What causes dyspareunia, or painful intercourse?
Painful intercourse can affect both men and women, but it is more common in women. According to the American Academy of Family Physicians (AAFP), up to 20 percent of American women experience it.
A variety of factors - both physical to psychological - can contribute. Treatment normally focuses on the underlying cause.
Here are some facts about dyspareunia. More detail is in the main article.
There is a number of reasons why intercourse can be painful. Dyspareunia affects women more than men.
The defining symptom of dyspareunia is pain with intercourse that may occur at the vaginal opening or deep in the pelvis.
The pain may be distinct and localized, or there may be a broader sense of discomfort.
There be an aching, burning, throbbing, or ripping sensation.
Dissatisfaction with, or disinterest in, intercourse can result.
Causes of dyspareunia are varied and include physical factors, psychological factors, or both.
The location of the pain may help identify a specific physical cause.
Physical causes: Entry pain
Entry pain may be associated with vaginal dryness, vaginismus, genital injury, and others.
Vaginal dryness: During sexual arousal, glands at the entrance of the vagina secrete fluids to aid intercourse. Too little fluid can lead to painful 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
Vaginismus: The involuntary contraction of the pelvic floor muscles causes vaginismus, leading to painful sexual intercourse.
Women with vaginismus may also experience difficulty with gynecological examinations and tampon insertion.
There are several forms of vaginismus. Symptoms vary between individuals and range from mild to severe. It can be caused by medical factors, emotional factors, or both.
Genital injury: Any trauma to the genital region can lead to dyspareunia. Examples include female genital mutilation (FGM), pelvic surgery, or injury arising from an accident.
Painful intercourse is also common after childbirth. Some research suggests 45 percent of participants experienced postpartum dyspareunia.
Inflammation or infection: 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.
Irritation or allergic reactions to clothing, laundry detergents, or personal hygiene products may also cause pain.
Abnormalities at birth: Less common underlying causes of dyspareunia include vaginal agenesis, when the vagina does not develop fully, or imperforate hymen, in which the hymen blocks the vaginal opening.
Physical causes: Deep pain
If pain occurs during deep penetration or is more acute in particular positions, it may be the result of a medical treatment or a medical condition.
Medical treatments that can lead to pain include pelvic surgery, hysterectomy, and some cancer treatments.
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
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.
A physician will also ask about the patient's medical history and carry out a pelvic examination, to try to identify the cause of the pain.
The patient should be ready to explain the exact location, length, and timing of the pain. They may need to talk about previous sexual experiences and reproductive history.
During a pelvic examination, a doctor checks for signs of infection or structural abnormalities.
They may use a device called a speculum, which is inserted into the vagina to enable a visual examination. This can cause some discomfort or pain to women with dyspareunia.
Telling the doctor when and where the pain occurs during the examination may help identify the cause.
The doctor may also gently press on the genitals and pelvic muscles to determine the location of the pain.
Treatment aims to relieve the underlying cause of the condition. Options include medication and counseling.
Painful intercourse can lead to relationship problems. It may be worthwhile to speak to a relationship counselor if this is the case.
If sexual abuse, trauma, or other emotional issues are the root cause of the dyspareunia, counseling may help.
Women whose dyspareunia does not have a psychological cause may also wish to attend counseling to cope with the emotional consequences of painful or difficult intercourse.
Couples may attend counseling together if painful intercourse is leading to communication or intimacy issues.
Medication can treat pain due to an infection or medical condition.
If existing medications are causing vaginal dryness, a doctor may recommend alternatives.
Topical estrogen may help women who experience vaginal dryness due to low estrogen levels.
In 2013, the United States (U.S.) Food and Drug Administration (FDA) approved a drug called ospemifene for women with moderate to severe dyspareunia due to menopause, at a dosage of 60 mg once a day.
Adverse effects include that mild to moderate hot flashes.
Learning some techniques can help relax the vaginal muscles and decrease 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 safe sex, and attending regular medical check-ups will help to prevent genital and urinary infections that can contribute to painful intercourse.
Some women with vaginismus may find Kegel exercises useful to strengthen the pelvic floor muscles.
To locate these muscles, try to stop urination midstream. If successful, the person urinating has found the correct muscles.
Squeeze and hold these muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times, three times each day. It can be helpful to practice deep breathing techniques while performing Kegels.