareunia): Pain felt at the opening of the vagina during initial penetration. Causes can include hormonal changes, dryness in the vulvar or vaginal area, ongoing irritation, infection, or past injury.
• Positional Pain: Pain related to certain sexual positions, often linked to issues with the pelvic floor muscles, vaginal dryness, or infections.
• Deep Pain (Collision Dyspareunia): Pain felt during deeper penetration, which may be worse in specific positions. Conditions like endometriosis, pelvic congestion, or bowel-related problems can cause this type of pain.

Dyspareunia can also vary by timing and consistency:

• Primary Pain: Pain that occurs from the start of sexual activity.
• Secondary Pain: Pain that starts after a time of pain-free intercourse.
• Complete Pain: Pain felt with every sexual encounter.
• Situational Pain: Pain that happens only in certain situations or times.

How Common is Dyspareunia?

Painful sex is fairly common, especially in people AFAB, with around 3 out of 4 experiencing it at some point. In the United States, up to 28% of people may have painful sex at least once in their lifetime. However, this number might be low since many people hesitate to seek help for such a sensitive issue.

Age and Dyspareunia

Dyspareunia can happen at any age, but it’s more common in postmenopausal individuals AFAB due to lower estrogen levels. Reduced estrogen often causes vaginal dryness and other changes in vaginal health. However, painful sex is not a normal part of aging, and treatment is available at any age.

Symptoms and Causes

Common Symptoms of Dyspareunia

If you experience pain during intercourse, symptoms may include:

• Sharp pain during initial penetration or at the vaginal entrance (even with tampon use).
• Deep, aching pain during thrusting.
• Throbbing or discomfort after intercourse.
• Pelvic cramps or muscle spasms.
• Bladder discomfort.

Many people describe dyspareunia as discomfort, burning, or sharp pain, either in one spot or affecting the entire genital area.

Causes of Dyspareunia

Dyspareunia often results from a lack of lubrication, infections, trauma, or health conditions. Key causes include:

• Medical Conditions: Conditions like endometriosis, skin disorders (like dermatitis), pelvic floor problems, and bladder issues (e.g., ongoing UTIs, interstitial cystitis) can make intercourse painful. Also, conditions like Crohn’s disease or irritable bowel syndrome (IBS) can cause inflammation, making sex uncomfortable.
• Hormonal Changes: Hormone shifts, especially during perimenopause or menopause, can cause vaginal dryness and discomfort.
• Nerve Issues: Nerve-related concerns, including pinched nerves, pudendal nerve problems, or nerve inflammation, can cause sexual pain.
• Vulvodynia: This condition involves chronic pain in the vulvar area that can affect comfort during sex.
• Vaginismus: Involuntary tightening of the vaginal muscles, often due to fear of pain or past trauma, can make penetration painful or impossible.

Trauma and Infection

Trauma to the genital area, including injuries from childbirth, surgery, or infections, can also lead to dyspareunia. Common infections linked to painful sex include:

• Vaginal Infections: Yeast infections and bacterial vaginosis are common causes of discomfort during sex.
• Sexually Transmitted Infections (STIs): Conditions like genital warts, herpes, and other STIs may cause pain.

Risk Factors

Dyspareunia is more common in postmenopausal individuals AFAB due to lower estrogen levels. However, anyone can experience this condition regardless of age or gender. Physical factors often play the main role, but mental health conditions can also contribute to dyspareunia.

Complications of Dyspareunia

Painful sex can lead to several complications, such as:

• Relationship Issues: Fear of pain may reduce intimacy, causing stress or distance in a relationship.
• Emotional Distress: Ongoing pain, along with restricted activity, can lead to sadness, anxiety, or depression.
• Untreated Health Conditions: Not treating the main cause can worsen specific conditions, possibly leading to serious problems. For example, untreated STIs can result in infertility.

Diagnosis and Testing

Diagnosing Dyspareunia

To find the cause of painful intercourse, healthcare providers start with a complete health history and physical exam, which may include checking the pelvis, abdomen, vagina, and uterus.

Tests for Diagnosing Dyspareunia

To locate the pain source, providers may recommend:

• Pelvic Exam: This may include collecting samples of vaginal fluid and urine to check for infections. In some cases, a rectal exam may be performed.
• Ultrasound: A transvaginal ultrasound provides a detailed view of the reproductive organs.
• Laparoscopy: If other tests are inconclusive, laparoscopy may be used to diagnose hidden issues.

Management and Treatment

Treatment Options for Dyspareunia

Treatment depends on the main cause. For instance, physical therapy is often suggested if pelvic floor problems are causing the pain. In some cases, prescription medications, such as estrogen creams, may be used to treat vaginal dryness due to menopause. The U.S. Food and Drug Administration (FDA) also approved ospemifene for dyspareunia related to menopause.

Natural Remedies

Applying a water- or silicone-based lubricant can help with vaginal dryness. Additionally, avoiding scented hygiene products like bubble baths, scented toilet paper, or fragranced sanitary pads may prevent irritation and pain.

Self-Management Techniques

There are several ways to manage dyspareunia symptoms at home, such as:

• Using a water- or silicone-based lubricant.
• Exploring positions or activities that minimize pain.
• Taking an over-the-counter pain reliever before intercourse.
• Doing relaxation exercises to reduce stress before sexual activity.
• Applying an ice pack to the vulva after intercourse to ease discomfort.

Prevention and Outlook

Can You Reduce the Risk of Dyspareunia?

While some factors are beyond your control, there are steps you can take to prevent dyspareunia. Practicing safe sex and maintaining proper hygiene can help reduce the chance of infections that may lead to painful intercourse.

Prognosis and Duration

The length of dyspareunia varies widely based on the main cause and treatment response. While some people feel relief quickly, others may need to try several options to find the right solution. However, treatment methods like medication, pelvic floor therapy, surgery, and lubricants provide relief for many, often leading to full recovery.

Living With Dyspareunia

When to Contact a Healthcare Provider

Contact your healthcare provider if you have symptoms such as new or worsening pain during sex, unexplained bleeding, genital sores, irregular periods, or unusual vaginal discharge.

Questions to Ask Your Healthcare Provider

Discussing dyspareunia can be challenging, but asking your provider the following questions can provide clarity and comfort:

• What’s causing my pain?
• What treatments are available?
• How long will it take to feel better?
• Is there anything I can do to decrease my pain?

A note from Cleveland Clinic: Pain during sex can cause physical discomfort, emotional distress, and intimacy issues. You don’t have to live with the pain. If sex hurts, reach out to your healthcare provider. Although it may feel uncomfortable to discuss, finding the main cause of your pain is key to getting relief and restoring intimacy in your life.

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