What Is Painful Intercourse (Dyspareunia)? What Causes Painful Intercourse?

23 Jun 2010 - 0:00 PDT

Dyspareunia is pain during or after sexual intercourse due to medical or psychological causes. It can affect men, but it is more common in women. The location of the pain can vary. Women with dyspareunia may have pain in the vagina, clitoris or labia. It is a common condition that affects up to one-fifth of women at some point in their lives.

Many of the numerous causes of dyspareunia are treatable.

Painful intercourse can be difficult to talk about. However it is important to get medical advice because there are treatments that can help eliminate or reduce this common problem.

According to Medilexicon's medical dictionary Dyspareunia is "Occurrence of pain during sexual intercourse."

What are the Signs And Symptoms Of Painful Intercourse (Dyspareunia)?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Many women experience episodes of genital pain that occur just before, during or after intercourse. However, the location of pain and frequency of pain varies greatly. There is superficial dyspareunia on penetration or deep dyspareunia that is felt with penile thrusting. Tightening of the vaginal muscles on penetration is called vaginismus.

Signs and symptoms may include:

• Burning pain or aching pain
• Deep pain during thrusting (often described as "something being bumped")
• New pain after previously pain-free intercourse
• Pain with certain partners
• Pain just under certain circumstances
• Pain with every penetration (even while putting in a tampon)
• Superficial (entry) pain

Most women with dyspareunia complain of superficial pain, which occurs during penetration.

Many women with persistent sexual pain never seek medical attention. They should be encouraged to do so, since treating the problem can be beneficial for their sex life, emotional intimacy and self-image.

What Causes Painful Intercourse (Dyspareunia)?

Numerous medical causes of dyspareunia exist, ranging from infections (candidiasis, chlamydia, trichomoniasis, urinary tract infections), endometriosis, tumors, xerosis (dryness, especially after the menopause). Dyspareunia is a complex problem and frequently has multifactorial causes.

The causes of painful intercourse differ according to the location of the pain.

Causes of entry pain

Pain during penetration may be associated with a range of factors, including:

• Insufficient lubrication. This is often the result of:
  • not enough foreplay
  • a drop in estrogen levels after menopause
  • a drop in estrogen levels after childbirth
  • a drop in estrogen levels during breast-feeding
  In addition, certain medications are known to inhibit 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.
  
  
• Injury, trauma or irritation. This includes injury or irritation from:
  • an accident
  • congenital abnormality
  • episiotomy
  • female circumcision
  • pelvic surgery
• Inflammation, infection or skin disorder. An infection in the genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in the genital area also can be the problem.
  
  
• Reactions to birth control products. Some people can have an allergic reaction to foams, jellies or latex. Pain may also be caused by an improperly fitted diaphragm or cervical cap.
  
  
• Vaginusmus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.
  
  
• Vestibulitis. Painful penetration also occurs in a condition called vestibulitis, which is characterized by unexplained stinging or burning around the opening of the vagina. The prevalence of Vulvar Vestibulitis Syndrome (VVS) is quite high: the syndrome has been cited as affecting about 10 to 15% of women seeking gynecological care.

Causes of deep painUsually, deep pain occurs with deep penetration and may be more pronounced with certain positions. Causes include:

• Certain illnesses and conditions. The list includes:
  • cystitis
  • endometriosis
  • hemorrhoids
  • irritable bowel syndrome
  • ovarian cysts
  • pelvic inflammatory disease
  • retroverted uterus
  • uterine fibroids
  • uterine prolapse
• Infections. An infection of the cervix, uterus or fallopian tubes can cause deep pain.
  
  
• Surgeries or medical treatments. Scarring from surgeries that involve the pelvic area, including hysterectomy, can sometimes cause painful intercourse. In addition, medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotional factors

Emotions are deeply related with sexual activity. They may play a role in any type of sexual pain.

Emotional factors include:

• Psychological problems. Anxiety, depression, concerns about physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
  
  
• Stress. The pelvic floor muscles are very sensitive to stress. So stress can lead to painful intercourse.
  
  
• History of sexual abuse. Most women with dyspareunia do not have a history of sexual abuse. However, for someone who has been abused, this may play a role.

In some cases, it can be difficult to determine whether psychological 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. As with any pain in the body, the person might develop a tendency to guard that area of their body. They can even avoid the activities that they associate with the pain.

The first step in resolving recurrent pain during sex is talking to your doctor. Primary care doctors and gynecologists often ask about sex and intimacy as part of a routine medical visit. The GP may diagnose and treat the problem or refer the patient to a specialist.

Interstitial Cystitis (IC). Dyspareunia is now believed to be one of the first symptoms of a disease called Interstitial Cystitis (IC). Patients may struggle with bladder pain and discomfort during or after sex. For men with IC, pain occurs at the moment of ejaculation and is focused at the tip of the penis. For women with IC, pain usually occurs the following day, the result of painful, spasming pelvic floor muscles. Interstitial cystitis patients also struggle with urinary frequency and/or urinary urgency.

Physical causes in men

In men, as in women, there are a number of physical factors that may cause sexual discomfort. Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation:

• Infections of the prostate, bladder, or seminal vesicles can lead to intense burning or itching sensations following ejaculation.
  
  
• Men suffering from interstitial cystitis may experience intense pain at the moment of ejaculation.
  
  
• Gonorrheal infections are sometimes associated with burning or sharp penile pains during ejaculation.
  
  
• Urethritis or prostatitis can make genital stimulation painful or uncomfortable.
  
  
• Anatomic deformities of the penis, such as exist in Peyronie's disease, may also result in pain during coitus. One cause of painful intercourse is due to the painful retraction of a too-tight foreskin, occurring either during the first attempt at intercourse or subsequent to tightening or scarring following inflammation or local infection.
  
  
• A rare form of male dyspareunia (post-ejaculatory pain syndrome) is characterized by persistent and recurring pain in the genital organs during ejaculation or immediately thereafter. The painful sensations are experienced as sharp, stabbing, and/or burning. The duration of pain is usually brief but it can sometimes persist and be quite intense.
  
  
• Guilt about sexual pleasure or about the nature of the erotic fantasies can lead to pain with orgasm. In other cases, men with liberal sexual attitudes might feel general resentment, or be angry at their current sexual partners for unconscious or conscious reasons.

How is Painful Intercourse (Dyspareunia) Diagnosed?

Many patients will see several doctors before a correct diagnosis is made. Many gynecologists are not familiar with this type of condition, but awareness has broadened with time. Many women are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the same time they become sexually active. Moreover, the absence of any visible symptoms means that before being successfully diagnosed many patients are told that the pain is psychosomatic.

Because there are numerous physical conditions that can contribute to pain during sexual encounters, a careful physical examination and medical history are always indicated with such complaints.

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