Pain During Sex (Dyspareunia)

The reasons for pain during intercourse can range from simple and easily addressed reasons such as vaginal dryness to more serious underlying medical conditions. These include infections, structural abnormalities and other rarer specific conditions (see below).

Vaginal dryness is one of the more common causes of pain during intercourse. It tends to give rise to a more superficial pain during sexual entry.

This may occur due to inadequate sexual arousal (whether it be due to inadequate foreplay or the presence of a sexual arousal disorder), or due to low levels of estrogen after menopause, leading to a condition called atrophic vaginitis.

Vaginal Infection

Vaginal infections may give rise to pain during intercourse as the vaginal canal and the cervix (entrance to the womb) may be inflamed. This is often accompanied by other symptoms of infection such as abnormal vaginal discharge.

Sometimes, structural abnormalities affecting the womb or pelvis may give rise to a deeper pain. This may occur in conditions where there is abnormal scar tissue in the pelvis (known as adhesions) such as previous infections, or endometriosis. Uterine fibroids or the positioning of the uterus may also cause pain during intercourse.

Other less common, specific conditions affecting the external genitalia or the vulva may result in pain provoked by any form of touch or pressure, including during sexual intercourse.

Urine Tract Infection

Urine tract infections affecting the bladder may manifest as pain during intercourse but would be accompanied by other symptoms such as painful urination or foul-smelling urine.

Vaginismus

Vaginismus is a specific condition in which pain on attempted penetration occurs due to involuntary pelvic muscle spasms.

During your visit, your doctor will ask you a series of questions to better understand the nature of your problem. These questions may require you to be fairly specific about the details of your sexual life and you should inform your doctor if you feel uncomfortable during any point of the discussion.

Your doctor will also perform a detailed physical examination of your external genitalia, as well as a pelvic examination and speak to you about further tests which may be useful for you.

Certain tests may be helpful in excluding underlying infective or medical conditions contributing to your pain. These include imaging such as ultrasound scans of the pelvis and high vaginal or endocervical swab tests for infections.

The treatments for dyspareunia should address not just the underlying cause of the pain but also the associated psychosexual impact and involvement of a sexual and relationship counsellor is useful.

Treatments depend on the underlying cause contributing to pain during intercourse. This may range from simple measures such as adequate lubrication during intercourse, to treatment of any vaginal infections. Treatment of pain due to structural abnormalities may require a more extensive discussion with a gynaecologist. Certain specific conditions such as vaginismus are best addressed with specific treatment protocols.

Simple steps which may help reduce discomfort during intercourse include ensuring there is adequate lubrication, be it through extending foreplay to ensure adequate sexual arousal or the use of lubricants. If you have noticed that certain positions tend to provoke pain, you and your partner can experiment to find alternative positions that are pleasurable for both parties.