Pain during Sexual Intercourse

Dyspareunia refers to the genital pain associated with penetration which some people suffer during or after intercourse. Its consequences include from small irritations or nuisances to great pain.

Both men and women can suffer from dyspareunia. Although it is more common in women, it can affect men as well. Within Spain, for instance, the incidence of dyspareunia is around 6% of men, while it reaches 26% in the case of women.

Painful intercourse

In the case of men, pain usually appears during ejaculation. Generally, it is due to urinary tract infections (UTIs), infections of the seminal vesicles or of the prostate, although it can also be a consequence of phimosis. On the other hand, using spermicides or feeling the IUD during intercourse can lead men to feel pain during penetration.

Dyspareunia in women

Experiencing painful intercourse can lead to sexual rejection or aversion in women. Pain intensity varies from women to women: while some of them just feel a burning sensation, others experience even great pain or painful spasms that might hinder them from getting an orgasm.

Pain may be located in the outer genitals or inside the vagina:

• Outer genitals: the pain is located in the area surrounding the opening of the vagina.
• Inside the vagina: the pain is felt in the uterus or in any other area inside the pelvic region, such as the bladder, rectum, ovaries, or internal parts of the vagina.

Women who have dyspareunia often feel the pain in the very moment of penetration due to the pressure exerted by the man on a particular area during intercourse.

The diagnosis of this pathology should be done by a physician and involves the following steps: firstly, performing an anamnesis in the woman, and secondly a physical gynecological exam. In addition, taking a sample of vaginal discharge is also required in order to detect the presence of potential pathogens. If necessary, an ultrasound scan of the internal female genitalia will be carried out.

Causes of painful intercourse

In women, the main reasons why dyspareunia occurs are related to urinary tract infections caused by fungus candida, bacteria, or viruses, the following being the most common ones:

• Vaginal infections
• Infections in the Fallopian tubes or in the ovaries (e.g. pelvic inflammatory disease, annexitis...)
• Infections in certain glands of the vaginal lips
• Sexual diseases such as trichomoniasis, candidiasis, gonorrhea, syphilis, etc.
• Genital warts
• Certain cancer types

Less common causes why a woman may feel pain during sexual intercourse include:

• Endometriosis
• Uterine fibroids
• Postpartum scars
• Birth defects of the internal sex organs
• Adverse effects of birth control methods
• Vaginal dryness
• Lack of sex education
• Psychological problems (traumatic events, relationship issues...)
• Stress

Treatment of dyspareunia

Different types of treatments are prescribed depending on the cause. If it is a case of dyspareunia caused by a genital infection, you will be prescribed a pharmacological treatment based on antibiotics.

Treatment of genital infections

If, conversely, the pain is caused by endometriosis, women are usually prescribed hormones or even advised to undergo surgery in most severe cases. When dyspareunia is originated by genital warts, medicines for inhibiting cell growth are the best option, although you can also remove them by means of cryotherapy, laser, or electrocautery.

Antibiotics are also the treatment of choice in cases of UTIs or infections in the internal reproductive organs caused by bacteria.

When pain appears as an adverse reaction to a birth control method, you may be advised to look for alternative options. If it is due to vaginal dryness, using a proper lube usually solves the problem. Finally, in case it is a psychologically-related issue, visiting a trained psychologist may be helpful.