What is Dyspareunia?
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.
What Causes Dyspareunia?
Several conditions can cause
dyspareunia. For some women, it is a sign of a physical problem. Other women
may experience pain as a result of emotional factors.
Common physical causes of
- vaginal dryness from menopause, childbirth,
breastfeeding, medications, or too little arousal before intercourse
- skin disorders that cause ulcers, cracks, itching,
- infections, such as yeast or urinary tract
- injury or trauma from childbirth, an accident, an episiotomy,
a hysterectomy, or pelvic surgery
- pain centered in the vulva area (vulvodynia)
- inflammation of the vagina (vaginitis)
- a spontaneous tightening of the muscles of the
vaginal wall (vaginismus)
- pelvic inflammatory disease
- uterine fibroids
- irritable bowel syndrome
- radiation and chemotherapy
Factors that reduce sexual desire
or affect a person’s ability to become aroused can also cause dyspareunia. These
- 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
- cancer, arthritis, diabetes, and thyroid disease
- history of sexual abuse or rape
Who Is at Risk for Dyspareunia?
Both men and women can experience
dyspareunia. But the condition is more common in women. Dyspareunia is one of
the most common problems of postmenopausal women, and a majority of women have
painful intercourse at some time (FDA). You are at an increased risk if you:
- take medications that cause vaginal dryness
- have a viral or bacterial infection
- are postmenopausal
What Are the Symptoms of Dyspareunia?
Dyspareunia pain can vary. Pain may
- 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
How is Dyspareunia Diagnosed?
Several tests help identify and
diagnose dyspareunia. A doctor will start by creating a complete medical and
sexual history. Possible questions 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, a doctor will look at the external and
internal pelvic area for signs of:
- inflammation or infection
- anatomical problems
- genital warts
- abnormal masses
The internal examination will
require a speculum, a device used with a Pap smear. A 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
a physician to request other tests, such as:
test to check for bacteria or yeast infection
to determine the presence of emotional causes
How is Dyspareunia Treated?
treatments are based on the cause of the condition. If your pain is caused by
an underlying infection or condition, your doctor may treat it with:
or antifungal medicines
or injectable corticosteroids
long-term medication is causing vaginal dryness, your physician may change your
prescription. Trying alternative medications may restore natural lubrication
and reduce pain.
levels cause dyspareunia in some women. A prescription tablet, cream, or flexible
ring can deliver a small, regular dose of estrogen to the vagina.
estrogen-free drug, called ospemifene (Osphena), acts like estrogen on vaginal tissues.
It is effective in making the tissues thicker and less fragile. This can reduce
the amount of pain women experience with sexual intercourse.
home remedies can also reduce dyspareunia symptoms:
- Have sex
when you are your partner are relaxed.
openly with your partner about your pain.
your bladder before sex.
- Take a
warm bath before sex.
- Take an
over-the-counter pain reliever before sex.
- Apply an
ice pack to the vulva to calm burning after sex.
may also recommend therapy. This can include:
- desensitization therapy: learning
vaginal relaxation techniques, such as Kegel exercises, that can decrease pain
- sex therapy: learning how to
reestablish intimacy and improve communication with your partner
What Is the Outlook for Dyspareunia?
Options 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
There is no specific prevention
for dyspareunia. But you can do the following to reduce the risk of pain during
- 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) with
- Encourage natural vaginal lubrication with enough
time for foreplay and stimulation.