Dyspareunia is the term for recurring pain in the genital area or within the
pelvis during sexual intercourse. The pain can be sharp or intense. It can
occur before, during, or after sexual intercourse.
Dyspareunia is more common in women than men. It has many possible causes,
but it can be treated.
Several conditions can cause dyspareunia. For some women, it’s a sign of a
physical problem. Other women may experience pain as a result of emotional
Common physical causes of dyspareunia include:
- vaginal dryness from menopause, childbirth,
breastfeeding, medications, or too little arousal before intercourse
- skin disorders that cause ulcers, cracks, itching, or burning
- infections, such as yeast or urinary tract infections
- injury or trauma from childbirth, an accident, an episiotomy, a hysterectomy, or pelvic surgery
- vulvodynia, or pain centered in
the vulva area
- vaginitis, or inflammation of the
- vaginismus, or a spontaneous tightening of the muscles of the
inflammatory disease (PID)
- uterine fibroids
bowel syndrome (IBS)
- radiation and chemotherapy
Factors that reduce sexual desire or affect a person’s ability to become
aroused can also cause dyspareunia. These factors include:
- stress, which can result in
tightened muscles of the pelvic floor
- fear, guilt, or shame related to sex
- self-image or body issues
- medications such as birth control pills
- relationship problems
- conditions such as cancer, arthritis, diabetes, and thyroid disease
- history of sexual abuse or rape
at risk for dyspareunia?
Both women and men can experience dyspareunia, but the condition is more
common in women. Dyspareunia is one of the most common problems of postmenopausal
women. Around 75 percent of women have painful intercourse at some time,
according to the American
College of Obstetricians and Gynecologists (ACOG). You’re at an increased
risk if you:
- take medications that cause vaginal dryness
- have a viral or bacterial infection
- are postmenopausal
are the symptoms of dyspareunia?
Dyspareunia pain can vary. Pain may occur:
- in the vagina, urethra, or bladder
- during penetration
- during or after intercourse
- deep in the pelvis during intercourse
- after pain-free intercourse
- only with specific partners or circumstances
- with tampon use
- along with burning, itching, or aching
- with a feeling of stabbing pain, similar to menstrual
is dyspareunia diagnosed?
Several tests help doctors identify and diagnose dyspareunia. Your doctor
will start by creating a complete medical and sexual history. Possible
questions your doctor may ask you include:
- When and where do you feel pain?
- Which partners or positions cause pain?
- Do any other activities cause pain?
- Does your partner want to help?
- Are there other conditions that may be contributing to
A pelvic examination
is also common in diagnosis. During this procedure, your doctor will look at
the external and internal pelvic area for signs of:
- inflammation or infection
- anatomical problems
- genital warts
- abnormal masses
The internal examination will require a speculum, a device used to view the
vagina during a Pap smear.
Your doctor also may use a cotton swab to apply slight pressure to different
areas of the vagina. This will help determine the location of the pain.
The initial examinations may lead your doctor to request other tests, such
is dyspareunia treated?
Dyspareunia treatments are based on the cause of the condition. If your pain
is caused by an underlying infection or condition, your doctor may treat it
- antifungal medicines
- topical or injectable corticosteroids
If a long-term medication is causing vaginal dryness, your physician may
change your prescription. Trying alternative
medications may restore natural lubrication and reduce pain.
estrogen levels cause dyspareunia in some women. A prescription tablet,
cream, or flexible ring can deliver a small, regular dose of estrogen to the
An estrogen-free drug called ospemifene (Osphena)
acts like estrogen on vaginal tissues. It’s effective in making the tissues
thicker and less fragile. This can reduce the amount of pain women experience
with sexual intercourse.
These home remedies can also reduce dyspareunia symptoms:
- Use water-soluble lubricants.
- Have sex when you and your partner are relaxed.
- Communicate openly with your partner about your pain.
- Empty your bladder before sex.
- Take a warm bath before sex.
- Take an over-the-counter pain reliever before sex.
- Apply an ice pack to the vulva to calm burning after
Your doctor may also recommend therapy. This can include desensitization therapy or
In desensitization therapy, you’ll learn vaginal relaxation techniques, such as
Kegel exercises, that can decrease pain. In sex
therapy, you can learn how to reestablish intimacy and improve
communication with your partner.
is the outlook for dyspareunia?
Alternatives to sexual intercourse may be useful until underlying conditions
are treated. You and your partner can use other techniques for intimacy until
penetration is more comfortable. Sensual massage, kissing, oral sex, and mutual
masturbation may be satisfying alternatives.
There’s no specific prevention for dyspareunia. But you can do the following
to reduce the risk of pain during intercourse:
- After childbirth, wait at least six weeks before
resuming sexual intercourse.
- Use a water-soluble lubricant when vaginal dryness is
- Use proper hygiene.
- Get proper routine medical care.
- Prevent sexually transmitted
with safe sex.
- Encourage natural vaginal lubrication with enough time
for foreplay and stimulation.