What causes pain during sexual intercourse. How is dyspareunia diagnosed. What are the treatment options for painful sex. Can dyspareunia be prevented. How does painful intercourse affect relationships and quality of life.

What is Dyspareunia and How Common is It.

Dyspareunia refers to recurring pain in the genital area or within the pelvis during sexual intercourse. This condition primarily affects women, though men can experience it as well. The pain may be felt externally in the vulva or deeper in the pelvis, and can range from mild discomfort to severe, burning pain that makes intercourse difficult or impossible.

Studies estimate that between 10-20% of women experience dyspareunia at some point in their lives. The prevalence tends to increase after menopause, with up to 45% of postmenopausal women reporting pain during sex. However, dyspareunia can affect women of all ages.

Types of Dyspareunia

• Entry dyspareunia – Pain felt at the vaginal entrance upon penetration
• Deep dyspareunia – Pain felt deep in the pelvis during thrusting
• Primary dyspareunia – Pain has been present since first sexual experiences
• Secondary dyspareunia – Pain developed after a period of pain-free intercourse

What Are the Main Causes of Painful Intercourse.

Dyspareunia can have many different underlying causes, both physical and psychological. Some of the most common causes include:

Physical Causes

• Vaginal infections (yeast infections, bacterial vaginosis)
• Urinary tract infections
• Vaginal dryness due to low estrogen levels
• Vaginismus (involuntary tightening of vaginal muscles)
• Endometriosis
• Pelvic inflammatory disease
• Uterine fibroids
• Ovarian cysts
• Vulvodynia (chronic vulvar pain)
• Injury or trauma to the pelvic area
• Poorly fitted contraceptive devices

Psychological Causes

• Anxiety about sexual intercourse
• Depression
• History of sexual abuse or trauma
• Relationship problems
• Poor body image

In many cases, dyspareunia may result from a combination of physical and psychological factors. Identifying the underlying cause is crucial for proper treatment.

How is Dyspareunia Diagnosed by Medical Professionals.

Diagnosing dyspareunia typically involves a comprehensive approach including a detailed medical history, physical examination, and potentially additional tests. The diagnostic process may include:

1. Medical history: The doctor will ask about the nature, location, and timing of the pain, as well as any associated symptoms or factors that worsen or alleviate the discomfort.
2. Physical examination: This usually includes a pelvic exam to check for signs of infection, anatomical abnormalities, or tender areas. The doctor may use a cotton-tipped swab to pinpoint areas of pain.
3. Pelvic ultrasound: This imaging test can help identify conditions like fibroids, ovarian cysts, or endometriosis.
4. Laboratory tests: Cultures or samples may be taken to check for infections.
5. Laparoscopy: In some cases, this minimally invasive surgery may be recommended to diagnose conditions like endometriosis.

It’s important for patients to communicate openly with their healthcare provider about their symptoms and concerns to ensure an accurate diagnosis.

What Are the Most Effective Treatments for Painful Intercourse.

Treatment for dyspareunia depends on the underlying cause. Some common treatment approaches include:

Medical Treatments

• Antibiotics for infections
• Topical or oral estrogen for vaginal dryness
• Pain medications
• Antidepressants for nerve pain
• Botox injections for vaginismus

Non-Medical Treatments

• Pelvic floor physical therapy
• Vaginal dilators
• Cognitive behavioral therapy
• Mindfulness and relaxation techniques
• Couples therapy

For many women, a combination of treatments may be most effective. It’s crucial to work closely with a healthcare provider to develop a personalized treatment plan.

Can Dyspareunia Be Prevented or Managed at Home.

While not all cases of dyspareunia can be prevented, there are several strategies that may help reduce the risk or manage symptoms:

• Use water-based lubricants during intercourse
• Engage in extended foreplay to increase arousal and natural lubrication
• Practice good hygiene to prevent infections
• Avoid irritating products in the genital area
• Communicate openly with sexual partners about comfort and preferences
• Practice relaxation techniques before and during intercourse
• Experiment with different sexual positions that may be more comfortable

If pain persists despite these measures, it’s important to consult a healthcare provider for proper diagnosis and treatment.

How Does Painful Intercourse Affect Relationships and Quality of Life.

Dyspareunia can have significant impacts on various aspects of a person’s life, including:

Emotional and Psychological Effects

• Decreased self-esteem and body image
• Anxiety and depression
• Feelings of inadequacy or guilt
• Fear of intimacy

Relationship Impacts

• Reduced sexual satisfaction for both partners
• Decreased frequency of sexual activity
• Communication challenges
• Increased relationship tension or conflict

Quality of Life Effects

• Interference with daily activities
• Reduced overall life satisfaction
• Difficulty with family planning or conception

Addressing dyspareunia often requires a holistic approach that considers both the physical symptoms and the emotional and relational impacts of the condition.

What Role Do Hormones Play in Painful Intercourse.

Hormones, particularly estrogen, play a crucial role in maintaining vaginal health and can significantly impact the occurrence of painful intercourse. Estrogen helps keep vaginal tissues elastic, well-lubricated, and thick. When estrogen levels decrease, as they do during menopause, breastfeeding, or certain medical treatments, it can lead to vaginal dryness and atrophy, which are common causes of dyspareunia.

Hormonal Factors Contributing to Dyspareunia

• Menopause and perimenopause
• Postpartum period and breastfeeding
• Hormonal contraceptives
• Certain cancer treatments
• Conditions affecting the endocrine system

Hormonal therapies, such as local or systemic estrogen treatments, can often help alleviate dyspareunia caused by hormonal imbalances. However, these treatments should always be prescribed and monitored by a healthcare professional, as they may not be suitable for everyone.

When Should Someone Seek Medical Help for Painful Intercourse.

While occasional discomfort during sex can be normal, persistent or severe pain should be evaluated by a healthcare provider. It’s important to seek medical attention if:

• Pain during intercourse is persistent or recurrent
• Pain is severe or unbearable
• There’s a sudden change in sexual comfort
• Pain is accompanied by other symptoms like bleeding, discharge, or fever
• Pain is affecting your relationship or emotional well-being
• You’re unable to have intercourse due to pain

Early intervention can help identify and address underlying causes, potentially preventing long-term complications and improving quality of life. Healthcare providers can offer a range of treatments and strategies to manage dyspareunia effectively.

Remember, painful intercourse is not something to be endured or ignored. With proper diagnosis and treatment, many people can find relief and return to a satisfying sex life. Open communication with healthcare providers and partners is key to addressing this sensitive but important health issue.

Dyspareunia – Painful Sex | familydoctor.org

What is dyspareunia?

Dyspareunia is painful sex for women. Also, it causes pain during tampon use. The pain can be felt in a woman’s genitals or deep inside her pelvis.

Symptoms of dyspareunia

The pain may feel sharp, burning, or like menstrual cramps. Pain during sex may feel like it is coming from deep inside the pelvis. Women often report the feeling that something is being bumped into inside them.

Dyspareunia can have many causes, including.

• Infection (such as a yeast infection, urinary tract infection)
• Injury to the vagina
• Inflammation of the vagina. The inflammation can be so bad that wearing pants can cause pain.
• Poorly fitted diaphragm or cervical cap. These are methods of birth control.
• Muscle spasms around the vagina. For some women, the pain of the spasms is so severe that sexual intercourse is impossible.
• Vaginal dryness. This dryness may be caused by menopause and changes in estrogen levels. Estrogen is a hormone. It could also be from a lack of foreplay before intercourse.
• Abnormalities inside the uterus. These could include fibroid growth, if the uterus is tilted, or if the uterus prolapses (falls) into the vagina.
• Certain conditions or infections of the ovaries
• Past surgeries. This may leave scar tissue that can cause pain.
• Endometriosis (scar tissue outside the uterus unrelated to surgery)
• Pelvic inflammatory disease
• Being tense during sex or being unable to become aroused

How is dyspareunia diagnosed?

During a visit with your doctor, they will ask you to describe your pain, where it is located, and when it began. They may also ask you to describe what you have tried in the past to relieve the pain. For example:

• Have you tried a sexual lubricant or more foreplay?
• Is it painful every time you try to have sex?
• Are there other problems associated with sex?

Your doctor may want to examine your genital area or perform a pelvic exam. During a pelvic exam, your doctor may apply a cotton-tipped swab to the area around the vagina to see if it is painful. Your doctor will examine your vagina and cervix using a tool called a speculum. This helps the doctor gently open the area for the exam. It is similar to the way you get a Pap smear. For some women, this part of the exam may be painful. Your doctor may use a smaller speculum to decrease the discomfort. Your doctor may also delay the exam until the pain has decreased. It is important to let your doctor know if the exam becomes too painful.

During the final part of the exam, your doctor will feel your uterus and ovaries with one hand on the abdomen and finger(s) in your vagina. This is similar to exams performed during a pelvic exam.

If your symptoms and exam suggest an infection, your doctor may take a sample from your vagina or cervix to send to the lab. A urine test is another possible test. Your doctor may order a pelvic sonogram, CT (computed tomography), or X-ray test to look inside your pelvis.

Can dyspareunia be prevented or avoided?

Depending on the cause of your dyspareunia, it could be prevented through treatment. For example, if it is caused by vaginal dryness or lack of foreplay, it can be prevented through the use of a sexual lubricant.

Dyspareunia treatment

Treatments depend on what is causing your pain. They may include sexual lubricants (over-the-counter products), antibiotics for infections, a different type of birth control, or surgery.

Living with dyspareunia

Living with dyspareunia may be physically uncomfortable. However, it may affect your sexual relationship as well. Anticipating pain during sex may cause you to avoid it. It may change the type of birth control you use (which may or may not be convenient for you).

Questions to ask your doctor

• Could tampon use or overuse be causing my pain?
• Does childbirth cause the pain?
• Can hormone replacement therapy (HRT) help vaginal dryness?
• Can the pain be related to ovarian or cervical cancer?

Resources

Office on Women’s Health, U. S. Department of Health and Human Services: Reproductive Health

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Dyspareunia (Painful Intercourse): Causes, Treatments, and More

Dyspareunia (Painful Intercourse): Causes, Treatments, and More

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Medically reviewed by Debra Sullivan, Ph. D., MSN, R.N., CNE, COI — By Anna Giorgi — Updated on February 4, 2020

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Overview

Dyspareunia is the term for recurring pain in the genital area or within the pelvis during sexual intercourse. The pain can be sharp or intense. It can occur before, during, or after sexual intercourse.

Dyspareunia is more common in women than men. It has many possible causes, but it can be treated.

Several conditions can cause dyspareunia. For some women, it’s a sign of a physical problem. Other women may experience pain as a result of emotional factors.

Common physical causes of dyspareunia include:

• vaginal dryness from menopause, childbirth, breastfeeding, medications, or too little arousal before intercourse
• skin disorders that cause ulcers, cracks, itching, or burning
• infections, such as yeast or urinary tract infections (UTIs)
• injury or trauma from childbirth, an accident, an episiotomy, a hysterectomy, or pelvic surgery
• vulvodynia, or pain centered in the vulva area
• vaginitis, or inflammation of the vagina
• vaginismus, or a spontaneous tightening of the muscles of the vaginal wall
• endometriosis
• cystitis
• pelvic inflammatory disease (PID)
• uterine fibroids
• irritable bowel syndrome (IBS)
• radiation and chemotherapy

Factors that reduce sexual desire or affect a person’s ability to become aroused can also cause dyspareunia. These factors include:

• stress, which can result in tightened muscles of the pelvic floor
• fear, guilt, or shame related to sex
• self-image or body issues
• medications such as birth control pills
• relationship problems
• conditions such as cancer, arthritis, diabetes, and thyroid disease
• history of sexual abuse or rape

Dyspareunia pain can vary. Pain may occur:

• in the vagina, urethra, or bladder
• during penetration
• during or after intercourse
• deep in the pelvis during intercourse
• after pain-free intercourse
• only with specific partners or circumstances
• with tampon use
• along with burning, itching, or aching
• with a feeling of stabbing pain, similar to menstrual cramps

Both women and men can experience dyspareunia, but the condition is more common in women. Dyspareunia is one of the most common problems of postmenopausal women.

Around 75 percent of women have painful intercourse at some time, according to the American College of Obstetricians and Gynecologists (ACOG). You’re at an increased risk if you:

• take medications that cause vaginal dryness
• have a viral or bacterial infection
• are postmenopausal

Several tests help doctors identify and diagnose dyspareunia. Your doctor will start by creating a complete medical and sexual history. Possible questions your doctor may ask you include:

• When and where do you feel pain?
• Which partners or positions cause pain?
• Do any other activities cause pain?
• Does your partner want to help?
• Are there other conditions that may be contributing to your pain?

A pelvic examination is also common in diagnosis. During this procedure, your doctor will look at the external and internal pelvic area for signs of:

• dryness
• inflammation or infection
• anatomical problems
• genital warts
• scarring
• abnormal masses
• endometriosis
• tenderness

The internal examination will require a speculum, a device used to view the vagina during a Pap test. Your doctor also may use a cotton swab to apply slight pressure to different areas of the vagina. This will help determine the location of the pain.

The initial examinations may lead your doctor to request other tests, such as:

• pelvic ultrasound
• culture test to check for bacteria or yeast infection
• urine test
• allergy test
• counseling to determine the presence of emotional causes

There’s no specific prevention for dyspareunia. But you can do the following to reduce the risk of pain during intercourse:

• After childbirth, wait at least six weeks before resuming sexual intercourse.
• Use a water-soluble lubricant when vaginal dryness is an issue.
• Use proper hygiene.
• Get proper routine medical care.
• Prevent sexually transmitted diseases (STDs) by using condoms or other barriers.
• Encourage natural vaginal lubrication with enough time for foreplay and stimulation.

Alternatives to sexual intercourse may be useful until underlying conditions are treated. You and your partner can use other techniques for intimacy until penetration is more comfortable. Sensual massage, kissing, oral sex, and mutual masturbation may be satisfying alternatives.

Last medically reviewed on July 15, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Dyspareunia in women. (2014).
  aafp.org/afp/2014/1001/p465.html
• Mayo Clinic Staff. (2015). Painful intercourse (dyspareunia).
  mayoclinic.org/diseases-conditions/painful-intercourse/basics/definition/con-20033293
• Steege JF, et al. (2009). Evaluation and treatment of dyspareunia. DOI:
  10.1097/AOG.0b013e3181a1ba2a
• When sex is painful. (2017).
  acog. org/Patients/FAQs/When-Sex-Is-Painful

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Medically reviewed by Debra Sullivan, Ph.D., MSN, R.N., CNE, COI — By Anna Giorgi — Updated on February 4, 2020

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causes and treatment in Moscow

In gynecological practice, painful sexual intercourse (dyspareunia) is a set of symptom complexes of various diseases of the female body, requiring close medical attention.

In order to timely diagnose female sexual dysfunction, special questionnaires have been introduced into medical practice, allowing subjectively to determine the psycho-emotional and physiological side of intimate relationships. Based on WHO evidence-based medicine for medical use, the MFSQ (McCoy Female Sexuality Questionnaire) and FSFI (Sexual Function Index) questionnaires have been introduced.

Contents of the article

1. Questionnaire for identifying conditions that cause pain during intercourse

2. Penetration pain during intercourse: causes

3. Deep pain during intercourse

4. Treatment of pain during intercourse

Article content

1. Questionnaire for identification conditions that cause pain during intercourse

2. Pain on penetration during intercourse: causes

3. Deep pain during intercourse

4. Treatment of pain during intercourse

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Prices for the treatment of conditions that cause pain during intercourse

• Destruction of foci of endometriosis of the cervix using the Surgitron apparatus2 700
• Removal of condylomas NPO using the apparatus “Surgitron” (up to 3 elements)2 200
• Opening of cysts of the cervix of the uterus with the apparatus “Surgitron” (up to 3 elements)2 900
• Vaginal cyst removal16 200
• Bartholin gland cyst removal19,000
• Opening of an abscess of the external genital organs2 700
• Opening of abscess of Bartholin’s gland8 100
• Opening of a bartholin gland abscess with marsupialization22,000
• Treatment of bartholinitis6 900
• Restoration of the patency of the excretory duct of the large gland of the vestibule15 000
• Loop biopsy with Surgitron3 600
• Application of medicinal substances, introduction of tampons (without the cost of the drug)820
• Vaginal sanitation560

Intercourse Pain Questionnaire

To study the sexual life of women with pelvic organ prolapse and urinary incontinence, we use the well-established Pelvic Organ Prolapse and Incontinence Sexual Function Questionnaire (PISQ-31), created by Rebecca Rogers in 2002, and its shorter, more popular version, PISQ 12 Their Russian-language version can be viewed below.

The experience of the specialists of our clinic shows that patients with dyspareunia most often present two types of complaints: “pain on penetration”, “deep, sometimes sharp, internal pain” during intimacy. Competent timely interpretation of them helps to determine the further tactics of examinations and treatment.

Causes of pain during intercourse

The most common gynecological causes of this condition are untreated or undiagnosed diseases of the vulva and vagina.

Such as:

• Bartholinitis and Bartholin gland cyst – Bartholin glands are located at the base of the labia majora in the vestibule of the vagina and are responsible for secretion production. Inflammation of the bortholin gland, blockage of its duct – causes this process. As a result, an extremely painful formation is formed in the area of ​​\u200b\u200bthe genital gap, affecting the general condition of the body and making intimate life unbearable.
• Vulvar kraurosis or lichen sclerosus – A very unpleasant pathology, the main and striking symptom of which is debilitating itching of the vulva. If it is not treated, then the scleroatrophic process progresses, there is a pronounced deformation of the woman’s external genital organs. The clitoris and small lips disappear, the genital gap narrows to a critical level. Sexual relations become impossible. Previously, the disease led to the disability of a woman, fortunately, at the moment, after the introduction of the technique of laser treatment of kraurosis of the vulva into gynecological practice, it was possible to save women from severe symptoms of the disease.
• Vaginitis of various etiologies — This is an inflammation of the vagina of an infectious nature. The clinical picture is characterized by profuse discharge, itching and pain during intercourse. Fortunately, the disease is easily curable, the main thing is not to delay contacting a specialist.
• Vaginal dysbacteriosis — Characterized by a violation of the vaginal bioflora. Against this background, dryness of the mucous membrane develops, it is easily injured, various secondary infections join. The production of vaginal mucus decreases and changes, and, as a result, intimacy becomes difficult.
• Diseases caused by sexually transmitted infections – Require mandatory treatment, as they can be a prelude to many gynecological pathologies.
• Diseases of the urinary system – interstitial cystitis – Inflammation of the bladder with severe pain, aggravated by urination. The pain is so bright that there can be no talk of any contact.
• Estrogenic urogenital aging – In the premenopausal and menopausal period, the secretion of sex hormones decreases and, as a result, atrophic and dystrophic changes develop in estrogen-dependent tissues, the production of vaginal mucous secretion decreases and atrophic vaginitis and cystourethritis are formed. There is discomfort, pain during intimacy, postcoital spotting

Also, intimate discomfort may occur due to anatomical and psychosomatic features, may be due to the phase of the menstrual cycle. An important role in its development is played by damage to the anatomical integrity of the vagina and vulva after childbirth or other mechanical injuries .

Deep pain during intercourse

In addition to psychosomatic causes, it is often a symptom of serious pathologies of the reproductive system, such as:

• Diseases of the cervix such as cervicitis, erosion, parakeratosis, cervical and cervical polyp, dysplasia and cancer. One of the first signs that destructive changes are taking place in the cervix may be pain during intercourse. In this case, pain will intensify with pressure and a change in position. Often this condition is accompanied by spotting at the end of intercourse. The appearance of the above symptoms is a reason to consult a gynecologist.
• Inflammatory diseases – Endometritis, perometritis, salpingo-oophoritis, etc.; Most often they are infectious. Patients, in addition to complaints of general malaise, usually vividly describe pain in the pelvis, aggravated by pressure. Relationships are difficult because there is a feeling of deep pain during intimacy.
• Uterine fibroids — Enlargement and deformation of the organ against the background of the growth of myomatous nodes leads to anatomical changes in the small pelvis. Among other things, the pathology itself can occur with a pain syndrome, the intensity of which increases with physical exertion. If you have the above complaints, do not delay contacting a doctor.
• Adenomyosis; external endometriosis – Pathological growth of the inner (endometrial) layer of the uterus both in the organ itself and beyond. The anatomy of the small pelvis changes, intracavitary pressure rises – any penetration becomes painful.
• Ovarian cysts of various etiologies — Requires mandatory and timely treatment. With a significant size of the cyst, the probability of its rupture is high. A common symptom is pain during sex.
• Adhesions of the pelvic organs – Usually the onset of the diseases described above.
• Pelvic Organ Prolapse and Urinary Incontinence Syndrome – Painful intercourse causes a desire to avoid sexual relations until complete cessation and negatively affects the quality of life of patients. Often it is combined with such a syndrome as stress urinary incontinence, a disease that until recently was treated only with a surgical method.
• Interstitial cystitis — Debilitating chronic bladder disease with pronounced pain syndrome, the pain is aggravated by sex.
• Other extragenital pathologies (inflammation of the sacroiliac joint, colitis, hemorrhoids, etc.).

Pain during intimacy may first appear after childbirth and is caused by injuries of the birth canal, stretching of the ligamentous apparatus of the uterus and its appendages, their cicatricial deformity.

Obstetrician-gynecologists and uro-gynecologists are involved in identifying the cause of pain during sexual intercourse

In our Clinic, during the initial consultation, the patient fills out a questionnaire, which we have described above. Laboratory tests are being taken. Ultrasound is required to make a diagnosis. A colpo or vulvoscopy is done, in some cases a more high-tech study (CTG, MRI) may be required. If the pain during intimacy is due to scleroatrophic lesions of the vulva, a biopsy is performed followed by a histological examination.

Treatment of pain during intercourse

Female sexual dysfunction becomes the root cause of the breakdown of relationships between partners and requires immediate treatment. After all, both suffer from this, moreover, painful sexual intercourse is the first symptom of the presence of gynecological problems.

The basis of treatment by specialists of our clinic will be based on diagnostics in order to identify the root cause of the process.