Find out how dyspareunia affects your sexual health.
Dyspareunia is a persistent pain that occurs during sexual intercourse. While dyspareunia can affect men and women, it is significantly more common in women. Up to 20 percent of women in the United States experience dyspareunia, according to the American Academy of Family Physicians (AAFP).
A wide range of physical and psychological factors can contribute to dyspareunia, and painful intercourse can lead to distress and relationship problems. Treatment typically focuses on the underlying cause.
The word "dyspareunia" comes from the Greek word "dyspareunos," which means "badly mated." In recent years, there's been debate over whether to recategorize dyspareunia as a pain disorder instead of a sex disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
The previous edition explained that the diagnosis of dyspareunia is made when the patient complains of recurrent genital pain before, during or after sexual activity that is not caused by lack of lubrication or vaginal spasm alone. Some physicians have argued for the removal of dyspareunia from the manual and the most recent edition groups dyspareunia under the diagnosis of genito-pelvic pain/penetration disorder.
Dyspareunia pain can vary from person to person. The pain may be sharp or feel like burning during sex. It could feel like it is coming from deep inside the pelvis. Some people may even experience pain after sex.
If you have dyspareunia, you might feel:
There are many different physical, emotional and mental health-related causes of dyspareunia. Because many things can contribute to the condition, it's sometimes challenging to pinpoint the exact cause. The physical causes can depend on whether the pain occurs at initial entry or with deep thrusting.
Potential causes of dyspareunia include:
Because emotions are closely intertwined with sexual activity, mental health can play a role in pain during intercourse. Emotional and mental factors can include:
Vaginal dryness is a common condition in women who have been through menopause. This condition is also common in people who have had their ovaries removed.
Vaginal dryness may not be bothersome, but it can lead to uncomfortable symptoms, such as pain during sex, burning or itching, or vaginal discharge. It could also be related to urinary symptoms, such as painful urination.
Vaginal dryness may lead to less satisfying sex and cause women to avoid intimacy.
The following tips may help you reduce the risk of pain during intercourse:
The underlying cause of dyspareunia can generally be diagnosed by discussing a patient's history and conducting a physical examination, which may include looking at the pelvis, vagina and uterus. A doctor may also collect a sample of vaginal fluid and urine to test for infection.
To pinpoint the source of the pain and diagnose any underlying conditions, doctors may perform a transvaginal ultrasound so they can take a closer look at the female genitals. In rare cases, a laparoscopy—a surgical operation performed through small incisions in the abdomen or pelvic area—may be conducted if other tests are inconclusive.
Treatment for dyspareunia typically requires a multifaceted approach. If the doctor identifies any vaginal infections, skin ailments or other treatable conditions that are contributing to the dyspareunia, they will generally prescribe medications. Strategies for managing dyspareunia include:
Men may experience recurrent or persistent pain in the genitalia or pelvic region during sexual intercourse. It's believed that 1 percent of men suffer from this. Fortunately, the condition in men is often treatable. Understanding the type of pain, where in the body it is located and when it occurs can be helpful in diagnosing and treating the issue.
The inescapable fact is that penetration requires lubrication, and without it, both partners can become sore. Some women naturally produce enough vaginal lubrication for sex, while other women may need extra lubrication. Lack of lubrication creates more friction from the thrusting, drying out the vagina and making it painful for both partners.
A man who suffers from delayed or absent ejaculation—where he has difficulty climaxing—can experience a sore penis caused by too much penetration and friction. Yeast infections, infections under the foreskin, and STIs such as trichomoniasis and genital herpes can also lead to painful sex for men.
Some men are allergic to latex condoms, which can cause irritation in the genital area. Peyronie's disease can be a cause of pain during intercourse, too. Men with Peyronie's have fibrous scar tissue that has formed within the penis. It can cause curved and painful erections that take much of the pleasure out of sexual intercourse.
Pain from dyspareunia is felt in the genital and pelvic regions in both men and women.
Women can have pain in and around the vulva, the labia or at the opening of the vagina. Some experience pain in the uterus, cervix or abdomen.
Men may feel pain in the penis, foreskin, testicles or other areas in the pelvic region.
Living with dyspareunia can be physically uncomfortable, and it may affect your relationship with your partner. Fearing that you will experience pain during sex may cause you to avoid it.
Remember, though, that being intimate with your partner does not have to include sexual intercourse. If intercourse is painful, try other ways to enjoy each other, such as mutual masturbation, kissing and giving each other massages. Look for support from online groups of fellow dyspareunia sufferers.
You can get further information on dyspareunia at websites for the American Academy of Family Physicians, the Cleveland Clinic and Mayo Clinic.
If you're experiencing pain during sex, it's critical you let your partner know as soon as possible. This can be difficult to talk about, but you shouldn't push through the pain.
If you think your partner is experiencing pain, it's important to keep an open mind. Remember, this is unlikely to be your fault, so don't make it about yourself. Listen carefully to what your partner has to say, then ask what you can do to help. Encourage them to speak to a doctor or a sex therapist and identify ways you and your partner can adapt your sexual encounters so any pain is avoided.
If a condition or infection contributes to dyspareunia, treating the cause could resolve the problem. Changing medications that are causing vaginal dryness could eliminate or reduce symptoms. For many postmenopausal women, the pain is caused by not having enough lubrication due to low estrogen levels. This can be treated with an estrogen gel applied directly to the vagina.
The U.S. Food and Drug Administration (FDA) approved ospemifene (brand name Osphena) to treat dyspareunia in women who have issues with vaginal lubrication. The drug prasterone (brand name Intrarosa) may also relieve dyspareunia. This is a capsule placed into the vagina daily.
Nonmedication therapies that might help with dyspareunia include desensitization therapy, where you learn vaginal relaxation exercises that reduce pain. Counseling or sex therapy may also help.
Deep dyspareunia refers to pain felt deep in the pelvis during vaginal penetration. Deep dyspareunia is often associated with endometriosis, a condition in which cells that normally line the uterus—endometrium-like tissue—grow outside the uterus. Deep dyspareunia may also be caused by:
Vaginismus (an involuntary tensing of the vagina) can make sex painful, but it is not the same thing as dyspareunia. Interestingly, though, vaginismus can cause dyspareunia.
Kegel exercises, vaginal dilators and cognitive behavioral therapy (CBT) can all help relax muscles and relieve the symptoms of vaginismus.
