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What is dyspareunia?

Dyspareunia is the medical term for pain during sex. You may experience discomfort in various ways; dyspareunia pain is often described as burning, cramping, sharp or throbbing. Along with painful intercourse, the condition can also cause discomfort when using a tampon.

Dyspareunia affects nearly 3 out of 4 women at some time in life, according to The American College of Obstetricians and Gynecologists. Although the condition is common, you don’t have to manage your pain alone. You can find relief with treatment, including prescribed therapies and at-home remedies.

Types of dyspareunia

Your OBGYN may classify the pain you feel based on where it occurs and when it first developed. Types include:

  • Entry pain (intraoital or superficial dyspareunia): Felt in the vulva (the area outside your vagina) or entrance of the vagina
  • Deep pain (collision dyspareunia): Felt inside the vagina or in your uterus, bladder, pelvis or lower back
  • Primary dyspareunia: Pain that occurs the first time you have sex
  • Secondary dyspareunia: Pain that occurs after you’ve had pain-free sex

Dyspareunia symptoms

The primary symptom of dyspareunia is pain during intercourse, but you may experience the pain differently based on the type you have. Superficial dyspareunia causes pain upon entry, while deep dyspareunia pain may occur with deep penetration. While you may experience only superficial or deep dyspareunia, some people experience both.

While it’s most common to feel discomfort in your genitals and pelvis, you may also feel pain in the perineum (the area between the vulva and the anus).

When to see a doctor

If you’re experiencing discomfort during sex, talk to your OBGYN. Sex should not be painful, and even occasional pain can be treated effectively.

Pain during sex can also be a sign of underlying conditions, including infections, ovarian cysts and pelvic floor dysfunctions, so seeking treatment may help you find solutions to seemingly unrelated symptoms and health issues.

Causes of pain during intercourse

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Painful intercourse can have a variety of causes, both physical and emotional. Medical conditions, structural problems in your pelvic organs and emotional factors can contribute to both types of dyspareunia.

In some cases, pain may occur due to an allergic reaction to douches, spermicides and feminine hygiene products or a poorly fitting diaphragm or cervical cap. You can address this by avoiding products that cause irritation or talking to your OBGYN about an alternative birth control method.

Superficial dyspareunia

Superficial dyspareunia may occur for the following reasons:

  • Changes related to menopause: Menopause can cause vaginal dryness, leading to painful intercourse.
  • Skin conditions: Conditions such as lichen planus, lichen sclerosis and psoriasis can cause inflammation in the vulva and lining of the vagina, which may be painful.
  • Vaginal health issues: Many conditions affecting the vagina can lead to pain upon entry, including Bartholin gland cysts (small lumps that can become painful), vaginitis (caused by bacteria, yeast or parasites) or vaginal stenosis (narrowing of the vagina, often related to surgery or radiation therapy).
  • Vaginal or uterine abnormalities present at birth: Structural problems with how the uterus or vagina forms can make sex painful.
  • Vulvodynia: Vulvodynia develops in the vulva, causing chronic pain that lasts three or more months and often occurs alongside dyspareunia.

Deep dyspareunia

Deep dyspareunia may develop due to:

  • Bladder diseases: These include UTIs and interstitial cystitis (a type of bladder pain).
  • Conditions affecting the uterus and ovaries: These include adenomyosis, endometriosis, ovarian cysts and uterine fibroids.
  • Digestive conditions: Irritable bowel syndrome and inflammatory bowel diseases (Crohn’s disease and ulcerative colitis) have been linked to pain during sex.
  • Infections: Sexually transmitted infections (STIs) such as herpes, pelvic inflammatory disease (often caused by STIs) and infections of the fallopian tubes or ovaries can lead to pain during sex.
  • Pelvic floor disorders: Tight pelvic floor muscles and pelvic organ prolapse, when the pelvic organs fall into or through the vagina, can cause pain.

Your emotional health

Some people experience painful sex if they can’t get aroused or have experienced psychological trauma or a history of sexual abuse. In some cases, the pain may stem from difficulty relaxing, which can make sex uncomfortable. Consider talking to your doctor or a counselor about resources to support your emotional well-being.

How is dyspareunia diagnosed?

A medical evaluation for dyspareunia usually consists of:

  • Medical history

    Diagnosing dyspareunia begins with a conversation with your women’s health provider, who will ask about your pain and the affected area. They will also ask questions about what you’ve tried (if anything) to alleviate the discomfort and if you experience pain each time you have sex or if pain is a recent issue.

  • Pelvic exam

    Your provider may perform a pelvic exam or a visual examination of the genital area. These examinations can sometimes be uncomfortable, causing similar discomfort to what’s experienced during intercourse or the insertion of a tampon. Your provider knows this and will try to make you as comfortable as possible. When examining you, your provider will look for potential causes of painful intercourse, such as infection, vaginal dryness and scarring. If your provider suspects an infection, they may take a sample of tissue from the vagina or cervix for examination. They may also ask for a blood or urine sample.

  • Imaging

    Based on the results of your medical history and pelvic exam, your OBGYN may recommend an imaging test to look inside your pelvic organs and try to find the cause of your pain. Common tests include transvaginal ultrasound, CT scan and X-rays.

  • Laparoscopy

    Laparoscopy is a minimally invasive surgical procedure your provider may suggest if the underlying cause of your pain is unclear or your provider needs to investigate a potential cause. This procedure is often used to diagnose conditions affecting the abdomen or pelvis.

Dyspareunia treatment

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You have many options for treating sexual pain. The right treatment for you will depend on the cause of your discomfort. Often, treating the underlying health issue will alleviate your pain. In many cases, dyspareunia can benefit from conservative treatment options. Otherwise, you may need a surgical procedure to treat endometriosis, adenomyosis or ovarian cysts.

Lifestyle changes and at-home care

You can help reduce or manage pain during sex with some simple home care tips, including:

  • Applying an ice pack wrapped in a towel to the vulva after sex
  • Setting aside a relaxing time for having sex
  • Taking a warm bath to ease inflammation
  • Trying sexual activities and positions that reduce pain
  • Using an over-the-counter water- or silicone-based lubricant for vaginal dryness

Additionally, maintaining good genital hygiene, practicing safe sex and attending regular medical check-ups can prevent genital and urinary infections that contribute to painful intercourse.

Medications

Medications can treat underlying causes or help alleviate pain. Your provider may recommend:

  • An alternative form of birth control, such as birth control pills, an implant, a patch or an intrauterine device
  • Antibiotics, antivirals and antifungal medications to treat infections
  • Antidepressants, which can treat psychological factors and can help reduce nerve pain
  • Botulinum toxin injections, which can address pain in your pelvic floor muscles
  • Hormone therapy which may help women with sexual dysfunction
  • Medications for endometriosis
  • Prescription topical estrogen creams or a drug called ospemifene to address dryness and other symptoms related to menopause
  • Over-the-counter pain relievers or anti-inflammatories taken before intercourse

Alternative therapies

When sexual tension, a lack of arousal or trauma contribute to painful intercourse, you may benefit from counseling to overcome those causes.

  • Cognitive behavioral therapy: Working with a mental health professional can help you address anxiety, depression and previous psychological trauma that contributes to your physical pain.
  • Pelvic floor physical therapy: Your provider may recommend combining other therapies with this specialized physical therapy, which can help address tight pelvic floor muscles.
  • Progressive desensitization: This type of guided therapy helps you become more comfortable with physical touch.

Surgery

Usually, the last option for treatment, surgery, can help if other options no longer provide relief. Your provider may recommend surgery to correct pelvic organ abnormalities, treat endometriosis, remove uterine fibroids and address other underlying causes of your pain.

Find a specialized care for dyspareunia

If you’re experiencing painful intercourse, you can trust the women’s health team at Baylor Scott & White to provide compassionate, personalized care. Our services are available at several locations in North and Central Texas.

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Frequently asked questions

  • What does dyspareunia feel like?

    You may experience pain and discomfort in different ways. Dyspareunia pain is often described as burning, menstrual cramp-like, sharp or throbbing.

  • Can dyspareunia cause infertility?

    Dyspareunia causes pain during sex. While it may not cause infertility, it can make sex and, thus, conception challenging. In addition, conditions that cause painful sex, such as endometriosis, can also cause infertility.

  • Can endometriosis cause dyspareunia?

    Yes, endometriosis can cause painful intercourse. It often causes deep pain during sexual activity.

  • Do fibroids cause dyspareunia?

    Yes, uterine fibroids can cause pain during sex for some women.

  • Can men get dyspareunia?

    While dyspareunia in females is more common, men can experience pain during sex. Typically, the pain is due to a lack of lubrication.