What Is Dyspareunia?

Many women experience pain or discomfort during sexual intercourse at some point in their lives. Medically known as dyspareunia, pain during sex can be traced to many different causes, including skin conditions, infections, and muscle weakness.

Roughly 10% to 20% of women will be diagnosed with dyspareunia during their lifespan and the condition is particularly common after the hormonal changes of menopause.

Though it can be difficult or embarrassing to discuss, having a candid conversation with your gynecologist about your symptoms is the first step toward a return to a satisfying sex life. While the right treatment depends on the exact cause, most women able to find relief from the condition fairly quickly.

Painful intercourse can take on many forms. To determine the cause your doctor will take a full history of your symptoms and perform a visual and pelvic exam. Your doctor will ask about the location of the pain, activities that cause pain, the type of pain, and how long it lasts.

The symptoms will depend on the cause of painful intercourse and may include:

• Pain in the entryway, deep in the vagina, or elsewhere in the pelvis
• Burning
• Itching
• Dryness

Dyspareunia can be due to a number of issues, including infections, skin disorders, ovarian cysts, fibroids, menopause, and psychological issues.

For some women, the first or only sign of a vaginal yeast infection is a painful or burning sensation during intercourse. Other symptoms include burning, itching, and thick, white discharge. 

Yeast infections can typically be easily treated with an over-the-counter medication, but check with your doctor before self-treating any infection.

Many sexually transmitted diseases do not present with obvious symptoms. In infections such as trichomoniasis, some women may only experience symptoms of pain or irritation during sexual intercourse. The rubbing motion of the penis against the vagina and genitalia sometimes causes stinging or burning to intensify. Other infections, such as genital herpes, are a frequent cause of pain during sex.

Many products contain substances that can cause vaginal irritation, leading to discomfort or pain during vaginal sexual intercourse. These include:

• Contraceptive foams, creams, or jellies
• Allergic reactions to condoms, diaphragms, or latex gloves
• Vaginal deodorant sprays
• Scented tampons
• Deodorant soaps
• Laundry detergents
• Vaginal douching

Vaginal dryness often causes painful sexual intercourse. Using a vaginal lubricant can help if you have vaginal dryness. You may have reduced natural lubrication due to several factors:

• Trying to achieve vaginal penetration too fast before enough stimulation has occurred to allow normal vaginal lubrication to take place.
• Feeling nervous or tense about the sexual experience, slowing the release of vaginal lubrication.
• Using a condom without the addition of a vaginal lubricant, such as K-Y Jelly. Saliva is acceptable for vaginal lubrication, but never use petroleum-based products, as they can deteriorate condoms and contribute to vaginal infections.
• Hormonal imbalance after menopause, the years preceding menopause, or following childbirth. Vaginal lubrication methods listed above may help. Menopausal women may benefit from a prescribed vaginal estrogen cream.

This occasionally happens when you feel tense or are not fully relaxed when penetration occurs. Difficulty penetrating a tight vagina can happen even when vaginal lubrication is not a problem. The first few times you engage in sexual intercourse, the vagina may be tight due to an unstretched hymen, which can cause pain at the time of penetration.

Sometimes a more severe condition called vaginismus is responsible for vaginal tightness. Women with vaginismus experience strong, involuntary muscle spasms of the vaginal muscles during sexual intercourse or vaginal insertion of a tampon or finger.

Pain during intercourse or foreplay can also be caused by an allergy or skin condition such as contact dermatitis, lichen simplex chronicus, lichen sclerosus, and lichen planus. These conditionals are also typically accompanied by itching and burning and treated with a topical or oral steroid.

Pain during sex can also be due to a lack of desire for sex or a sexual partner or a lack of physical and emotional arousal in the body as a result of sexual stimulation. These issues can be due to stress, anxiety, depression, or PTSD or can be a side effect of medications taken to treat mental health conditions.

One side effect of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) is a lack of sexual desire and vaginal dryness. According to research published in Mayo Clinic Proceedings, medications that impact serotonin such as Zoloft (sertraline), Celexa (citalopram), and Effexor (venlafaxine) are associated with much higher rates of sexual dysfunction than antidepressants that work on dopamine, norepinephrine, or monoamine, such as Remeron (mirtazapine) and Wellbutrin (bupropion).

The clitoris is the most sensitive part of the female genitalia. Gentle touching or rubbing of the clitoris is extremely pleasurable for some women, while it is unbearably painful for others. Clitoral pain may also occur due to poor hygiene; vaginal secretions may collect under the clitoral hood and may lead to pain if not properly cleaned.

Occasionally, a woman will experience pelvic pain upon deep, thrusting penetration. Many conditions may cause this pain, including:

• Tears in the ligaments that support the uterus. Causes include problems during childbirth, abortion, previous violent sexual intercourse, or rape.
• Cervical, uterine, or tubal infections, such as pelvic inflammatory disease (PID)
• Pelvic adhesions following pelvic surgery or PID
• Endometriosis
• Ovarian cysts
• Uterine fibroid tumors

Vulvodynia is a chronic condition that is painful and often hard to diagnose. It causes a burning and/or stinging sensation of the vulva and vagina. The exact cause of vulvodynia is unclear, though it may be due to injury or irritation to nerves in the vulvar region, previous vaginal infections, dermatological conditions, hormonal changes, or muscle spasm or weakness in the pelvic floor.

Getting an accurate diagnosis starts with a candid conversation with your gynecologist. Your doctor will ask questions and take a complete health history including any medications you may be taking or other health conditions before performing a pelvic exam.

Depending on your symptoms, your doctor may order tests including vaginal swabs to rule out infections, bloodwork to test hormone levels, or an ultrasound to check for fibroids or cysts. In some cases, a laparoscopy may be needed to further determine the cause of pain.

Dyspareunia is treated based on the cause of the symptoms. A topical anesthetic, such as lidocaine, is sometimes prescribed to treat the pain while the root cause of the issue is also being treated.

Yeast infections, for example, are typically treated with an over-the-counter anti-fungal cream, though some infections may require a prescription-strength cream or oral anti-fungal medication, such as Diflucan (fluconazole).

Dermatological conditions may be treated with a corticosteroid cream such as hydrocortisone. Hormonal-related vaginal dryness may be treated with prescription estrogen cream, like Estrace, Premarin, or estradiol.

Physical therapy may help women for whom painful intercourse is due to pelvic floor issues. When painful intercourse is due to emotional health issues, talking with a therapist and possibly changing medications can help.

Pain or discomfort is never part of normal sexual intercourse. If you experience pain during sex, don't be afraid to tell your partner, who has no way of knowing that you're uncomfortable unless you talk about what you're feeling. Also, make sure to see your doctor for diagnosis and treatment of the underlying cause.

While discussing intimate details with your doctor can be uncomfortable for some women, having an open conversation about painful intercourse is necessary to help set you on a course for treatment and relief.