What is the cause of dyspareunia?

Dyspareunia is pain that happens just before, during, or after sex. 

In women, common causes include:

  • Giving birth– Sex can be painful for several weeks or months after giving birth.
  • Endometriosis
  • Stiffness of the muscles around the vagina.
  • A condition called “vulvodynia” – This is pain in the vulva.
  • Chronic pelvic pain –  Or pain in the pelvic area that lasts 6 months or longer.
  • An infection in the vagina or bladder
  • Skin problems around the vagina
  • Anxiety about sex or your partner
  • A painful experience – This could be a past experience of sex or a medical exam that hurt. It could even be pain from using a tampon
  • Birth control pills – A rare side effect of some birth control pills is dyspareunia.
  • Vaginal dryness either due to menopause or not being aroused before sex.

What are the symptoms of dyspareunia?

The main symptom of dyspareunia is pain during sex. However, it is not limited to sexual pain. Symptoms also include:

  • Pain only at sexual entry (penetration)
  • Pain with any penetration, including inserting a tampon.
  • Deep pain during thrusting.
  • Burning pain or sharp pain.
  • Throbbing pain, that can last for hours after intercourse.

What is dyspareunia due to menopause?

Dyspareunia in menopause  is caused by insufficient lubrication due to low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina. Another medication that is sometimes used to relieve painful intercourse is prasterone (Brand name: Intrarosa or Imvexxy).

How is painful intercourse treated?

Depending on the cause of dyspareunia and your specific symptoms, our providers treat it with:

  • Antibiotics or antifungal medicines – These can help if the pain is caused by an infection in the vagina or bladder.
  • Prescription creams or gels to keep the vagina moist and prevent dryness.
  • Gels that numb the vagina before and after sex.
  • Physical therapy to loosen the muscles around the vagina.
  • Counseling – This can help if pain is caused by bad feelings about sex, a relationship, or yourself.
  • Managing stress, fatigue, and relationship issues if that is what is causing the pain.

What can I expect when I see a provider about pain during sex?

Your medical and sexual history, signs and symptoms, and findings from a physical exam are all factors in determining the cause of your pain. 

You may also be asked about medications that you are taking, whether you have any medical conditions, and past events that may affect how you feel about sex, such as sexual abuse. Other health care professionals may be consulted for further evaluation and treatment, such as a physical therapist or a dermatologist.

More Information About dyspareunia from ACOG (American College of Obstetricians and Gynecologists)

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