Dyspareunia (Painful Intercourse): Symptoms, Causes, Treatment, and Prognosis

Dyspareunia (pronounced: dis-pahr-OON-eeuh) is the medical term for painful sexual intercourse. This pain can happen before, during, or after sex, depending on its cause. You can treat dyspareunia with the help of a healthcare provider, who can prescribe medications and other treatments to decrease your pain.
Overview Overview What Is Dyspareunia? Dyspareunia describes genital, vaginal, or pelvic pain right before, during, or after sexual intercourse.e60dc2a1-f33c-4a05-9b50-8e3e8e597629061b5c80-733b-4294-849a-229eef7072ede60dc2a1-f33c-4a05-9b50-8e3e8e597629f9d43855-368a-4e2d-8fbf-784edc0ba269 This pain can feel sharp, throbbing, cramping, or burning. Dyspareunia happens most often in women, and about 3 out of 4 people with vaginas experience this type of pain at least once in their lives.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292ace4830-a4f3-48f8-a31d-82495753099b The group at highest risk for dyspareunia is women who have passed menopause (around age 50).
But painful sex can happen because of anything from your feelings about sex to medical conditions.e60dc2a1-f33c-4a05-9b50-8e3e8e597629161bc67a-f7ea-40a0-9881-72759c479228e60dc2a1-f33c-4a05-9b50-8e3e8e5976292212e95c-82af-46dd-ae0b-1dfd0c216e16 If you feel pain during sex, you may find it hard to share that with your partner. In fact, one study of almost 400 women found that about half didn’t tell sexual partners about their dyspareunia.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c2486ac6-ddd6-4755-b9f2-3e2aac1663e6 But even if you don’t loop your partner in right away, it’s important to share your symptoms so you can get some relief.
Signs and Symptoms of Dyspareunia Symptoms Dyspareunia symptoms can vary based on its type. These types fall under two categories: where and when you feel pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296500dd03-4dfb-4120-a862-ea336202cd51 Sexual intercourse can cause pain in a few different places:e60dc2a1-f33c-4a05-9b50-8e3e8e597629839d3268-6412-42e5-83a1-e1ae8d5c09dee60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e5976296500dd03-4dfb-4120-a862-ea336202cd51 Entry pain : Felt at the vagina’s opening when penetration first happens Positional pain : Felt in some sexual positions, but not others Deep pain : Felt during deep penetration, and can be worse in some sexual positions Providers may also label dyspareunia based on the history and timing of your pain:e60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e5976296500dd03-4dfb-4120-a862-ea336202cd51 Primary pain : You have felt pain during sex since you became sexually active Secondary pain : You begin to feel sexual pain after a period of pain-free sex Complete pain : You feel pain every time you have intercourse Situational pain : Sexual pain only happens in certain times and situations Sexual pain can come with a wide range of physical sensations, and dyspareunia symptoms can include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e597629c4972e08-b43f-4501-b2ef-9b24899da8df Sharp or deep pain during thrusting Throbbing and aching to the pelvic region or genitals hours after intercourse Cramping in your pelvic area Pelvic floor muscle tightness or spasms Pain in the bladder Burning or piercing pain during penetration Pain when inserting a tampon Dyspareunia can affect any area in the pelvis, including the pelvic floor muscles, uterus, vagina , vulva, bladder, lower back or abdomen, and tissues surrounding your pelvic organs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e5976298ad233a5-458e-4284-930a-a974520d623a
Causes and Risk Factors of Dyspareunia Causes Dyspareunia can have many causes, including medical conditions, trauma or injury to the pelvic area, or psychological factors surrounding sex.e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfbe60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8e60dc2a1-f33c-4a05-9b50-8e3e8e59762929423e67-c407-4e86-9c52-bc3676045542 Medical Conditions Pain during sexual intercourse can be a symptom of these medical conditions:e60dc2a1-f33c-4a05-9b50-8e3e8e59762929423e67-c407-4e86-9c52-bc3676045542e60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8e60dc2a1-f33c-4a05-9b50-8e3e8e597629205a4b77-16b6-43c6-a72e-a0a9b3f5fc26 Skin disorders : Such as contact dermatitis Vulvodynia : A pain disorder that affects the vulva Cysts : Fluid-filled growths in the pelvic area Endometriosis : Tissues similar to the uterus lining appearing in other places (like the abdomen) Pelvic inflammatory disease : Infection of the vagina, uterus, fallopian tubes, or ovaries Genitourinary syndrome of menopause (GSM) : Thinning, inflammation, and dryness of the vaginal lining Hormonal changes : Perimenopause and menopause -related estrogen drops and hormonal changes from breastfeeding Nerve problems : Pinched or inflamed nerves in the back or pelvic area Vaginitis : Inflammation of the vagina caused by bacterial, viral, or yeast infection Vaginismus : Vagina muscle tightening Vaginal dryness : Lack of lubrication leading to irritation. Sometimes extending foreplay can help.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b19b53d-fcc8-461b-88dc-4ff9cd7e4a86 Pelvic floor dysfunction : Tight ligaments and muscles in the pelvic floor (around the vagina) Bowel conditions : Like irritable bowel syndrome Bladder conditions : Like urinary tract infections Several medical conditions can cause vaginal dryness, which can lead to painful sex. These include having your ovaries removed, some tumors, diabetes, and treatment for cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8 Medications can also lower lubrication, including some for depression, high blood pressure, allergies, and birth control.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ede8b2fd-f104-4e51-be33-dee0b1204f5f Trauma or Injury Any injury or trauma to the pelvic area can cause painful sex, including the following:e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b19b53d-fcc8-461b-88dc-4ff9cd7e4a86e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfbe60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8 Pelvic surgery : Like hysterectomy or ovary removal Childbirth : From unhealed tearing or stretching while giving birth Accidents : Any injury to the vulva, vagina, or pelvis Female genital mutilation : Also known as female circumcision or cutting, in which the clitoris and labia are removed or altered for cultural or religious reasons Psychological Factors Sometimes, psychological factors can lead to dyspareunia. These can include a lack of desire or arousal because of several issues, including:e60dc2a1-f33c-4a05-9b50-8e3e8e59762929423e67-c407-4e86-9c52-bc3676045542e60dc2a1-f33c-4a05-9b50-8e3e8e597629ede8b2fd-f104-4e51-be33-dee0b1204f5f Anxiety Depression Stress Concerns over appearance Fear of intimacy Relationship problems History of sexual abuse Your mental and emotional state can play a big part in your ability to become aroused, and can lead to painful sex. Emotional and Psychological Impact Dyspareunia can cause more than physical pain. Discomfort during sex often leads to lower desire and less sex, which can put a strain on your quality of life and relationship.e60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfb Sexual issues can also prompt lower self-confidence, self-image, and self-esteem.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b4fd815-798e-49d5-beeb-93c64fa7e96b Sometimes these issues can even turn into depression and anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfb But once you address the cause of these issues with a healthcare provider, you may soon have less painful and more fulfilling sex.
How Is Dyspareunia Diagnosed? Diagnosis A healthcare provider can diagnose the cause of dyspareunia through several methods.e60dc2a1-f33c-4a05-9b50-8e3e8e597629929f6bfc-3033-44db-94fa-c9ad790eb8d2e60dc2a1-f33c-4a05-9b50-8e3e8e597629180fea96-c4b7-439b-8801-e1e87f8d573d Medical History First, your provider may ask when and where you feel pain. They may want to know if sexual pain happens with some partners and positions but not others. If these questions make you feel uncomfortable, remember their answers will help your provider solve this puzzle and start you on the path to recovery. Pelvic Exam To rule out some medical causes of dyspareunia, your provider may do a pelvic exam. During this exam, your provider may observe your genitals and may also look inside your vagina. They may try to find the painful areas by pushing gently and asking for feedback. Pelvic Ultrasound If your provider thinks your pain may come from something inside your pelvis, like endometriosis or a cyst, they may want to do an ultrasound to see that area. This ultrasound can be done through the skin of your lower abdomen, or through a wand inserted in the vagina. Laparoscopy Rarely, your provider may not see the cause through an ultrasound but still suspects the pain is coming from an internal problem. In that case, they might recommend a minimally invasive surgery to investigate. It can feel difficult to bring up sexual pain with a healthcare provider, but whatever you tell them will help. Remember: They have heard it all. And the more they know, the better they can direct your care.
Treatment and Medication Options for Dyspareunia Treatment Depending on its cause, you can treat dyspareunia with medications, natural remedies, mental health therapy, or surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a76144a0-0db7-4bb7-9a10-c0df444a7990 The best treatment will address all aspects of your pain: physical, emotional, and behavioral.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b Medication Options The cause of your sexual pain will direct whether medications may help you. Some common medication options for dyspareunia include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825be60dc2a1-f33c-4a05-9b50-8e3e8e597629792d7f51-4ff4-4191-bb7d-51f391c15495e60dc2a1-f33c-4a05-9b50-8e3e8e597629778bfc0f-0d3c-4a6e-a033-18bcb8626ff3 Tricyclic antidepressants : Block some pain signals to and from your braine60dc2a1-f33c-4a05-9b50-8e3e8e5976290ec44060-427e-4cd2-84bb-ea6897d09f05 Oral or topical hormone replacement : Increase estrogen and natural lubrication NSAIDS : Over-the-counter pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil) Botox injections : Stabilize pelvic floor muscles Ospemifene (Osphena) : Nonhormonal oral medication that behaves like estrogen and decreases vaginal dryness Prasterone (Intrarosa) : Works similarly to ospemifene, but is inserted in the vagina Therapies Various therapies can help rewrite the script on your sexual pain and the emotions that cause or come with the experience. Physical Therapy A physical therapist uses pelvic floor therapy to help you learn to relax your pelvic muscles.e60dc2a1-f33c-4a05-9b50-8e3e8e597629792d7f51-4ff4-4191-bb7d-51f391c15495 These exercises can also retrain how your brain responds to sensations in that area, leading to less pain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b Vaginal Dilators Your therapist may also recommend vaginal dilators to gently stretch your vaginal tissue. These dilators start small (about 12 millimeters wide) and progressively get bigger as you’re able to insert them.e60dc2a1-f33c-4a05-9b50-8e3e8e59762992f59628-f0c4-4c81-a0d4-63fe4762927d Sex Therapy If your sexual pain comes from an emotional response, a sex therapist can help you unravel those feelings. They can also help you work through any relationship issues with your partner and help you get back to sexual intimacy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629778bfc0f-0d3c-4a6e-a033-18bcb8626ff3 Cognitive Behavioral Therapy In cognitive behavioral therapy (CBT), a mental health professional helps you change negative thought and behavior patterns around sex. This therapy can also lessen fear and anxiety surrounding sex and sexual pain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b e60dc2a1-f33c-4a05-9b50-8e3e8e597629778bfc0f-0d3c-4a6e-a033-18bcb8626ff3 Surgery Surgery provides another option if your pain is caused by scar tissue from an injury or previous surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b You can also have your vagina surgically widened if your pain comes from vaginal tightness. But surgical options are more rare, and often only considered after you’ve tried other therapies.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a3dcfcfd-72a4-464f-adf5-6426d2b3ad90
Lifestyle Changes for Dysparuenia Lifestyle Changes For less painful sex, you can adjust some habits around the act:e60dc2a1-f33c-4a05-9b50-8e3e8e5976293334984c-5aa6-4936-9b79-68de2448c34de60dc2a1-f33c-4a05-9b50-8e3e8e5976297aaf1b38-790b-49f9-9766-a8f2cc420e69 Use lubricants : Lubricants with a water or silicone base can keep your vulva and vagina from becoming too dry during sex. Avoid irritants : Use lubricants, soaps, and sanitary pads with no added perfumes. Practice relaxation techniques : Take some time before sex to relax and calm your body. You can try activities like meditation , massage, or deep breathing exercises to help. Take it slow : Longer foreplay can help your body prepare for penetration with less pain. Try different positions : Avoid positions that hurt more than others. Communicate : Throughout a sexual encounter, talk to your partner about what feels good and what’s hurting — never hesitate to ask for a break or change. Use ice after sex : If soreness in your vulva lingers after intercourse, a wrapped ice pack to the area can help lessen inflammation and pain. If you’re working through some therapies and don’t feel ready for intercourse yet, you can still experience sexual pleasure as well as intimacy with your partner. Oral sex, mutual masturbation , and other nonpenetrative sex options can fulfill you and keep you close to your partner while avoiding pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297ed31b8c-69a9-4ee0-ae94-0059f9787fa3
Prevention of Dyspareunia Prevention Dyspareunia can’t always be prevented, but you can do a few things to make sex less painful and more pleasurable. Visit a healthcare provider on the schedule they recommend to stay up-to-date on wellness exams and important tests like pap smears.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b1d04d7-3066-46b6-8dfd-92b5022e850c Use condoms during sex to protect against sexually transmitted infections and keep your genital area clean.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b1d04d7-3066-46b6-8dfd-92b5022e850c Use plenty of lubrication during sexual encounters to prevent friction and irritation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629db4ac9ee-4543-4509-bb62-58a2d7fb2a9e You can also use stress management techniques like regular exercise, mindfulness, and journaling to prevent muscle tightness.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293a98f038-b6bc-4c89-8858-70cff2a30192
How Long Does Dyspareunia Last? Prognosis and Outlook Dyspareunia can resolve quickly or may persist for years, depending on its cause and how quickly you can get treatment. For example, your prognosis will be short if sexual pain comes from vaginal dryness, and you can resolve it by using lubrication the next time you have sex.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a13156ad-9a59-4e06-962b-86276d9b363f But if painful sex comes from a medical condition or psychological issues, it may take longer to address. Whatever the cause, it’s important to let a healthcare provider know what’s going on. This is especially true if you experience any of these symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a13156ad-9a59-4e06-962b-86276d9b363f New pain during sex Sexual pain has gotten worse Bleeding during or after intercourse Unusual vaginal discharge Sores on your genitals Irregular periods The Takeaway Dyspareunia is pain in the vaginal or pelvic region that happens right before, during, or after sexual intercourse. Medical and psychological conditions, including hormonal changes, injury, anxiety, or stress, can cause dyspareunia. You can treat dyspareunia with medications, physical therapy, counseling, and through some lifestyle modifications. It can feel awkward to speak to a healthcare provider about sex, but it’s important to share your symptoms so your provider can help you make a plan for pain relief.
Resources We Trust Mayo Clinic: Painful Intercourse (Dyspareunia)Cleveland Clinic: Dyspareunia (Painful Intercourse)American Family Physician: Dyspareunia in WomenAmerican College of Obstetricians and Gynecologists: When Sex Is PainfulSexual Medicine Society of North America: Why Does Sex Hurt?: A Guide for Figuring Out What Might Be Causing Painful Sex



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