Persistent or recurring genital pain that occurs just before, during, or after sex. Painful intercourse can have causes that are not due to an underlying disease. Examples include inadequate lubrication, rough sex, trauma, or negative feelings towards a partner.
What is Painful Intercourse?
Painful intercourse is recurring pain or discomfort in the genitals during or after sex. The pain may be described as a raw sensation or as a burning, itching, or tingling sensation. Painful intercourse is medically known as dyspareunia.
Depending on the cause, painful intercourse can be a persistent problem or can occur sporadically. It might get better or worse with movement or sexual activity. Painful intercourse can vary in intensity from mild to severe. Symptoms caused by an injury often appear suddenly, such as those following sexual abuse. Other symptoms can develop slowly, such as those related to an infectious disease.
The causes of painful intercourse vary widely among individuals and can be organic, emotional, or psychogenic. One of the most common is pain or discomfort in the vulva (vulvodynia), which can be due to skin irritation from a rash or household chemicals. Painful intercourse can also occur if you have sustained damage or injury to any of the external structures of the vulva (the genitals) or internal sexual organs, such as the vagina, cervix, ovaries, or uterus. Also, recurrent infections, such as vaginal yeast infection or sexually transmitted diseases, may be associated with painful intercourse. Precancerous conditions and cancer of the vulva or cervix can also cause pain during intercourse.
Sometimes painful intercourse is linked to an underlying chronic condition that affects not only the reproductive system but other parts of the body as well. Sometimes painful intercourse is actually because of psychological symptoms following sexual abuse, rape, or trauma.
Painful intercourse alone is rarely a serious medical condition; however, it can be associated with symptoms of a serious or life-threatening condition. See a doctor right away if you have a sudden high fever (over 101 degrees Fahrenheit), severe pain, chills, or rapid heart rate (tachycardia)
Causes
The causes of dyspareunia are varied and include physical, psychological, or both factors. The location of the pain can help identify a specific physical cause.
Physical causes:
Entrance pain
Entrance pain can be associated with vaginal dryness, vaginismus, genital lesions, and others.
Vaginal dryness
- During sexual arousal, the glands at the entrance to the vagina secrete fluids to facilitate intercourse. Too little fluid can lead to painful intercourse.
- Inadequate lubrication can result from:
- a lack of foreplay
- reduced estrogen, especially after menopause or childbirth
- medicines, such as some antidepressants, antihistamines, and birth control pills
Vaginismus
- The involuntary contraction of the pelvic floor muscles causes vaginismus, leading to painful intercourse.
- Women with vaginismus may also have difficulty with pelvic exams and the insertion of the tampon.
- There are several forms of vaginismus. Symptoms vary among individuals and range from mild to severe. Medical factors, emotional factors, or both can cause it.
Genital injury
- Any trauma to the genital area can lead to dyspareunia. Examples such as female genital mutilation (FGM), pelvic surgery, or injury resulting from an accident.
- Painful intercourse is also common after childbirth. Some research suggests that 45% of participants suffered from postpartum dyspareunia.
Inflammation or infection
The inflammation around the vaginal opening is called vulvar vestibulitis. This can cause dyspareunia. Vaginal yeast infections, urinary tract infections, or sexually transmitted infections (STIs) can also lead to painful intercourse.
Skin disorders or irritation:
- Dyspareunia can result from eczema, lichen planus, lichen sclerosus, or other skin problems in the genital area.
- Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products can also cause pain.
Abnormalities at birth
Less common underlying causes of dyspareunia include vaginal agenesis, when the vagina does not fully develop, or the imperforate hymen, in which the hymen blocks the vaginal opening.
Deep pain
- If the pain occurs during deep penetration or is more acute in certain positions, it may result from medical treatment or a medical condition.
- Medical treatments that can cause pain include pelvic surgery, hysterectomy, and some cancer treatments.
- Medical conditions include:
- Cystitis: Inflammation of the bladder wall, usually caused by a bacterial infection
- Endometriosis: A condition resulting from the presence of tissue from the uterus in other areas of the body
- Fibroids: Non-cancerous tumors that grow on the lining of the uterus
- Interstitial cystitis: a chronic painful condition of the bladder
- Irritable bowel syndrome (IBS): A functional disorder of the digestive tract
- Ovarian cysts: A buildup of fluid in an ovary
- Pelvic inflammatory disease (PID): Inflammation of the female reproductive organs, usually caused by infection
- Uterine prolapse: One or more pelvic organs extend into the vagina
Psychological causes
There are some common emotional and psychological factors that can play a role in painful intercourse.
- Anxiety, fear, and depression can inhibit sexual arousal and contribute to vaginal dryness or vaginismus
- Stress can trigger the pelvic floor muscles to tighten, leading to pain
A history of sexual abuse or sexual violence can contribute to dyspareunia.
Diagnosis
Several tests help physicians identify and diagnose dyspareunia. Your physician will start by creating a complete medical and sexual history. Possible questions your physician may ask you include:
- When and where do you experience pain?
- Which partners or positions cause pain?
- Are other activities causing pain?
- Does your partner want to help you?
- Are there other conditions that may be contributing to your pain?
A pelvic exam is also common in the diagnosis. During this procedure, your doctor will examine the outer and inner pelvic area for signs of:
- drought
- inflammation or infection
- anatomical problems
- genital warts
- scars
- abnormal masses
- endometriosis
- tenderness
The internal exam will require a speculum, a device used to view the vagina during a Pap test. Your doctor may also use a cotton swab to apply gentle pressure to different areas of the vagina. This will help determine the location of the pain.
Initial exams may lead your doctor to order other tests, such as:
- pelvic ultrasound
- culture test to look for bacteria or a yeast infection
- urine test
- allergy test
- tips for determining emotional causes
Treatment
Drugs
- If an infection or medical issues is contributing to your pain, treating the cause may solve your problem. Changing medications known to cause lubrication problems can also eliminate your symptoms.
- For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low levels of estrogen. Often, this can be treated with topical estrogen applied on the vagina.
- The Food and Drug Administration has approved the drug ospemifene (Osphena) to treat moderate-to-severe dyspareunia in women who have vaginal lubrication problems. Ospemifene acts like estrogen on the vaginal lining.
- The downsides are that the drug can cause hot flashes and carry a risk of stroke, blood clots, and cancer of the lining of the uterus (endometrium)
- Another medicine to relieve painful intercourse is prasterone (Intrarosa). It is a capsule that you place in the vagina daily.
Other treatments:
Some non-drug therapies can also help with dyspareunia:
- Desensitization therapy: You learn vaginal relaxation exercises that can decrease pain.
- Sexual counseling or therapy: If sex has been painful for a while, you may have a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful sex, you may also need help to improve communication with your partner and restoring sexual intimacy. Talking to a sex counsellor or therapist can help solve those problems.
Cognitive-behavioral therapy can also be helpful in changing negative thinking patterns and behaviors.
When to see a Doctor?
Seek immediate medical attention if you have:
- pain or bleeding for a week or more
- fever or unusual tiredness
- unusual bleeding or discharge when you poop
- pain or other symptoms after sex, especially with a new partner
- severe abdominal or back pain and cramps
- newly formed bumps near your anus
Prevention
There is no specific prevention for dyspareunia. But you can do the following to reduce the risk of pain during sex:
- After giving birth, wait at least six weeks before resuming intercourse.
- Use a water soluble lubricant when vaginal dryness is a problem.
- Use good hygiene.
- Obtain appropriate routine medical care.
- Prevent sexually transmitted diseases (STDs) by using condoms or other barriers.
- Encourage natural vaginal lubrication with ample time for foreplay and stimulation.
