What causes pain with intercourse? 18 possible conditions
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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 is a sign of a physical problem. Other women may experience pain as a result of emotional factors.
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
- pain centered in the vulva area (vulvodynia)
- inflammation of the vagina (vaginitis)
- a spontaneous tightening of the muscles of the vaginal wall (vaginismus)
- pelvic inflammatory disease
- uterine fibroids
- irritable bowel syndrome
- 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
- cancer, arthritis, diabetes, and thyroid disease
- history of sexual abuse or rape
Both men and women can experience dyspareunia. But the condition is more common in women. Dyspareunia is one of the most common problems of postmenopausal women, and a majority of women have painful intercourse at some time (FDA). You are at an increased risk if you:
- take medications that cause vaginal dryness
- have a viral or bacterial infection
- are postmenopausal
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 cramps
Several tests help identify and diagnose dyspareunia. A doctor will start by creating a complete medical and sexual history. Possible questions 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 your pain?
A pelvic examination is also common in diagnosis. During this procedure, a 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 with a Pap smear. A 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 a physician to request other tests, such as:
- pelvic ultrasound
- culture test to check for bacteria or yeast infection
- urine test
- allergy test
- counseling to determine the presence of emotional causes
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 with:
- antibiotics or 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.
Low estrogen levels cause dyspareunia in some women. A prescription tablet, cream, or flexible ring can deliver a small, regular dose of estrogen to the vagina.
A new, estrogen-free drug, called ospemifene (Osphena), acts like estrogen on vaginal tissues. It is 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 are 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 sex.
Your doctor may also recommend therapy. This can include:
- desensitization therapy: learning vaginal relaxation techniques, such as Kegel exercises, that can decrease pain
- sex therapy: learning how to reestablish intimacy and improve communication with your partner
Options 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 is 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 an issue.
- Use proper hygiene.
- Get proper routine medical care.
- Prevent sexually transmitted diseases (STDs) with safe sex.
- Encourage natural vaginal lubrication with enough time for foreplay and stimulation.
- Dyspareunia Information (2013). Mount Sinai Hospital. Retrieved August 26, 2013, from http://www.mountsinai.org/patient-care/health-library/diseases-and-conditions/dyspareunia
- Evaluation and Treatment of Dyspareunia. (2009). UNC School of Medicine. Retrieved August 26, 2013, from http://www.med.unc.edu/ppru/publications/Evaluation and treatment of dyspareunia.pdf
- FDA approves Osphena for postmenopausal women experiencing pain during sex. (n.d.). U S Food and Drug Administration Home Page. Retrieved August 27, 2013, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm341128.htm
- Frequently Asked Questions Gynecologic Problems. (2011). The American College of Obstetricians and Gynecologists. Retrieved August 27, 2013, from http://www.acog.org/~/media/For Patients/faq020.pdf?dmc=1&ts=20130827T2244306842
- Dyspareunia | Overview (2010). FamilyDoctor.org. Retrieved August 26, 2013, from http://familydoctor.org/familydoctor/en/diseases-conditions/dyspareunia.html
- Painful intercourse (dyspareunia). (2012). Mayo Clinic. Retrieved August 26, 2013, from http://www.mayoclinic.com/health/painful-intercourse/DS01044
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