Dyspareunia

Dyspareunia is pain during sexual intercourse. It is most common in women, but it also happens in men.

CAUSES

Female

The pain from this condition is usually felt when anything is put into the vagina, but any part of the genitals may cause pain during sex. Even sitting or wearing pants can cause pain. Sometimes, a cause cannot be found. Some causes of pain during intercourse are:

  • Infections of the skin around the vagina.

  • Vaginal infections, such as a yeast, bacterial, or viral infection.

  • Vaginismus. This is the inability to have anything put in the vagina even when the woman wants it to happen. There is an automatic muscle contraction and pain. The pain of the muscle contraction can be so severe that intercourse is impossible.

  • Allergic reaction from spermicides, semen, condoms, scented tampons, soaps, douches, and vaginal sprays.

  • A fluid-filled sac (cyst) on the Bartholin or Skene glands, located at the opening of the vagina.

  • Scar tissue in the vagina from a surgically enlarged opening (episiotomy) or tearing after delivering a baby.

  • Vaginal dryness. This is more common in menopause. The normal secretions of the vagina are decreased. Changes in estrogen levels and increased difficulty becoming aroused can cause painful sex. Vaginal dryness can also happen when taking birth control pills.

  • Thinning of the tissue (atrophy) of the vulva and vagina. This makes the area thinner, smaller, unable to stretch to accommodate a penis, and prone to infection and tearing.

  • Vulvar vestibulitis or vestibulodynia. This is a condition that causes pain involving the area around the entrance to the vagina. The most common cause in young women is birth control pills. Women with low estrogen levels (postmenopausal women) may also experience this. Other causes include allergic reactions, too many nerve endings, skin conditions, and pelvic muscles that cannot relax.

  • Vulvar dermatoses. This includes skin conditions such as lichen sclerosus and lichen planus.

  • Lack of foreplay to lubricate the vagina. This can cause vaginal dryness.

  • Noncancerous tumors (fibroids) in the uterus.

  • Uterus lining tissue growing outside the uterus (endometriosis).

  • Pregnancy that starts in the fallopian tube (tubal pregnancy).

  • Pregnancy or breastfeeding your baby. This can cause vaginal dryness.

  • A tilting or prolapse of the uterus. Prolapse is when weak and stretched muscles around the uterus allow it to fall into the vagina.

  • Problems with the ovaries, cysts, or scar tissue. This may be worse with certain sexual positions.

  • Previous surgeries causing adhesions or scar tissue in the vagina or pelvis.

  • Bladder and intestinal problems.

  • Psychological problems (such as depression or anxiety). This may make pain worse.

  • Negative attitudes about sex, experiencing rape, sexual assault, and misinformation about sex. These issues are often related to some types of pain.

  • Previous pelvic infection, causing scar tissue in the pelvis and on the female organs.

  • Cyst or tumor on the ovary.

  • Cancer of the female organs.

  • Certain medicines.

  • Medical problems such as diabetes, arthritis, or thyroid disease.

Male

In men, there are many physical causes of sexual discomfort. Some causes of pain during intercourse are:

  • Infections of the prostate, bladder, or seminal vesicles. This can cause pain after ejaculation.

  • An inflamed bladder (interstitial cystitis). This may cause pain from ejaculation.

  • Gonorrheal infections. This may cause pain during ejaculation.

  • An inflamed urethra (urethritis) or inflamed prostate (prostatitis). This can make genital stimulation painful or uncomfortable.

  • Deformities of the penis, such as Peyronie's disease.

  • A tight foreskin.

  • Cancer of the male organs.

  • Psychological problems. This may make pain worse.

DIAGNOSIS

  • Your caregiver will take a history and have you describe where the pain is located (outside the vagina, in the vagina, in the pelvis). You may be asked when you experience pain, such as with penetration or with thrusting.

  • Following this, your caregiver will do a physical exam. Let your caregiver know if the exam is too painful.

  • During the final part of the female exam, your caregiver will feel your uterus and ovaries with one hand on the abdomen and one finger in your vagina. This is a pelvic exam.

  • Blood tests, a Pap test, cultures for infection, an ultrasound test, and X-rays may be done. You may need to see a specialist for female problems (gynecologist).

  • Your caregiver may do a CT scan, MRI, or laparoscopy. Laparoscopy is a procedure to look into the pelvis with a lighted tube, through a cut (incision) in the abdomen.

TREATMENT

Your caregiver can help you determine the best course of treatment. Sometimes, more testing is done. Continue with the suggested testing until your caregiver feels sure about your diagnosis and how to treat it. Sometimes, it is difficult to find the reason for the pain. The search for the cause and treatment can be frustrating. Treatment often takes several weeks to a few months before you notice any improvement. You may also need to avoid sexual activity until symptoms improve. Continuing to have sex when it hurts can delay healing and actually make the problem worse.

The treatment depends on the cause of the pain. Treatment may include:

  • Medicines such as antibiotics, vaginal or skin creams, hormones, or antidepressants.

  • Minor or major surgery.

  • Psychological counseling or group therapy.

  • Kegel exercises and vaginal dilators to help certain cases of vaginismus (spasms). Do this only if recommended by your caregiver. Kegel exercises can make some problems worse.

  • Applying lubrication as recommended by your caregiver if you have dryness.

  • Sex therapy for you and your sex partner.

It is common for the pain to continue after the reason for the pain has been treated. Some reasons for this include a conditioned response. This means the person having the pain becomes so familiar with the pain that the pain continues as a response, even though the cause is removed. Sex therapy can help with this problem.

HOME CARE INSTRUCTIONS

  • Follow your caregiver's instructions about taking medicines, tests, counseling, and follow-up treatment.

  • Do not use scented tampons, douches, vaginal sprays, or soaps.

  • Use water-based lubricants for dryness. Oil lubricants can cause irritation.

  • Do not use spermicides or condoms that irritate you.

  • Openly discuss with your partner your sexual experience, your desires, foreplay, and different sexual positions for a more comfortable and enjoyable sexual relationship.

  • Join group sessions for therapy, if needed.

  • Practice safe sex at all times.

  • Empty your bladder before having intercourse.

  • Try different positions during sexual intercourse.

  • Take over-the-counter pain medicine recommended by your caregiver before having sexual intercourse.

  • Do not wear pantyhose. Knee-high and thigh-high hose are okay.

  • Avoid scrubbing your vulva with a washcloth. Wash the area gently and pat dry with a towel.

SEEK MEDICAL CARE IF:

  • You develop vaginal bleeding after sexual intercourse.

  • You develop a lump at the opening of your vagina, even if it is not painful.

  • You have abnormal vaginal discharge.

  • You have vaginal dryness.

  • You have itching or irritation of the vulva or vagina.

  • You develop a rash or reaction to your medicine.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop severe abdominal pain during or shortly after sexual intercourse. You could have a ruptured ovarian cyst or ruptured tubal pregnancy.

  • You have a fever.

  • You have painful or bloody urination.

  • You have painful sexual intercourse, and you never had it before.

  • You pass out after having sexual intercourse.