Painful Sex in Women (Dyspareunia)
Dyspareunia is persistent or recurrent genital pain that occurs just before, during, or after intercourse and may be felt at the vaginal entrance or deeper in the abdomen.
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Understanding Pain During Intercourse Better
Pain at the entrance to or within the vagina during intercourse
Deeper abdominal pain during sex
Pain related to dryness, inflammation, pelvic floor tension, infection, endometriosis, ovarian cysts, fibroids, or other underlying conditions
What Is Dyspareunia?
Dyspareunia, or painful sex, is defined as persistent or recurrent genital pain that occurs just before, during, or after intercourse. There are two types: entry, or superficial, dyspareunia, where pain is felt at the entrance to or within the vagina, and deep, or abdominal, dyspareunia, where pain is felt in the abdomen.
Dyspareunia is common and may cause considerable distress to women and their sexual partners. It may be caused by structural, infective, and inflammatory diseases of the vulva, vagina, and internal organs. Psychosocial factors can also contribute to and result from dyspareunia.
Dyspareunia may be primary, meaning it occurred with the first attempt at intercourse and ever since, or secondary, meaning it began later after previously having no pain with intercourse. Pain can occur with every attempt at intercourse or only on certain occasions or in certain situations.
Types and Possible Causes of Painful Sex
Entry dyspareunia is pain felt at the entrance to or within the vagina. The most common vulval skin diseases that may cause superficial or entry dyspareunia include dryness or eczema/dermatitis, primary fissuring of the posterior fourchette, medications that dry the skin, genital herpes or other sexually transmitted infections, lichen sclerosus, lichen planus, and plasma cell vulvitis.
Dyspareunia associated with vaginal dryness or inflammation may be related to insufficient lubrication, hormonal changes such as birth control medication, lactation, cancer treatment, or menopause, irritation from vaginal lubricants or products, medications that dry mucosal surfaces, Sjogren syndrome, vulvovaginal candidiasis, bacterial vaginosis, chlamydia infection, trichomoniasis, erosive vaginal lichen planus, desquamative inflammatory vaginitis, or radiation-induced vaginitis following treatment for uterine or cervical cancer.
Dyspareunia may also result from genital malformations, injury during childbirth or surgery, urinary tract infection, interstitial cystitis, pain affecting the vestibule or vulva, tense pelvic floor muscles, vaginismus, or low libido related to fear, anxiety, relationship problems, or sexual abuse.
Deep dyspareunia means sexual pain felt in the abdomen rather than in the vagina. Causes may include recent pregnancy or childbirth, retroverted uterus, uterine prolapse, pelvic inflammatory disease or infection, endometriosis, ovarian cysts, uterine fibroids, bowel disease such as irritable bowel syndrome, lumbosacral arthritis, adhesions following previous surgery or radiation, or genital tract cancer.
Frequently Asked Questions
What is dyspareunia?
Dyspareunia is persistent or recurrent genital pain that occurs just before, during, or after intercourse.
What are the types of dyspareunia?
The two types are entry, or superficial, dyspareunia, where pain is felt at the entrance to or within the vagina, and deep, or abdominal, dyspareunia, where pain is felt in the abdomen.
Can painful sex begin after previously having no pain?
Yes. Dyspareunia may be primary, meaning it has occurred since the first attempt at intercourse, or secondary, meaning it began later after previously having no pain with intercourse.
What can cause entry dyspareunia?
Entry dyspareunia may be related to vulval skin conditions, vaginal dryness or inflammation, infections, irritation, hormonal changes, injury, urinary tract infection, interstitial cystitis, vulvar or vestibular pain, tense pelvic floor muscles, vaginismus, or psychosocial factors.
What can cause deep dyspareunia?
Deep dyspareunia may be related to recent pregnancy or childbirth, retroverted uterus, uterine prolapse, pelvic inflammatory disease or infection, endometriosis, ovarian cysts, uterine fibroids, bowel disease, lumbosacral arthritis, adhesions, or genital tract cancer.
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