What Is Dyspareunia?

Dyspareunia is pain that occurs only (or primarily) during sexual intercourse. It is not a disease but rather a symptom of an underlying physical or psychological disorder. The pain, which can be mild or severe, may occur in the genitals, the pelvic region or the lower back. The condition is much more common among women than among men. Treatment for dyspareunia is aimed at identifying and properly treating the underlying disorder.

What Causes Painful Intercourse?

  • For women, causes include vaginismus (a condition characterized by involuntary spasms of the vaginal muscles), insufficient vaginal lubrication, scars from an episiotomy (an incision made to facilitate childbirth), thinning and dryness of the vaginal wall due to estrogen deficiencies accompanying menopause or breastfeeding and inadequate foreplay.
  • Disorders that may cause pain upon deep vaginal penetration include pelvic inflammatory disease, ovarian cysts, endometriosis, varicose veins in the pelvis and ectopic pregnancy.
  • Other causes include infections, such as sexually transmitted diseases, which may irritate the vaginal walls, bladder or other urinary tract disorders such as cystitis or urethritis, cancer in the sex organs or the pelvic region, arthritis (especially in the lower back) and allergic reaction to clothes, spermicides or latex in condoms and diaphragms.
  • For men, dyspareunia can result from such disorders as irritation of the skin of the penis due to an allergic rash; sexually transmitted diseases, which may irritate the skin of the penis; physical abnormalities of the penis, such as a tight foreskin or a bowed penis with erection (chordee); and infections of the prostate gland or testes.
  • Psychological trauma, especially as a result of sexual abuse or rape

Symptoms of Dispareunia

  • Any type of pain that occurs during intercourse—from burning sensations in the genitals caused by infection to lower back pain due to arthritis—qualifies as dyspareunia. The pain may be mild or severe, and it may last throughout sexual activity or occur only under certain circumstances.

Dyspareunia Prevention

  • Practice safe sex techniques to reduce the possibility of infection (e.g., use condoms during intercourse).
  • Use water-based lubricants during intercourse.
  • Experiment with different coital positions to determine which ones minimize discomfort.
  • Observe proper hygiene and avoid wearing a tight clothing to prevent yeast infections.

Diagnosis of Dyspareunia

  • Detailed history (including sexual) and physical examination (including pelvic exam) are performed. During the pelvic exam, the health care provider will look for abnormal masses, tenderness and sign of endometriosis.
  • Various laboratory tests may be performed to determine the underlying cause.
  • The diagnosis of vaginismus is made only after exclusion of other potential causes.

How Dyspareunia Is Treated

  • Medications are prescribed to treat infections.
  • If you suspect an allergy to latex, consult your doctor for alternative methods of birth control and disease prevention.
  • If your spermicide is causing discomfort, try a different brand or consider using an alternative method of birth control.
  • A water-based lubricant may help ease discomfort and friction. However, avoid oil-based lubricants, such as petroleum jelly, since they dissolve the latex in condoms and may actually promote infection.
  • Insertion of a graduated set of dilators into the vagina may be used to treat vaginismus.
  • Pain during intercourse due to an episiotomy generally subsides over time.
  • Psychological evaluation may be advised if no underlying physical anomalies can be identified.

In February 2013, the U.S. Food and Drug Administration (FDA) approved ospemifene (Osphena) to treat moderate to severe dyspareunia in women. This medication, which is taken with food once a day, helps improves vaginal tissue dryness and thinness, reducing pain during sexual intercourse. Common side effects include hot flashes, vaginal discharge, muscle spasms and excessive sweating. Ospemifene carries a boxed warning indicating that it may stimulate the growth of the uterine lining (endometrium) and increase DVT (deep vein thrombosis) and stroke risk.

When to Call a Doctor

  • Make an appointment with a doctor if you or your partner is experiencing pain during intercourse.
  • Call a doctor if pain worsens or if symptoms do not abate with treatment.

Source:

Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 16 Nov 2011

Last Modified: 16 Dec 2014