The Symptoms, Diagnosis and Treatment of Dyspareunia

Statistics vary with different sources but indicate that many women experience dyspareunia, the medical term for painful intercourse.

"Dyspareunia, by definition, occurs during vaginal penetration," said Alexander Lin, M.D., a board-certified OB-GYN at Northwestern Medicine with locations in Orland Park and Mokena, Illinois. "It can occur at any point in time during intercourse."

Though common, dyspareunia can be challenging to treat because there are many types of pain and possible causes. Accurately describing your symptoms can help your doctor narrow down the possible reasons, test for the underlying cause and recommend the best treatment.

Symptoms of dyspareunia

If you have pain during sex, you might experience very localized pain or deep pelvic discomfort. The pain might also flare at specific moments during sexual intercourse.

"Some patients will have intense pain with initial attempts to have penetration," Lin said. "Other patients will feel pain more when penetration is deep or thrusting."

He said patients have described painful intercourse as sharp, knife-like, dry, burning or nauseating.

Depending on the cause of your dyspareunia, symptoms might include the following:

• Internal discomfort or throbbing during deep thrusting
• Sharp or burning pain at entry
• Tight, spasming or cramping pelvic muscles

Some women feel distinct pain in very specific locations at a very specific time. Others experience pain in the entire genital region during intercourse.

Types of dyspareunia

Dyspareunia can be divided into two main categories: entry pain (mostly external) and deep pain (internal).

Specifics locations of the pain include the following:

• Vulva (this includes the labia, clitoris, and urethral and vaginal openings)
• Perineum (the area between the genitals and anus)
• Deep in the pelvis (cervix, uterus or bladder)

In general, it's important to remember that dyspareunia symptoms vary depending on the underlying cause.

How is dyspareunia diagnosed?

Dyspareunia differs from other gynecological conditions because the term can be used to describe a symptom or diagnosis.

For example, Lin explained, one patient might need a treatment plan for dyspareunia itself, such as when it is caused by overly active pelvic muscles. In contrast, another patient might experience dyspareunia as a symptom of a different problem, such as low estrogen.

The first step to getting a proper diagnosis is to talk to a gynecologist or primary care physician. They can discuss your symptoms and health history, perform a physical examination and suggest other tests as needed.

What tests are done to diagnose dyspareunia?

Pinpointing the cause of dyspareunia can be tricky. Sometimes the pain has a clear physical cause, like endometriosis or some types of uterine fibroids. Other times, painful sex has no apparent cause or is psychologically triggered by past trauma or current relationship problems.

Evaluating dyspareunia typically includes the following:

Medical history discussion

Your doctor typically asks when the pain began, where it occurs, how often it happens and whether you notice other symptoms with the pain. Discussing your sexual history and any significant life changes just before symptom onset can help inform the next steps, Lin said.

"Most of the time, spending the time to take a thorough history and listening to the patient tell her story will lead you to the correct diagnosis or cause of the patient's pain," Lin explained. "Many times, the patient may already have a strong suspicion as to the cause of her pain. Typically, she is correct."

A successful diagnosis hinges on being open and honest. Talking about your sexual habits and history might feel embarrassing or uncomfortable, but it's essential to pinpoint the cause of your pain.

Physical exam

During a pelvic exam, your doctor checks your external genitalia for signs of irritation, infection and injury. Lin said he uses a soft cotton swab to check for points of tenderness or involuntary muscle contraction before proceeding to the internal exam.

An internal exam requires a speculum, a tool used to gently open the vagina so the doctor can see inside. In cases of dyspareunia, the doctor may use a narrow speculum, according to Lin.

"I evaluate her tolerance for penetration with a narrow object, look for evidence of pelvic prolapse and usually test for vaginal and cervical infections in this part of the exam," he said.

If you are comfortable with it, the doctor might also use their fingers to feel for pelvic masses and press on your pelvic floor muscles to evaluate their level of tension.

Some women feel pain or discomfort during pelvic exams. Remember that you can always ask the doctor to take a break or stop the exam if it's too painful.

Other tests 

After the consultation and physical exam, your doctor might recommend further tests. These could include a blood test to check your estrogen level, a transvaginal or pelvic ultrasound to get a better look at what's going on internally, or a laparoscopy to check for endometriosis, fibroids or other potential causes of the pain.

Next steps

Some causes of painful sex require medical intervention. Others resolve on their own over time. And then sometimes there's more than one cause of your dyspareunia, requiring a multifaceted approach that might include physical and emotional support.

If you still experience painful sex after receiving treatment for the presumed cause of dyspareunia, don't hesitate to tell your doctor.

"A thorough evaluation will usually unveil an underlying cause if one exists," Lin said. "The vast majority of patients do get better over time. Each case is unique, requiring a customized plan of care."

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