Pain During Sexual Intercourse

PAIN DURING SEXUAL INTERCOURSE
(DYSPARUNIA)

CONDITION

Pain during sexual intercourse, called dysparunia, may occur any time in a woman’s life. It may be mild or so severe that intercourse is impossible. The pain may be felt in:

  • the vulva (the outer part of the female genitals)
  • the vagina (the passage leading from the uterus to the outside of a woman’s body)
  • the pelvis (the area of the body surrounded by the hips that contains the uterus, fallopian tubes and ovaries)
  • the lower back.

The location of the pain is important in making an accurate diagnosis of the problem and in treating it. Depending on the cause, that treatment may involve medication, surgery or psychological counseling.

CAUSES

Pain in the vulva area may result from:

  • changes in the skin, called vulvar dystrophy, that can cause an area of the skin to be thickened, thinned or irritated
  • an infection (bacterial, yeast or viral)
  • a cyst in lubricating glands located near the opening of the vagina
  • irritation from soaps, douches or vaginal sprays.

Pain in the vagina may be caused by:

  • an infection (bacterial, yeast or viral)
  • scar tissue from an injury, such as a tear during delivery, or from an episiotomy
  • dryness due to:
    • hormone changes, which can occur during menopause and during and after pregnancy;
    • lack of sexual arousal, which can result in less lubrication during intercourse
    • certain medications including oral contraceptives, antihistamines and antidepressants
  • muscle spasms in and around the vagina (called vaginismus) that can result from emotional problems or scars from an injury or an episiotomy
  • inflammation around the opening of the vagina (called vestibulitis)
  • an allergic reaction to condoms
  • irritation from soaps, douches, spermicides or scented tampons.

Pain in the pelvis or lower back may be due to one of a number of medical conditions including:

  • fibroids (benign tumors on or in the uterus)
  • endometriosis, which occurs when the kind of tissue that normally lines the uterus grows in other places within the abdominal cavity
  • pelvic inflammatory disease, ( infection of the female organs that lie within the pelvis)
  • adhesions (fibrous bands of scar tissue that can form between tissues and organs)
  • an ovarian cyst (a fluid-filled sac in or on the ovary)
  • ectopic pregnancy (a pregnancy that occurs when a fertilized egg implants outside the uterus)
  • the uterus being tipped backward or prolapsed (falling down) into the vagina
  • bowel or bladder disease
  • hemorrhoids
  • bladder infection.

Deep and forceful penetration movements and certain positions during intercourse can also result in pain during sex. So can emotional problems arising from a previous sexual assault, fear of getting pregnant or becoming infected with a sexually transmitted disease and/or feelings of guilt or stress.

WHEN TO CALL YOUR DOCTOR

Call 911 or go to the emergency room immediately if:

  • You develop severe abdominal pain during sexual intercourse or soon afterward. You may have a ruptured ovarian cyst or tubal pregnancy.

Call your doctor right away (day or night) if, after sexual intercourse:

  • You develop pain and a fever of 100F or higher within 12 hours.
  • You have pain and vaginal bleeding.
  • You develop a painful lump at the opening of the vagina and a fever of 100F or higher.

Call your doctor within 24 hours if:

  • You have pain during intercourse that you never have had before.
  • You develop a lump at the opening of the vagina that is not painful.
  • You develop irritation, pain or itching of the vulva.
  • You have an abnormal vaginal discharge that smells bad, causes itching and irritation and/or is a yellow or gray color that developed soon after having sex.
  • It hurts to urinate.

Call your doctor during regular office hours if:

  • You need a referral for counseling, either for yourself or for you and your partner.
  • You need refills for prescription medications such as hormones, hormone creams or antidepressants
  • You’ve tried the self-care measures below but they are not helping.

SELF-CARE AT HOME:

  • After having a baby, wait about six weeks to have intercourse, and begin by having intercourse gently and slowly.
  • Try to avoid medications that may cause you to have vaginal dryness.
  • If you have vaginal dryness, use a water-based lubricant when having sex. Oil-based lubricants such as mineral oil can cause irritation and damage latex condoms.
  • Foreplay should last long enough to allow your vagina to become lubricated.
  • If you have pain with intercourse, try to find other positions that are comfortable.
  • Wear panty hose with a cotton crotch.
  • Avoid scented soaps, douches, vaginal sprays and tampons.
  • Avoid contraceptive spermicides that irritate or cause vaginal dryness.
  • Talk to your sex partner about your sexual likes and dislikes, including what you want during foreplay, which positions you prefer, what is comfortable or uncomfortable for you, what arouses you and what does not.
  • If you feel it would be helpful, see a sex therapist or counselor.

For More Information

References

American College of Obstetricians and Gynecologist

  • Compendium of Selected Publications, 2008 Volume ll, Practice Bulletin Number 51, March 2004, Chronic Pelvic Pain, Page 1186
  • Precis V, An Update in Obstetrics and Gynecology, Low Abdominal and Pelvic Pain, Page 69, Sexuality and sexual Dysfunction, Page 101
  • ACOG Educational Pamphlet, AP020, Pain During Intercourse

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Disclaimer:

Peer-Reviewed by the Faculty of the University of Colorado Denver Department of Obstetrics and Gynecology

This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional