(Painful Sexual Intercourse)
Dyspareunia is recurrent or persistent genital pain experienced just before, during, or after sexual intercourse. Although this condition can occur in both men and women, it is more common in women.
Menopause is one of the main causes of dyspareunia. It can also be caused by not having enough lubrication because of a lack of sexual arousal and stimulation. Certain medication, such as antihistamines, may also cause dyspareunia as a side effect.
Other causes in women include:
- Postpartum period after childbirth
- Vaginal infections, such as yeast vaginitis
- Postmenopausal atrophic vaginitis—irritation of the vaginal mucosa due to lack of estrogen
- Herpes or genital warts
- Pelvic inflammatory disease —serious infection of the female reproductive organs
- Urinary tract infection
- Problems affecting the pelvic bones
- Chronic constipation
The cause of dyspareunia may also be related to psychological factors, although this is less common. Some examples include:
- Previous sexual trauma, such as rape or abuse
- Feelings of guilt
- Negative attitudes toward sex
These factors may lead to a condition called vaginismus. This is painful and involuntary contractions of vaginal muscles. It is usually a response to past sexual trauma or other painful circumstances, but it can also be the result of chronic irritation from a physical cause.
The most common causes of pain in men are:
Pain occurs at the time of ejaculation.
Pain that occurs while obtaining an erection may be associated with:
- Inflammation of the foreskin
- Loss of elasticity of the foreskin
- Trauma to the penis
- Herpes or genital warts
- Local allergies or irritations
- Curvature of the penis caused by Peyronie disease
Factors that may increase your chance of dyspareunia include:
- Being postmenopausal
- Taking medications that result in vaginal dryness
- Prior vaginal surgery
In men and women, viral or bacterial infections may also increase the chance of dyspareunia.
Pain associated with dyspareunia may:
- Occur during or after sex
- Be itching, burning, stabbing, or aching
Be located in the:
- Occur during all phases of sexual contact
- May also occur with tampon use—fabric absorbs natural vaginal lubricant
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A medical and sexual history will be taken. A physical exam will be done. The diagnosis is often made based on your symptoms.
Your vaginal wall will be checked for:
- Signs of dryness
- Genital warts
An internal pelvic exam will be done to look for:
- Abnormal pelvic masses
- Signs of endometriosis
For men and women:
- Your doctor may suggest more tests. They may include cultures to find infections. Imaging studies like an ultrasound may also be used.
- You may be referred to a counselor. This will help to determine whether psychological issues may be a cause.
- Your doctor may advise that you use water-soluble lubricants or estrogen supplements.
- Infections may be treated with antibiotics or antifungal medication.
- Inflammation and dermatitis may be treated with topical or injectable corticosteroids.
- Viral infections like herpes and genital warts will need to be treated.
- Endometriosis may be treated with medications. In some cases, surgery may be necessary.
To treat prostatitis and urethritis, the doctor may recommend:
- Antibiotic treatment
- Sitz baths—soaking the hip and buttocks area in warm water
- Avoiding alcohol and caffeine, which may be helpful for prostatitis
Sometimes, surgery may be done to treat foreskin and other erectile problems.
Men and Women
When no physical cause of the pain can be found, sex therapy may be helpful. Some concerns need to be worked through in counseling. These may include:
- Inner conflict
- Unresolved feelings about past abuse
- Wait at least 6 weeks before having sexual relations after childbirth. It may be necessary to use a lubricant because of hormonal changes causing vaginal dryness.
- Use proper hygiene and get routine medical care.
- Practice safe sex to prevent sexually transmitted diseases.
- Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
- Use a water-soluble lubricant. Vaseline should not be used as a lubricant. It is not water-soluble, and it may encourage vaginal infections.
American Congress of Obstetricians and Gynecologists
Family Doctor—American Academy of Family Physicians
Sex Information and Education Council of Canada
Sexuality and U—Society of Obstetricians and Gynaecologists of Canada
American Congress of Obstetricians and Gynecologists Committee on Practice Bulletins—Gynecology. Female sexual dysfunction. Obstet Gynecol. 2011;117(4):996-1007. Reaffirmed 2015.
Female sexual dysfunction. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116816/Female-sexual-dysfunction. Updated February 10, 2017. Accessed December 7, 2017.
Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician. 2001;63(8):1535-1544.
Lightner DJ. Female sexual dysfunction. Mayo Clin Proc. 2002;77(7):698-702.
Last reviewed November 2018 by Beverly Siegal, MD, FACOG Last Updated: 12/11/2015