Because there are numerous physical conditions that can contribute to pain during sexual encounters, a careful physical examination and medical history are always indicated with such complaints. In women, common physical causes for coital discomfort include infections of the vagina, lower urinary tract, cervix, or fallopian tubes (e.g., Trichomonas, coliform bacteria, mycotic organisms); endometriosis; surgical scar tissue (following episiotomy); and ovarian cysts and tumors (Bancroft 1989). In addition to infections and chemical causes of dyspareunia such as monilial organisms and herpes, anatomic conditions, such as hymenal remnants, can contribute to coital discomfort (Sarrell and Sarrell 1989). Estrogen deficiency is a particularly common cause of sexual pain complaints among postmenopausal women, although vaginal dryness is often reported by lactating women as well (Bachmann et al 1984). Women undergoing radiation therapy for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and their susceptibility to trauma.
Bancroft (1989) noted that even following apparently successful treatment of acute vaginal infections, the normal lubrication response may be impaired. Both Fordney (1978) and Bancroft (1989) observed that subclinical or low-grade infection is common among some women and should be considered of etiological relevance in women without discernible clinical findings.
Revision date: July 5, 2011
Last revised: by Jorge P. Ribeiro, MD