Pain During Sex (Dyspareunia)

A quick look at dyspareunia

Dyspareunia is the medical term for pain that occurs just before, during or after sex.

Pain during sex may be a sign of a gynecologic problem, such as endometriosis or an ovarian cyst. It can also be the result of muscle spasms, emotional or psychological issues, or trauma.

Severe or frequent pain during sex is not normal and should be addressed by a gynecologist.

Our doctors understand the issues a woman may be facing and can discuss these matters in a caring and understanding manner.

Treatment for painful intercourse depends on the source of the pain, and may include the use of lubricants, relaxation exercises, counseling or medical intervention that addresses any present conditions.

What is pain during sex?

Women with dyspareunia may experience pain in the vulva (the area surrounding the opening of the vagina) or pain within the vagina. Women may also experience “deep pain” in the lower back, pelvic region, uterus or bladder. Recurring pain can affect self-esteem and relationships, dramatically altering a person’s sex life.

According to the American College of Obstetricians and Gynecologists, 75% of women will experience pain during sex at some point in their lives. Some women may experience pain during intercourse temporarily or occasionally. Other women may experience chronic pain during intercourse. Unintended severe, sharp or chronic pain during intercourse is not normal.

Symptoms of dyspareunia

The type and location of pain during sex can vary greatly from woman to woman. Common symptoms that may occur prior to, during or after intercourse could include:

• Sharp or severe pain during penetration.
• Pain with every kind of penetration, including when using tampons.
• Deep pain inside the vagina or pelvis during intercourse.
• Burning, itching or aching.

A woman may experience pain during intercourse throughout her life, or she may experience pain in certain circumstances or with certain partners. Intense or chronic pain during intercourse should be assessed by a doctor.

What causes pain during sex

Frequent or severe pain during sex should be addressed by an OB-GYN or trained women’s healthcare provider. Pain during sex can be the result of physical or psychological conditions. One of our providers will discuss with the woman experiencing it possible causes for her dyspareunia.

Physical causes of pain during intercourse

Pain during penetration can be due to a number of factors including the following.

• Dryness or insufficient lubrication.
• Infections within the urinary tract or genitals.
• Inflammation or skin irritation in the genital area.
• Vaginismus, a condition where the vaginal wall spams involuntarily.
• Genetic or structural abnormalities within the vaginal canal.
• Inadequate healing or scarring from childbirth.
• Scar tissue (adhesions) from existing conditions, previous infections or past surgeries.
• Side effects from cancer treatments, such as radiation and chemotherapy.
• Presence of endometriosis, adenomyosis, uterine fibroids, ovarian cysts, pelvic inflammatory disease or pelvic organ prolapse.
• Vaginal dryness due to hormonal changes associated with breastfeeding.
• Hormonal changes during menopause.
• Medications such as some antidepressants, blood pressure medication, allergy pills or birth control pills can lead to lubrication issues, resulting in discomfort or pain during sex.

Psychological & emotional causes of pain during intercourse

The emotional well-being of a woman can play a role in her sexual health, and cause pain during intercourse. Potential emotional causes of dyspareunia include:

• Feelings of shame, stress, guilt or fear.
• Changes in sexual desire.
• Anxiety or depression.
• Concerns about physical appearance.
• Relationship problems.
• History of sexual abuse or trauma.

Sexual health conditions can be sparked by anxiety about sexual intimacy, infertility or body changes. Sometimes these symptoms can be associated with menopause, childbirth or cancer treatment.

When to see a doctor for painful intercourse

Some vaginal soreness is common after intercourse, but sharp or severe pain before, during or after sex is not normal. A woman should discuss her pain with her gynecologist if:

• Sex has always been painful.
• It has always been painful, but the pain seems to be getting more intense.
• Sex has recently become painful, when it was not before.
• She isn’t sure whether the pain she is experiencing is normal.

Diagnosis of dyspareunia

In order to diagnose the cause of pain during intercourse, our OB-GYN will conduct a thorough medical history of the patient. Our provider may ask about previous sexual experiences, medical conditions, prescription use, childbirth experiences and the emotional well-being of the woman.

The provider will also perform a pelvic exam and additional testing to rule out infections. If a complex condition is suspected, we may also use a pelvic ultrasound to identify potential causes of the woman’s pelvic pain.

Treatment of dyspareunia

Treatments for pain during sex vary greatly depending on the suspected cause of the pain. Some women may be able to manage their pain with at-home treatments, where others may require medical attention.

Managing painful sex at home

Some basic treatments for sexual pain do not require a doctor’s visit – for example using water-soluble or silicone-based lubricants during intercourse can limit vaginal irritation. Silicone-based lubricants should not be used with latex condoms, as the lubricant can weaken the condom or cause it to break.

Methods for managing painful sex at home may include:

• Have an honest conversation about how and when pain is experienced with sexual partners.
• Apply a towel-wrapped ice pack to the vulva after intercourse.
• Make time for sex when feelings of anxiety are expected to be lower.
• Try different sexual activities or positions.
• Try nonsexual, intimate acts.

These methods may improve symptoms in some individuals, but they cannot replace professional diagnosis or treatment when the symptoms persist.

Medical approaches for treating pain during sex

Women who seek help from a doctor may be eligible for a variety of treatments. Multidisciplinary tactics can include our care as well as sex therapy, physical therapy or cognitive-behavioral therapy. CU Medicine OB-GYN East Denver (Rocky Mountain) healthcare providers may recommend one or more of the following approaches to treatment.

• Sexual health education and guidance.
• Treatment of gynecologic conditions contributing to pain.
• Medication or adjustment of medications.
• Vaginal moisturizers.
• Vaginal dilators.
• Pelvic floor physical therapy.
• Behavioral therapy.
• Individual and/or couple’s sex therapy.
• Relaxation and anxiety management techniques.