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OVERVIEW

What is dyspareunia?

Dyspareunia (say: “dis-par-oon-ya”) is painful sexual intercourse for women. The pain can be in the genital area or deep inside the pelvis. The pain is often described as sharp, burning or similar to menstrual cramps. It can have many causes. It is important to contact your healthcare provider if you have this problem because there are effective treatments for many of the causes.

Where can I turn for help?

Discuss your symptoms with your healthcare provider. Depending on the situation, you may need to see a healthcare provider who specializes in women’s problems. Various support groups are also available.

CAUSES & RISK FACTORS

What are some of the causes of dyspareunia?

Any part of the genitals can cause pain during sex. Some conditions affect the skin around the vagina. The pain from these conditions is usually felt when a tampon or penis is inserted into the vagina, but pain can also occur even when sitting or wearing pants. Inflammation or infection may be the cause (such as a yeast infection, urinary tract infection or inflammation of the vagina). Injury to the vagina and the surrounding area can also cause pain. If a diaphragm or cervical cap (which are types of birth control) does not fit correctly, sex may also be painful.

Vaginismus (say: “vag-in-is-mus”) is a spasm of the muscles around the vagina. In some women, the pain of the spasms is so severe that penile penetration is impossible. Vaginal dryness can also cause painful sex. This dryness may be caused by menopause and changes in estrogen levels, or from a lack of foreplay before intercourse.

Pain during intercourse may feel like it is coming from deep in the pelvis. Women often report the feeling that “something is being bumped into.” The uterus may hurt if there are fibroid growths, the uterus is tilted or if the uterus prolapses (falls) into the vagina. Certain conditions or infections of the ovaries may also cause pain, especially in certain sexual positions.

Past surgeries may leave scar tissue that can cause pain. Because the bladder and intestines are close to the vagina, they may also cause pain during sex. Endometriosis and pelvic inflammatory disease may also cause pain.

We know that the mind and the body work together. This is also seen with sexual problems. Often the problem that first caused the pain may go away, but you have learned to expect the pain. This can lead to further problems because you may be tense during sex or you may be unable to become aroused. The problem can then become a cycle and you are caught in the middle.

Negative attitudes about sex, misinformation about sex and misinformation about the functions of the woman’s body are often associated with some types of pain. Is painful sex all in your head? No! But it is important to discuss feelings and difficulties with your partner and your healthcare provider.

DIAGNOSIS & TESTS

How can my healthcare provider tell what is causing my pain?

Your healthcare provider may ask you to describe your pain, where it is located and when it began. They may also ask you to describe what you have tried in the past. For example, have you tried a sexual lubricant or more foreplay? Is it painful every time you try to have sex? Are there other problems associated with sex? These are some of the questions that your healthcare provider will need to discuss with you. Your healthcare provider may want to examine your genital area or give you a pelvic exam.

What will the exam be like?

During the exam, your healthcare provider may apply a cotton-tipped swab to the area to see if the area around the vagina is painful.

A gentle exam of the vagina and cervix is done with a speculum, similar to the way you get a Pap smear. For some women, this part of the exam may be painful. Your healthcare provider may use a smaller speculum to decrease the discomfort. Or, your healthcare provider may delay the exam until the pain has decreased.

It is important to let your healthcare provider know if the exam becomes too painful. Discuss this with your healthcare provider ahead of time. Many women find it useful to hold a mirror during the exam to see the appearance of their genital structures.

During the final part of the exam, your healthcare provider will feel your uterus and ovaries with one hand on the abdomen and one finger in your vagina. This is similar to exams performed during a pelvic exam.

Will I need any tests?

If your symptoms and exam suggest an infection, tests may be needed done to check for yeast or bacteria. If there is no infection, your healthcare provider may do some other tests, such as urine or allergy tests.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• What is the likely cause of my pain?
• Do I need any tests?
• What can I do to relieve my pain?
• Will medicine or some other treatment help?
• Is it safe for me to have sex? What if the pain starts to interfere with my relationship?

Sources

Evaluation and Differential Diagnosis of Dyspareunia by Lori J. Heim, LTC, USAF, MC (04/15/01, http://www.aafp.org/afp/20010415/1535.html)