Intimate Wellness Institute

What is dyspareunia?

Pain during sex, or dyspareunia, is persistent or recurring pain just before, during or after sex. The pain is felt in the genital region. Women can have pain externally in the vulvar region — to the labia (lips of the vagina) or at the opening to the vagina. Some feel the pain internally—in the cervix, uterus or lower abdomen.  Some women have pain in the vaginal lining itself.  The pain also can commonly involve the muscles and nerves in the pelvis.  

It’s a common condition that can have negative emotional and psychological effects. In addition to the physical pain, couples may suffer from loss of intimacy or experience strain in their relationship.

This is condition is hard to discuss and is often ignored by your doctor.  Dr. Guerette and the IWI team specialize in treating pain with sex and recognize how important it is to your quality of life.  We will  listen you, make you comfortable to be open and put the effort required in to get a diagnosis and successful treatment plan. 

Who is most likely to have dyspareunia?

Pain during sex is more common in women. It can affect both men (male dyspareunia) and women (female dyspareunia) of all ages. The pain is usually due to physical factors or medical conditions, but it can also have a psychological component.

How common is dyspareunia?

Pain during sex is one of the more common gynecologic problems. It affects up to 30% of premenopausal women and over 50% of postmenopausal women.

Are there different types of dyspareunia?

The location of the pain can help determine what type of dyspareunia you are experiencing:

Entry pain (superficial dyspareunia): This pain is felt at the entrance to the vagina during initial penetration. Some factors associated with entry pain can be lack of lubrication, hormone changes, skin conditions such as lichen sclerosis, injury or infection.

Vaginismus (high tone pelvic floor disorder): This is a condition in which the muscles of the pelvis don’t relax or contract more during penetration.  This is discussed further in it’s own section.

Deep pain (collision dyspareunia): This is pain that occurs in deep penetration and can feel worse in certain sexual positions. You will feel this pain in the cervix or lower abdomen. A medical condition or prior surgery usually causes sexual pain that occurs deeper.  A very common condition that causes this type of pain is pelvic organ prolapse.

Pain during intercourse can also be described as primary, secondary, complete or situational:

  • Primary pain is pain you’ve had since becoming sexually active.
  • Secondary pain develops after experiencing pain-free sex.
  • Complete pain means you feel pain every time you have sex.
  • Situational pain is when the pain only happens at certain times.


What causes dyspareunia?

In many cases, you can experience pain during sex if there is not sufficient vaginal lubrication. In these cases, the pain can be resolved if you become more relaxed, increase foreplay or if you use a sexual lubricant.

In some cases, you have painful intercourse if one of the following conditions is present:

Vaginal atrophy: The vaginal lining can lose its normal moisture and thickness and become dry, thin and inflamed. This can be caused by medication, menopause or other hormonal changes.

Vaginismus: The fear of being hurt or prior trauma causes a spasm of the vaginal muscles.

Vaginal infections: These conditions are common and include yeast infections.

Problems with the cervix (opening to the uterus): The penis can reach the cervix at maximum penetration. Therefore, problems with the cervix (such as infections) can cause pain during deep penetration.

Problems with the uterus: These may include fibroids that can cause deep intercourse pain.

Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.

Problems with the ovaries: Such problems might include ovarian cysts.

Pelvic inflammatory disease: The tissues deep inside become badly inflamed, and the pressure of intercourse causes deep pain.

Ectopic pregnancy: A pregnancy in which a fertilized egg develops outside of the uterus.

Intercourse too soon after surgery or childbirth.

Sexually transmitted infections (STIs): These may include genital warts, herpes sores or other STIs.

Vulvodynia: Causes chronic pain in the vulvar area.

Injury to the vulva or vagina: These injuries may include a tear from childbirth or from a cut (episiotomy) in the perineum (area of skin between the vagina and the anus) that is made during labor.  They can also be the consequence of sexual trauma to pelvic surgery.

Skin disorders affecting the genitalia: The most common skin condition is Lichen Sclerosis.  The chronic inflammation causes dryness and burning made worse with penetration.  The inflammation can also cause the opening of the vagina to fuse partially closed causing superficial pain and excessive tightness. 

Psychological issues: Anxiety, depression and low self-esteem can prevent sexual arousal. If you have been a victim of sexual abuse, it can also contribute to your pain during sex.

What are the symptoms of dyspareunia?

If you have pain during sex, you may feel:

  • Sharp pain during penetration or at entry.
  • Deep pain during thrusting.
  • Throbbing or aching after intercourse.
  • Burning pains.
  • Pelvic cramping.
  • Muscle tightness or spasms.

What does dyspareunia feel like?

The most common symptom is pain with intercourse that occurs at the vaginal opening or deep in the pelvis. It can be a distinct pain in one area or it may affect the entire genital region. There can be feelings of discomfort, burning or throbbing.

Does dyspareunia cause bleeding?

Dyspareunia doesn’t necessarily cause bleeding. Any bleeding that occurs during sexual intercourse is likely caused by the underlying medical issue. The bleeding could be caused by the same issue that is causing the painful sex.

How do I talk to the IWI team about painful sex?

Talk openly with us about any pain during sexual intercourse. We are here to help you and make you feel heard.  Some common questions we may ask are:

  • Where is the pain occurring?
  • How often does the pain occur?
  • How long have you been having painful intercourse?
  • What does the pain feel like?
  • What medications are you taking?
  • Have you had any prior surgeries in the area?
  • Have you been treated for any conditions of the vagina?


How is dyspareunia diagnosed?

Dr. Guerette and the IWI team will diagnose the underlying cause of pain during sex with a thorough, specialized health history and physical examination. 

What tests are done to diagnose dyspareunia?

To locate the source of the pain and diagnose any medical conditions, we may perform the following:

  • Physical exam: This examination could include a specialized pelvic exam, rectal exam and Pap test. We may also collect a sample of vaginal fluid and urine to test for signs of infection.
  • Ultrasounds: Transvaginal ultrasound can get a better view of the female reproductive system.
  • Physiology testing: We may recommend tests to look and nerve, muscle, bladder and rectal function depending of the location of the pain.  These are simple office tests.
  • Laparoscopy: In rare cases, laparoscopy is used if other tests are inconclusive.


How is dyspareunia treated?

The key is a correct diagnosis.  Dr. Guerette and the IWI team will provide a diagnosis and design a treatment plan that specifically addresses your issue.

How can you treat dyspareunia naturally?

Applying a water-based lubricant to your vagina, vulva and labia is helpful to some women when dryness is the main cause. Those who have pain during sex often stop using vaginal perfumes, bubble baths or scented sanitary pads or toilet paper.

Are there medications to take for dyspareunia?

Yes, there is a medicine available to treat pain during sex. If vaginal dryness due to low estrogen is the cause of your painful sex, topical estrogens can be applied to the vagina. The Food and Drug Administration (FDA) approved a drug called ospemifene for dyspareunia due to menopause. It can be taken orally. Medication can also be prescribed to treat pain due to infection or underlying medical conditions.

How do I manage symptoms of dyspareunia?

There are some things you can do on your own to manage the pain you feel during or after sex:

  • Use a water- or silicone-based lubricant to help with vaginal dryness.
  • Try sexual activities or positions that do not cause pain.
  • Take over-the-counter pain reliever before sex.
  • Find time to relax and de-stress before having sex.
  • Apply ice packs to the vulva after sexual intercourse.

What questions should I ask the IWI team?

Painful sexual intercourse can be physically and emotionally difficult. We understand. Some questions you may want to ask are:

  • What is causing my pain?
  • What treatments are available?
  • Is there anything I can do to decrease my pain?
  • How long will it take to feel better?