What causes dyspareunia, or painful intercourse?

Dyspareunia is an chronic or persistent pain that can occur during sexual intercourse. Causes are highly variable. It can cause distress and problems with relationships.

Painful intercourse can affect both men and women, but women are more likely to experience it. According to the American Academy of Family Physicians (AAFP), up to 20 percent of American women encounter it.

A number of factors can contribute-both physical and psychological. Treatment typically focuses on the root cause.

Important facts about exercise dyspareunia

Here are some facts about dyspareunia. More detail is in the main article.

  • Dyspareunia refers to pain during sexual intercourse. It mostly affects women.
  • Pain can range from moderate to severe.
  • Reasons can be physical or psychological, and they may be related to menopause.
  • Solutions include estrogen therapy, changing existing medications, and counseling.

Symptoms

Painful sex
There is a number of reasons why intercourse can be painful. Dyspareunia affects women more than men.

Dyspareunia’s defining symptom is intercourse pain that can occur at the vaginal opening, or deep in the pelvis.

The pain may be distinct and localized, or the feeling of discomfort may be wider.

There’s a feeling of aches, pain, throbbing, or tearing.

This may result in disappointment with, or disinterest in, relationships.

Causes

Dyspareunia causes are complex and include physical factors, psychological factors, or both.

The location of the pain can aid in identifying a particular physical cause.

Physical causes: Entry pain

Entry discomfort may be associated with dryness in the vagina, vaginism, genital injury and others.

Vaginal dryness: Glands at the vagina’s entrance secrete fluids to facilitate intercourse during sexual arousal. Too little fluid can lead to distressing intercourse.

Inadequate lubrication can arise from:

  • a lack of foreplay
  • a reduction in estrogen, particularly after menopause or childbirth
  • medications, including some antidepressants, antihistamines, and birth control pills

Vaginism: The involuntary contraction of the muscles of the pelvic floor triggers vaginism, which leads to uncomfortable sexual intercourse.

Females with vaginism can also undergo gynecological exams and insertion of tampons.

Vaginism occurs in many ways. Symptoms range from mild to extreme and differ between individuals. It may be caused by medical, emotional or both factors.

Genital injury: Any trauma to the genital area may result in dyspareunia. Examples include female genital mutilation (FGM), pelvic surgery, or accidental injury.

After birth painful intercourse is also common. Some study indicates 45 per cent postpartum dyspareunia reported by participants.

Inflammation or infection: Vulvar vestibulitis is considered an inflammation around the opening of the vagina. This may contribute to dyspareunia. Infections with the vaginal yeast, urinary tract infections or sexually transmitted infections ( STIs) can also lead to painful intercourse.

Skin disorders or irritation: Eczema, lichen planus, lichen sclerosus, or other skin problems in the genital area can cause dyspareunia.

Pain may also be caused by irritation or allergic reactions to clothing, laundry detergents or personal hygiene products.

Birth abnormalities: The less common underlying causes of dyspareunia include vaginal agenesis where the vagina does not completely grow or imperforate hymen, in which the hymen blocks the opening of the vagina.

Physical causes: Deep pain

When pain occurs during deep penetration, or in specific positions becomes more severe, it may result from a medical treatment or a medical condition.

Medical treatments which can lead to pain include pelvic surgery, hysterectomy and some treatments for cancer.

Medical conditions include:

  • cystitis: An inflammation of the bladder wall, usually caused by bacterial infection
  • endometriosis: A condition arising from the presence of tissue from the uterus in other areas of the body
  • fibroids: Non-cancerous tumors that grow on the wall of the uterus
  • interstitial cystitis: A chronic painful bladder condition
  • irritable bowel syndrome (IBS): A functional disorder of the digestive tract
  • ovarian cysts: A build-up of fluid within 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

Some common emotional and psychological factors 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 a tightening of the pelvic floor muscles, resulting in pain

A history of sexual abuse or sexual violence may contribute to dyspareunia.

Diagnosis

A doctor will also ask about the medical history of the patient and perform a pelvic examination, to try to identify the cause of the pain.

The patient should be prepared to explain the exact location, length and pain timing. They may need to talk about past sexual experiences and a history of reproduction.

Pelvic examination

A doctor shall check for signs of infection or structural abnormalities during a pelvic examination.

They can use a tool called a speculum that is inserted into the vagina to allow for visual inspection. This can cause women with dyspareunia to experience some discomfort or pain.

Telling the doctor when and where the pain happens during the exam may help to identify the cause.

The doctor can may gently apply pressure on the genitals and pelvic muscles to assess where the pain is going.

A pelvic ultrasound can help detect irregularities in the structure, endometriosis, fibroids, or cysts.

Treatment options

Treatment is intended to soften the underlying cause of the condition. Medication and counselling are options.

Counseling

Painful sex
Painful intercourse can lead to relationship problems. It may be worthwhile to speak to a relationship counselor if this is the case.

If the root cause of dyspareunia is sexual abuse, trauma, or other emotional issues, counselling may help.

People who do not have a medical reason for dyspareunia may also choose to seek therapy to deal with the emotional effects of painful or unpleasant intercourse.

When painful intercourse leads to communication or intimacy issues, couples may attend counseling together.

Medication

Medicine can treat pain caused by an infection or a medical condition.

Where existing drugs cause vaginal dryness, a doctor may recommend alternatives.

Topical estrogen can be of assistance to women who experience vaginal dryness due to low levels of estrogen.

In 2013, the Food and Drug Administration of the United States (FDA ) approved a medication called ospemifene for women with mild to serious menopause dyspareunia, at a dose of 60 mg once daily.

Adverse effects include that the hot flashes are mild to moderate.

Desensitization therapy

Learning some techniques can help relax the muscles in the vagina and reduce pain levels.

Lifestyle and home remedies

Some lifestyle changes can address painful intercourse.

Changes to sexual behavior

Pain experienced during intercourse can be reduced by:

  • using water-based personal lubricants
  • engaging in longer foreplay to encourage secretion of the body’s natural lubricants
  • enhanced communication between sexual partners
  • choosing comfortable sexual positions to minimize deep pain

Maintaining sexual and reproductive health

Practicing good genital hygiene and healthy sex and attending routine medical check-ups can help avoid genital and urinary infections which can lead to painful intercourse.

Kegel contractions

Some women with vaginism can find Kegel exercises useful for strengthening muscles in the pelvic floor.

Try stopping urination midstream to locate those muscles. If successful, the individual that urinates has found the right muscles.

Squeeze those muscles and keep them for 10 seconds, then relax them for 10 seconds. Repeat 10 times, 3 times a day. Practicing the deep breathing techniques while performing Kegels can be helpful.

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