An Overview of 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 causes, some temporary and others the source of ongoing pain. If you have frequent or severe pain during sex, discuss it with your doctor to find a solution. Here are the most common sources.

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.

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.

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.