What is Painful Intercourse?

Painful intercourse, also known as dyspareunia, is a medical condition characterized by persistent or recurrent pain in the genital or pelvic area during sexual intercourse. Painful intercourse is more common in women than men and can lead to distress and relationship problems. It can occur due to a variety of factors, with the treatment usually focusing on the underlying cause.

Causes of Painful Intercourse

Painful intercourse can be caused by several factors, including physical factors, psychological factors, or both.

Common physical causes of painful intercourse include:

Vaginal dryness due to menopause, childbirth, certain medications, lack of foreplay, or too little arousal before intercourse
Infections, such as urinary tract infections, sexually transmitted infections, or yeast
Vaginitis (inflammation of the vagina)
Vulvodynia (chronic pain or discomfort around the opening of the vagina)
Vaginismus (involuntary tightening of muscles around the opening of the vagina)
Pelvic inflammatory disease (infection of the female reproductive organs)
Cystitis (inflammation of the bladder)
Skin diseases that cause itching, cracks, burning, or ulcers
Trauma or injury from childbirth, hysterectomy, pelvic surgery, or an accident
Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
Uterine fibroids (noncancerous tumors in the uterus)

Common psychological factors that can cause painful intercourse include:

Anxiety, fear, shame related to sex, or depression
Self-image or body issues
Stress, which can cause tightening of the pelvic floor muscles, resulting in pain
History of sexual abuse or rape

Symptoms of Painful Intercourse

The defining symptom of painful intercourse or dyspareunia is pain that may occur at the vaginal opening or deep in the pelvis. The pain may be localized and distinct, or there may be a broader sense of discomfort. There may be an aching, burning, throbbing, or ripping sensation along with the primary sensation of pain.

Diagnosis

Your doctor can diagnose the underlying cause of painful intercourse by conducting:

A thorough review of your medical and sexual history
Pelvic exam to check for signs of inflammation, dryness, genital warts, tenderness, or abnormal masses
Additional tests, such as a culture test to rule out bacteria or yeast infections, urine test, or allergy test
A pelvic ultrasound exam to help detect structural abnormalities, endometriosis, fibroids, or cysts

Treatment for Painful Intercourse

Treatment options aim at relieving the underlying cause of the condition and include:

Medications: Medications can treat pain due to an infection or medical condition. If a long-term medication is causing vaginal dryness, changing medications may help alleviate symptoms. Low estrogen levels can cause dyspareunia in some women. Topical estrogen may help such women who experience vaginal dryness due to low estrogen levels. Medications like prasterone and ospemifene may also be used to treat painful intercourse.
Home care: These home remedies could also help alleviate symptoms of painful intercourse:
- Emptying your bladder before sex
- Having sex when in a relaxed state
- Using water-soluble lubricants
- Taking an over-the-counter pain reliever before sex
- Taking a warm bath before sex
- Applying an ice pack to the vaginal area
Alternative therapies: Certain alternative therapies might also help with painful intercourse. These include:
- Desensitization therapy: In desensitization therapy, you will learn vaginal relaxation techniques, such as Kegel exercises, that can reduce pain.
- Counseling or sex therapy: In this therapy, you will learn how to improve communication and reestablish intimacy with your partner, with the help of a counselor or sex therapist.

Prevention of Painful Intercourse

There is no specific preventive measure for painful intercourse; however, following certain steps can help reduce the risk of pain during sex, including:

Use of water-soluble lubricants for vaginal dryness
Practice safe sex to prevent sexually transmitted infections
Engage in adequate foreplay before sex to induce natural lubrication
After childbirth, wait for at least 6 weeks before resuming sex
Follow proper hygiene
Visit a doctor for routine medical care