Dyspareunia

Dyspareunia means persistent or recurrent pain that happens right before, during, or after sex. According to the American College of Obstetricians and Gynecologists, 3 in 4 women experience pain during sex at some point in their lives. Pain may occur where penetration begins (superficial dyspareunia) or deeper within (deep dyspareunia).

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Impacts of dyspareunia on fertility

When sex is painful, it may make you want to avoid it around ovulation. It may also lead to problems with a male partner’s sexual performance as he doesn’t want to hurt you. Infections and gynecological conditions including pelvic inflammatory disease, endometriosis, and scarring on the reproductive organs, as well as diabetes and thyroid problems, can also lead to painful sex while reducing fertility.

Potential causes of dyspareunia

Many things can cause pain during sex. Superficial dyspareunia is pain in the vulva, the area around the vaginal opening, the skin inside your vagina, or in the area between your vagina and anus. It can be due to:

• Lack of desire or arousal which results in low lubrication
• Low estrogen levels
• Inflammation or infection in the genital area or urinary tract 
• Skin irritation due to an allergic reaction to a substance (e.g. perfumed soap or lubricants)
• Vulvodynia (a pain disorder that affects the vulva)
• Vaginismus (involuntary muscle contractions and spasms at the opening of the vagina)
• Certain medications (e.g. antidepressants, high blood pressure meds, sedatives, antihistamines)
• Injury or irritation from an accident or surgery
• Structural abnormalities present at birth such as vaginal agenesis (not having a fully formed vagina) or a membrane that blocks the opening to the vagina (imperforate hymen)

Deep dyspareunia is pain in the pelvic area, uterus, bladder, lower back, or the front of the thighs. It has the following causes:

• Endometriosis (a condition where uterine tissue grows outside the uterus)
• Pelvic inflammatory disease (an infection of the reproductive organs often caused by STDs like chlamydia and gonorrhea).
• Uterine prolapse or retroverted uterus
• Uterine fibroids (non-cancerous growths on the uterus)
• Ovarian cysts
• Scarring on the reproductive organs
• Irritable bowel syndrome
• Pelvic floor dysfunction
• Hemorrhoids (swollen veins in the anus and rectum)
• Adenomyosis (a condition where tissue that normally lines the uterus grows into the uterine wall)
• Cystitis (bladder inflammation) 

Chronic conditions including diabetes, thyroid disease, and arthritis as well as cancer treatments can also lead to pain during sex.

Symptoms of dyspareunia

Superficial dyspareunia is an instant pain at the vaginal opening that usually stops after sex.

Deep dyspareunia is a sharp or dull pain deep in the pelvis that starts during sex and may continue for several minutes or even hours after you stop having sex.

Diagnosis of dyspareunia

In order to find what’s causing you to experience pain during sex, you should have an open and in-depth conversation with your healthcare provider about where exactly you feel the pain, how it feels, when it started, and if you feel it in all positions. Be sure to mention any prior surgeries you’ve had in the pelvic area.

Then you can get a pelvic exam where your OB-GYN will check to see if you have any skin irritation, infection, or structural problems. You may also have an ultrasound of your pelvic area so that your doctor can take a look at your reproductive organs.

Treatment to improve fertility

There are many ways to treat dyspareunia so that you can enjoy sex again. First it’s important to figure out what is causing the pain so you can start targeted treatment. This could involve medication, a minimally invasive procedure (such as laparoscopy), or a surgical operation.

There are also medications to increase vaginal lubrication (Ospemifene) and relieve pain during sex (Intrarosa).

You may also want to explore mind-body therapeutic techniques to lessen pain and any negative emotions that have built up around sex due to dyspareunia. If it has put a strain on your relationship, you may consider doing psychological counseling or sex therapy.

In addition, Kegel exercises strengthen and relax the pelvic floor muscles, improve circulation to the area, and decrease pain during sex and pelvic exams.

Getting into a relaxed state, like by taking a warm bath and using aromatherapy beforehand, can be helpful for reducing pain and anxiety surrounding sex too.

• When Sex Is Painful. The American College of Obstetricians and Gynecologists. Accessed 27 Oct 2022.
• Sexual Dysfunction and Infertility. Reproductive Science Center of New Jersey. Accessed 27 Oct 2022.
• Diabetes and Sexual Problems In Women. Diabetes UK. Accessed 27 Oct 2022.
• Painful intercourse (dyspareunia). Mayo Clinic. Accessed 27 Oct 2022.
• Dyspareunia. Patient. Accessed 27 Oct 2022.
• Uterine Fibroids. Mayo Clinic. Accessed 27 Oct 2022.
• Pelvic Floor Muscle (Kegel) Exercises for Women to Improve Sexual Health. Memorial Sloan Kettering Cancer Center. Accessed 27 Oct 2022.