Painful intercourse (dyspareunia)
Medically Reviewed by Dr Sravya, MBBS, MS
Introduction
Is sex a reason for creating differences between you and your partner? Painful intercourse (dyspareunia) is a feeling of pain every time before, during, or after sex. Dyspareunia can be experienced by both men and women, but it mostly affects women after menopause (when the period stops permanently). People shy away from talking about it because they are unaware of the treatments and preventive measures.
Dyspareunia, or painful intercourse, is a feeling of pain in the genital area before, during, or after sex. The term dyspareunia comes from a Greek word that means ‘badly mated.’ Male dyspareunia is pain experienced by males, and female dyspareunia is pain experienced by females. Dyspareunia primarily affects women at some point in their lives.
Painful intercourse (dyspareunia) in females:
Dyspareunia in females is more common than in males. Below are the causes of painful intercourse (dyspareunia) in females. Causes are different for different types of pain. Let’s see them one by one in detail:
Causes of entry pain
- Dry vagina – During intercourse, the glands around the vagina secrete some fluids to lubricate and allow easy insertion of the penis. Not giving time for foreplay, reduced estrogen levels due to menopause or breastfeeding, or post-pregnancy, medications that cause reduced sexual desire like antidepressants, blood pressure control medicines, birth control pills, sedatives, and antihistamines cause reduced fluid secretion, resulting in dryness in the vagina. A dry vagina causes friction during intercourse and thus gives rise to pain.
- Vaginitis or other skin infection – Inflammation of the vagina (vaginitis), eczema, or other skin diseases affecting the genitals can cause pain.
- Vaginismus – It is the contraction of the muscles of the vagina, causing reduced opening of the vaginal passage resulting in difficult penetration and pain during intercourse.
- Accidental injury or trauma – Any injury to the vagina during an accident or surgery might cause pain.
- Abnormal vagina – When the vagina is not properly developed since birth, it can also lead to pain.
Causes of pain during intercourse
Health issues like cysts in ovaries, fibroids in the uterus (abnormal growth in the uterus), retroverted uterus (uterus tilted backward towards the spine), uterine prolapse (muscles of the pelvic area become so weak that they cannot hold the uterus anymore and the uterus drops down and protrudes through the vagina), irritable bowel syndrome, piles, and endometriosis (abnormal lining growing on the uterus) can cause deep pain. Sexually transmitted infections and ectopic pregnancy (development of the egg outside the uterus) are also causes of deep pain.
Surgical removal of the uterus from the body, known as hysterectomy, and episiotomy (cut made at the vaginal opening during delivery) can cause painful intercourse. Radiation causes vaginal stenosis (thickening and narrowing of vaginal opening due to fibrous tissue formation), and chemotherapy causes a burning sensation or vaginal atrophy (thinning and drying of the vagina), leading to deep pain.
Causes of pain in men
Any damage to the skin or a defect of the penis, priapism (prolonged erection of the penis), and infections like STDs (sexually transmitted diseases) can cause pain in men.
Emotional factors such as stress, anxiety, depression, shame, and sexual abuse in the past might also be causative factors for painful sex.
Painful intercourse (dyspareunia): Symptoms
Pain is the most common sign and symptom, but the location of pain can differ in men and women.
Painful intercourse in males
Men experience burning pain in their genitals, a skin rash on their penis, a lack of sexual desire, an inability to attain orgasm, or erectile dysfunction (penis fails to harden during sex).
Painful intercourse in females
Women experience entry pain or deep pain. Entry pain is the pain felt when the penis enters through the vagina (tube-like structure connecting the external genitalia to the womb or the uterus). Deep pain is felt when the penis goes deep inside the woman’s body in specific positions. When suffering from dyspareunia, some women also experience emotional breakdowns in addition to physical pain.
Pain in women can also be classified into primary, secondary, complete, and situational. Primary pain is experienced during the first sexual intercourse. Secondary pain is experienced after the sexual experience has become pain-free. Complete pain is the pain experienced every time during sexual intercourse. Situational pain is pain experienced only occasionally during sexual intercourse.
Diagnosis and tests to detect dyspareunia.
If you are experiencing painful intercourse, don’t shy away from talking to your doctor about it, as he can guide you and treat you for the underlying condition.
Medical history
The doctor will take a complete history of your medications, surgery, pregnancy, location of pain, and sexual abuse. The doctor might also ask about your sexual partners and the sexual positions that you follow.
Physical examination and tests
Other tests include a physical examination of the vagina or penis, anus, and pelvic area. Pap test for checking the cervical area (it is the mouth of the uterus), urine test to detect any urinary tract infections, culture test (to detect any infections), ultrasound to check for the cause of pain, and allergy test to detect any allergies.
Painful intercourse (dyspareunia): Treatment methods
All cases of dyspareunia don’t need medications, but some cases do need medications to treat the causative factor. Medicines that cause vaginal dryness should be changed by the doctor. There are medicines available to put into the vagina for increased lubrication as well as to treat any underlying cause. Topical lubricants are also available to apply on the vagina before sex.
Vaginismus treatment– To prevent abnormal contraction of vaginal muscles, certain exercises, like Kegel exercises, which strengthen the pelvic muscles, need to be learned and practiced.
Laser and heat treatments are done to tighten the vaginal walls when muscles are relaxed due to childbirth.
Self-treatment methods
- Taking painkiller medicines before sexual intercourse is recommended, but avoid prolonged use of painkillers as it can cause other side effects.
- Vaginal dryness is the main cause of dyspareunia, so methods for vaginal lubrication should be adopted. Use water-based lubricants to prevent vaginal dryness.
- Communicate with your partner before intercourse and decide which position is comfortable for you. Relax, de-stress, and give more time for foreplay.
- Wait till 6 weeks post-pregnancy for sexual intercourse.
- Use ice packs for vaginal burning after sexual intercourse.
- Cooperate with your partner and avoid sexual intercourse until the dyspareunia cures. Mutual masturbation can be made for pleasure.
- Yoga is the best exercise to stretch, relax, and tighten the muscles. It is not only good for your physical strength, but it also gives you mental peace and calmness.
Conclusion
Dyspareunia is very common, especially in postmenopausal women, and communication is the key to overcoming this painful disorder. Speak up about your problem first with your partner and then with your doctor. Maintain proper hygiene and take preventive steps.
Frequently Asked Questions
Vaginal lubricants are completely safe, but you should check the ingredients before use if you have any allergies. Allergy signs include difficulty breathing, rashes, and a swollen face. Contact your doctor immediately if you experience any such side effects.
It is because of multiple factors like surgery, breastfeeding, back pain, dry vagina, and reduced blood flow to the uterus and pelvic area. Medications should be taken only from a doctor if the mother is breastfeeding. Masturbation increases the blood flow to the pelvic area, so it should be practiced regularly.
It depends on the factor that is causing dyspareunia. It can take from a week to months to get completely cured.