Painful Sexual Intercourse (Dyspareunia)

What Is It?

Pain during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. There are numerous causes of dyspareunia, many of which are treatable. Common causes include the following:

• Vaginal dryness
• Atrophic vaginitis, a common condition causing thinning of the vaginal lining in postmenopausal women
• Side effects from drugs such as antihistamines and tamoxifen (Nolvadex)
• An allergic reaction to clothing, spermicides or douches
• Endometriosis, an often painful condition in which tissue from the uterine lining migrates and grows abnormally inside the pelvis
• Vulvar vestibulitis, which is inflammation of the area surrounding the vaginal opening
• Skin diseases affecting the vaginal area
• Urinary-tract infections, vaginal yeast infections, or sexually transmitted diseases
• Psychological trauma, often stemming from a past history of sexual abuse or trauma

Symptoms

Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain with penetration or penile thrusting. Some women may also experience severe tightening of the vaginal muscles with penetration, a condition called vaginismus.

Diagnosis

Dyspareunia typically is diagnosed based on your symptoms. Your medical and sexual history and your physical examination will help your doctor to determine the cause of your symptoms.

Distinguishing pain that occurs with touching the genitals or early penetration from pain that occurs with deeper penetration is a clue to the cause of your symptoms. Therefore, your doctor will ask you questions about the exact location, duration and timing of your pain. He or she also will ask you:

• If there was ever a time you had painless intercourse, or if you have always had dyspareunia
• If you have adequate natural lubrication, and if your symptoms improve if you use commercially available lubricants
• About your sexual history (to help assess your risk for sexually transmitted infections)
• If you have ever been sexually abused, or had a traumatic injury involving your genitals
• If you are middle-aged, your doctor will ask whether you are experiencing irregular periods, hot flashes or vaginal dryness, symptoms suggesting that you may have atrophic vaginitis.
• If you are a new mother, breast-feeding your baby, because breast-feeding also can lead to vaginal dryness and dyspareunia