Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many women have painful intercourse at some point in their lives.
The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh), defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you're having painful intercourse. Treatments focus on the cause, and can help eliminate or lessen this common problem.
If you have painful intercourse, you might feel:
If you have recurrent pain during sex, talk to your doctor. Treating the problem can help your sex life, your emotional intimacy and your self-image.
Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors might be associated with many types of painful intercourse.
Pain during penetration might be associated with a range of factors, including:
Not enough lubrication. This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breast-feeding also can be a cause.
Certain medications are known to affect sexual desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
Deep pain usually occurs with deep penetration. It might be worse in certain positions. Causes include:
Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain. Emotional factors include:
It can be difficult to tell whether emotional factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. You might start avoiding sexual intercourse if you associate it with the pain.
A medical evaluation for dyspareunia usually consists of:
A thorough medical history. Your doctor might ask when your pain began, where it hurts, how it feels and if it happens with every sexual partner and every sexual position. Your doctor might also inquire about your sexual history, surgical history and childbirth.
Don't let embarrassment stop you from answering truthfully. These questions provide clues to the cause of your pain.
A pelvic exam. During a pelvic exam, your doctor can check for signs of skin irritation, infection or anatomical problems. He or she might also try to locate your pain by applying gentle pressure to your genitals and pelvic muscles.
A visual exam of your vagina, using an instrument called a speculum to separate the vaginal walls, might be performed as well. Some women who have painful intercourse also have discomfort during a pelvic exam. You can ask to stop the exam if it's too painful.
Treatment options vary depending on the cause of the pain.
If an infection or medical condition contributes to your pain, treating the cause might resolve your problem. Changing medications known to cause lubrication problems also might eliminate your symptoms.
For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina.
The Food and Drug Administration approved the drug ospemifene (Osphena) to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining.
Drawbacks are that the drug might cause hot flashes, and it carries a risk of stroke, blood clots and cancer of the lining of the uterus (endometrium).
Another drug to relieve painful intercourse is prasterone (Intrarosa). It's a capsule you place inside the vagina daily.
Certain nonmedication therapies also might help with dyspareunia:
Counseling or sex therapy. If sex has been painful for some time, you might have a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you might also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.
Cognitive behavioral therapy also can be helpful in changing negative thought patterns and behaviors.
You and your partner might be able to minimize pain with a few changes to your sexual routine:
Until vaginal penetration becomes less painful, you and your partner might find other ways to be intimate. Sensual massage, kissing and mutual masturbation offer alternatives to intercourse that might be more comfortable, more fulfilling and more fun than your regular routine.
Talking to your doctor is the first step in resolving painful intercourse. Your regular doctor might diagnose and treat the problem or refer you to a specialist.
To prepare for this discussion with your doctor, make a list of:
Some questions to ask your doctor include:
Your doctor might ask you questions, including: