Painful Intercourse (Dyspareunia)

What is Painful Intercourse?

Painful intercourse (dyspareunia) eventually occurs in most women. It is characterized by tenderness before, throughout, and after sexual intercourse takes place. It has many causes including an underlying physical condition such as scaring or illness, lack of sufficient lubrication because of hormone levels or medication, or physiological problems. For some, the problem goes away without concern or explanation, but for others the condition is far more serious and requires medical attention.

50 to 60% of women experience this phenomenon after childbirth. This issue is known as postpartum dyspareunia and can last up to six months after delivery.

What are the Symptoms of Painful Intercourse?

The symptoms of painful intercourse can greatly vary. In some women the pain is deep and caused by specific positions, and in others it is not as easy to determine. The pain can range from mild to severe. Symptoms of dyspareunia may include:

  • Pain only during sexual entry
  • Pain with every type of penetration including tampon usage
  • New or worsening genital pain
  • Deep cervical pain during sexual intercourse
  • Genital burning or achiness
  • Throbbing pain that continues long after intercourse

Additional symptoms that require medical attention may include:

  • Abnormal vaginal discharge or bleeding
  • Menstrual irregularity
  • Genital sores

Painful Intercourse (Dyspareunia) Causes

There are many potential causes of dyspareunia, many of which can be prevented. Sometimes, painful intercourse occurs due to vaginal dryness, which is a common problem for women during menopause. Similarly, vaginal atrophy, which is where the lining of the vagina becomes thinner, can make intercourse painful and this often occurs during or after menopause.

Sometimes infections are to blame for dyspareunia. Vaginal yeast infections, urinary tract infections, and STIs can all make penetration uncomfortable.

Painful intercourse is sometimes caused by allergies. It is possible to be allergic to spermicides, latex condoms and even semen which can make sex uncomfortable. In other instances, it might be clothing, intimate hygiene products or other items which have caused an allergic reaction prior to sex and irritated the vagina enough that sex becomes painful.

Sometimes dyspareunia occurs as a symptom of another medical condition, such as:

  • Endometriosis (abnormal growth of the uterine lining)
  • Vulvar vestibulitis (inflammation of the vaginal opening and vulva)
  • Lichen planus or lichen sclerosus (skin rashes which can affect the genitals)

Finally, dyspareunia can occur as a result of psychological trauma, particularly in cases where the patient has a history of sexual abuse or sexual trauma.

How is Painful Intercourse Treated?

The treatment of painful intercourse depends on the underlying cause. A pelvic exam, medical history, imaging and other tests may be used to determine the reason and the best course of action. Treatment may include:

  • Sex counseling or therapy
  • Vaginal desensitization therapy
  • Changes in medication
  • Lubricant use
  • Positioning techniques
  • Medical treatment of underlying cause

Pain during sexual intercourse can start a cycle of painful events. The pain can cause anxiety, tension, and involuntary muscle contractions which can result in more pain. Underlying medical conditions can worsen and/or cause other complications. Dyspareunia can also cause serious relationship and emotional problems if the condition is left untreated.

Painful Intercourse (Dyspareunia) Prevention

Painful intercourse may be prevented in women who suffer from vaginal atrophy and dryness by using a gentle lubricant. The lubricant could be used solely during intercourse, or throughout the day to help relieve general irritation caused by vaginal dryness.

Women who experience painful intercourse due to other medical conditions may find that some positions are more painful than others. Try experimenting with different positions to find the most comfortable for you.

Rushing into intercourse can often make dyspareunia worse because the body needs time to prepare for sex. Longer foreplay may help to stimulate natural lubrication and relax vaginal muscles in readiness for intercourse.

Women who find intercourse painful due to past sexual or emotional trauma may benefit from psychological therapies to help them process past events. It might also be helpful to bring your sexual partner along to therapy sessions so that together you can work through the emotions which make sex difficult and find techniques to slowly introduce sexual activity at a rate you feel comfortable with.