Painful intercourse (dyspareunia)

Overview

Painful intercourse can happen for reasons that range from structural problems to psychological concerns. Many people have painful intercourse at some point in their lives.

The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh). It is lasting or recurrent genital pain that occurs just before, during or after sex. Talk with your healthcare professional if you're having painful intercourse. Treatments focus on the cause and can help stop or ease this common problem.

Symptoms

If you have painful intercourse, you might feel:

• Pain only at sexual entry, called penetration.
• Pain with every penetration, including putting in a tampon.
• Deep pain during thrusting.
• Burning pain or aching pain.
• Throbbing pain lasting hours after sex.

When to see a doctor

If you have recurrent pain during sex, talk with your healthcare professional. Treating the problem can help your sex life, your emotional intimacy and your self-image.

Causes

Physical causes of painful intercourse differ, depending on whether the pain happens at entry or with deep thrusting. Emotional factors can be linked to many types of painful intercourse.

Entry pain

Pain during penetration might be associated with a range of factors, including:

• Not enough lubrication. This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breastfeeding also can be a cause.

  Certain medicines can affect sexual desire or arousal. That can decrease lubrication and make sex painful. Those medicines include antidepressants, high blood pressure medicines, sedatives, antihistamines and certain birth control pills.

• Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal, called episiotomy.
• Inflammation, infection or skin disorders. An infection in the genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in the genital area also can be the cause.
• Vaginismus. These involuntary spasms of the muscles of the vaginal wall can make penetration painful.
• A problem present at birth. Not having a fully formed vagina, called vaginal agenesis, or having a membrane that blocks the vaginal opening, called imperforate hymen, could cause painful intercourse.

Deep pain

Deep pain usually occurs with deep penetration. It might be worse in certain positions. Causes include:

• Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor conditions, adenomyosis, hemorrhoids and ovarian cysts.
• Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy, can cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotional factors

Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain. Emotional factors include:

• Psychological issues. Anxiety, depression, concerns about physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and resulting discomfort or pain.
• Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
• History of sexual abuse. Not everyone with dyspareunia has a history of sexual abuse. But if you have been abused, it can play a role.

It can be hard to tell whether emotional factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. You might start avoiding sex if you associate it with the pain.

Risk factors

Many factors can raise the risk of painful intercourse. They include illnesses, surgeries and other medical treatments, and mental health issues.