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Orgasms, pleasure, sensual, and love are words often associated with healthy sex. Physical pain and hurting are not. But for the men and women who live with dyspareunia—painful intercourse—these words are all too meaningful. Luckily, the condition is usually treatable.
Both psychological and physical factors contribute to painful sex, and treatments vary. Sometimes, something as simple as choosing a different brand of condom or discovering new foreplay techniques that will alleviate the problem. In other cases, medication or more rarely, surgery may be necessary. When the cause is more psychological than physical, individual or couples therapy may be the solution.
Vaginal dryness is often the culprit causing pain that is felt on entry, but eases later on. When a woman becomes sexually aroused, glands in her vagina secrete a fluid that acts as a lubricant. Anything that disrupts this process can result in inadequate lubrication and subsequently, painful intercourse.
Other factors can cause lubrication problems, such as insufficient foreplay or changes in women's hormone levels caused by postmenopause or breastfeeding. Medications, such as antihistamines, can also have an overall drying effect.
Extended foreplay or more effective stimulation techniques may resolve the problem simply and easily. If not, using a lubricated condom or applying a water-soluble lubricant (K-Y Jelly or liquid, Astroglide gel, or Silken Secret gel) may do the trick. Vaseline and other petroleum-based lubricants should not be used as lubrication aids because they can decrease a condom's effectiveness and/or encourage vaginal infections. Postmenopausal women may want to consider vaginal estrogen creams to alleviate dryness and pain.
Feeling pain at or near the entrance to the vagina may be the result of a vaginal or urinary tract infection, cysts or abscesses, or related to scarring from an episiotomy. Spermicides, feminine hygiene sprays, douches, or tight clothing can also create soreness. Simply treating the infection or removing the irritant may solve the problem. Pain caused by an episiotomy scar may go away on its own as time passes and the area becomes less tender. If not, surgical treatment may be a consideration.
Pain that is felt deeper inside the vagina or into the lower abdomen during intercourse may be a sign of endometriosis, pelvic inflammatory disease, or other disorders of the reproductive tract. These conditions all require prompt attention from a doctor. In a few women, sexual activity triggers a sudden and involuntary contraction of the vaginal muscles, called vaginismus. The vagina clamps down, making penetration and intercourse very painful and sometimes even impossible. This is an automatic muscular response, often associated with psychological trauma. It may be linked to past experiences of painful intercourse or sexual abuse. Vaginismus can often be resolved by gradually dilating the vagina with the fingers or with specially prescribed, graduated dilators. Therapy is also helpful with this condition.
When a man experiences pain during intercourse, it is usually when he becomes erect or as he ejaculates. As with women, a man's genital pain may originate from an infection or an irritation, such as the use of a spermicide. Inflammation of the urethra or the prostate are also common causes of pain during ejaculation. Both of these conditions can usually be medically treated.
Other infections, including STDs like herpes or genital warts, may cause pain while a man is getting or maintaining an erection. If a man's foreskin is inflamed or tight, it may hurt as it is retracted. When the cause of painful intercourse is a bacterial infection, the pain usually resolves with antibiotics.
Pain is sometimes associated with a pronounced curvature of the erect penis, called Peyronie's disease. Found primarily in men age 40-60, Peyronie's disease is caused by scar tissue build up inside the penis. During erection, the scar tissue does not fill with blood, which causes the penis to curve. The curvature may or may not be painful. The condition can be treated and the pain often resolves over time.
In addition to the immediate physical discomfort, the repercussions of painful intercourse can interfere with relationships and sexual compatibility. Pain can also signal a medical condition in need of attention. If simple remedies, such as increasing lubrication and foreplay do not provide relief, talk to your doctor. Be prepared to describe when the pain began, where it is located, and what it feels like. Bring a list of the medications you take, and be sure to bring up any other medical conditions for which you receive treatment. If you are concerned that you may have an STD, share this information with your doctor as well. Tests can be done to check for infections.
Do not let embarrassment keep you from seeking help. Although you may feel uncomfortable discussing sexual intimacy, painful intercourse is a common problem. Your doctor has probably held similar conversations with other people. Above all, remember the intent: more fulfilling sexual intimacy.
The Society for Human Sexuality
The VP Foundation
Sexuality and U—The Society of Obstetricians and Gynaecologists of Canada (SOGC)
2015 Sexually transmitted diseases treatment guidelines. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/tg2015/default.htm. Updated October 21, 2015. Accessed March 1, 2016.
Erectile dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15, 2015. Accessed March 1, 2016.
Female sexual dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 20, 2015. Accessed March 1, 2016.
Peyronie disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 2, 2015. Accessed March 1, 2016.
Tredgold R, Wolff H. Sexual disorders. In: Psychiatry in General Practice. New York, NY: International Universities Press; 1994.
Last reviewed March 2016 by Michael Woods, MD Last Updated: 3/1/2016