Causes of pain during sex (dyspareunia) and remedy

 Key takeaways

• Painful intercourse, medically called dyspareunia, is more common in people with a uterus, but people with a penis can also experience it.
• Painful intercourse can be a symptom of an underlying medical issue like endometriosis or fibroid. Other possible causes of painful intercourse in males and females include infections, pelvic injuries, sexually transmitted diseases, and pelvic inflammatory disease.
• Dyspareunia is treated based on the underlying cause, which is why a diagnosis by your doctor is important. 

Painful intercourse is medically known as dyspareunia, and it refers to persistent or recurring pain in the genitals or pelvic area before, during, and/or after sexual intercourse. Dyspareunia can feel like a sharp burning pain, intense discomfort, or throbbing sensation in the genital and pelvic areas.

Many people experience painful intercourse sometimes in their lives. But a 2018 review article shows that dyspareunia is more common among women aged 55–64 and 16–24 years.

Dyspareunia is classified into two types: entry pain and deep pain. Entry pain is the pain you experience in your external genital area (vagina and vulva) during penetration, while deep pain is experienced during deep penetration.

 Causes of dyspareunia in women

Dyspareunia in women can be caused by different conditions, some of which can be easily treated. Also, some of the conditions associated with this symptom may require immediate medical attention.

 1. Insufficient vaginal lubrication or vaginal atrophy

Painful intercourse may be a result of insufficient lubrication of the walls of the vagina. One remedy for this is indulging in foreplay to increase stimulation before intercourse.

Vaginal dryness is also common among menopausal women. According to a 2021 research, vaginal dryness and other effects of estrogen drop affect about 50% of women in their menopause. 

Vaginal atrophy is a medical condition where the vaginal lining gets dry and inflamed. It can cause burning pain on entry and deep penetration. 

 2. Vaginismus

Vaginismus is the involuntary contraction of the vaginal muscles. It is the body’s automatic response to any form of vaginal penetration, and it can make intercourse painful.

 3. Infections and inflammation

Having sexual intercourse when you have an infection—especially in the pelvic or genital area—can make the experience painful because your genital area can be sore, inflamed, and tender. Some possible infections that can be present include vaginal infections like yeast and urinary tract infections (UTIs).

 4. Psychological and emotional trauma

How you feel emotionally can affect your sexual performance. According to a 2020 study that evaluated sexual pain in 450 married, sexually active females, psychological factors like depression and anxiety are risk factors for dyspareunia. 

Another 2018 study suggests that a history of sexual abuse can cause dyspareunia and intimacy issues among survivors.

 5. Injuries from Surgical procedures

Episiotomy is a surgical procedure where an incision is made between the vaginal canal and anus during childbirth, and hysterectomy is the surgical removal of the uterus. According to a 2019 review article, dyspareunia is one of the complications of episiotomy.

 6. Endometriosis

Endometriosis is a medical condition where a tissue similar to the endometrial tissue grows outside the uterus. The endometrial tissue is the tissue lining the inner part of the uterus, called the endometrium.

An observational study published by the Journal of Sexual Medicine shows that severe deep dyspareunia is common among women with endometriosis.

 7. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is the infection of one or more upper female reproductive organs, including the ovaries, uterus, or fallopian tubes. This leads to inflammation. PID usually starts as a bacterial infection in the vagina that ascends and spreads to other reproductive organs.

According to a 2018 review article, 85% of the infections in PID are caused by sexually transmitted bacteria.

 Causes of dyspareunia in men

The common causes of dyspareunia in men are penile disorders, and they include:

 1. Foreskin damage

The foreskin is the layer of skin that covers the head of a penis. Painful intercourse in men can be a result of foreskin problems like tightness, swelling, infection, or inflammation.

 2. Sexually transmitted infections (STIs)

The manifestation of symptoms of STIs like herpes and warts in men can make intercourse painful.

 3. Penile deformities

Penile deformities are unusual penis structures or changes to the normal structure of the penis due to diseases or congenital conditions. 

 4. Painful erections

Painful erection is medically known as priapism, and it is an abnormal condition where you have an erection that lasts longer than 4 hours. A 2023 study shows that priapism is common among adult males living with sickle cell anemia.

 Symptoms of dyspareunia

A person with dyspareunia may experience the following symptoms:

• Pain in the vagina, urethra, or bladder
• Pain during penetration
• Pain or discomfort during or after intercourse
• Pain when using tampons
• Pain accompanied by a throbbing, aching, or burning sensation
• Pain in the pelvic area, similar to menstrual cramps

 Is it normal to have pain after sex?

Sex for a healthy person is not typically painful. It may not be an issue if you experience pain or soreness occasionally after vigorous sex. But it becomes concerning when this happens constantly.

If after-sex pain becomes frequent or you experience other unusual symptoms in addition to this, then you should see your doctor immediately.

 Is there a cure for dyspareunia?

Yes, there are available medications for treating pain before and after sex, and the treatment may provide a cure for some people.

Your doctor will recommend the appropriate treatment for dyspareunia after a proper diagnosis to determine the cause of this issue. These treatments will not always include medications, but they can just include lifestyle changes to help with this condition.

 Diagnosis and Treatment for Painful Sex

Before your doctor makes a diagnosis of dyspareunia, you will need to provide information about your medical history and undergo some physical tests. These procedures help your doctor rule out several disorders and confirm the diagnosis.

 1. Medical history

Your doctor will ask several questions about your medical history or sexual history. Some of these questions include:

• When did the pain start?
• Where does it hurt?
• What does the pain feel like?
• Does the pain happen with every partner?
• Does the pain happen in every position?
• Does any other activity cause pain in the same area?

Other questions may relate to surgical and childbirth histories.

 2. Pelvic exams

If you are a person assigned female at birth, a gynecologist may carry out a pelvic exam on your female reproductive system to check your gynecological health. This exam can be external, which involves examining the vulva and vagina, or your doctor may use a speculum to open the vagina for a full analysis of this part and the cervix for any abnormalities. 

Your doctor may also perform a pap smear or test to check for abnormal cells in your cervix, and fluids collected from this area can be used to test for infection. A rectal test can be part of the pelvic exam, where your doctor puts on gloves and lubrication before gently sliding their index finger into your rectum to feel for any abnormalities. In men, a rectal test also examines the prostate gland.

 Treatment for dyspareunia

Your doctor will administer or recommend the appropriate treatment for dyspareunia after diagnosis. Some possible treatments for this health condition include:

 1. Medications

If you’ve been using any medication that may have caused dyspareunia, your doctor will recommend new ones.

Your doctor's prescription will depend on the underlying cause of your symptoms. If you are experiencing dyspareunia caused by an infection, your doctor may prescribe antibiotics or antifungals to solve this problem. 

For dyspareunia that results from vaginal dryness, e.g., during menopause, your doctor may prescribe tablets or creams that will give you increased doses of estrogen for proper vaginal lubrication.

 2. Lifestyle changes

Some treatment for dyspareunia does not require medications, so your doctor may recommend lifestyle changes. Some of the recommendations your doctor may give you include:

• Change positions to see what works. This includes the female being on top to control the depth and rhythm of penetration during intercourse.
• Wait until about 3 months after childbirth before having intercourse. A 2022 study shows a high prevalence of dyspareunia in postpartum mothers three months after childbirth.
• Prolong foreplay. This may help you reach your peak of arousal for proper vaginal lubrication.
• Use lubricants. This helps loosen the vaginal walls, makes them wetter, and hence makes sexual intercourse more comfortable.
• Communicate with your partner. Communicating with your partner during sex is important for couples as it helps them understand your body so they know what makes you uncomfortable.

 3. Sexual Therapy

Painful sex can be a result of intimacy or emotional issues. Counseling or sex therapy is the recommended treatment in this situation, and it helps you communicate better with your partner on intimacy and sexual issues.

 Tips for managing the symptoms of dyspareunia

If you feel pain during and after sex, here are some tips you can take to feel better:

• Try water-based gel lubricants. They may be great for vaginal dryness and not harmful to the vaginal microbes.
• Take an over-the-counter (OTC) pain reliever before intercourse. 
• Have intercourse when you and your partner are relaxed, and always take time to de-stress afterward.
• Have a warm bath before intercourse.

 When to see a doctor for painful sex

It is easy to rule out painful sex if it is a one-time occurrence. However, if it becomes recurrent, painful sex may be an indication of an underlying medical condition such as cervical cancer, endometriosis, or fibroid. If you notice any of the symptoms below, see your doctor immediately:

• Increased pain during intercourse
• Vaginal bleeding
• Unusual vaginal or penile discharge
• Fever
• Persistent pain even after OTC medications

Your doctor may review these symptoms to make a diagnosis and give the appropriate treatment for these new symptoms.

 Wrap up

Research has shown that many women experience painful intercourse, which can be caused by hormonal changes that may or may not be related to menopause, psychological factors, and infections. 

The common symptom of dyspareunia is an intense, sharp, or burning pain that happens before, during, or after sexual intercourse. While the cause of dyspareunia can be minor, like a lack of lubrication, it can also be a symptom of a serious medical issue like PID or endometriosis.

When concerned about your experience during or after sex, you may want to speak to your doctor. If, after running tests, they suspect it is a psychological issue, they may refer you to a psychologist or sex therapist.