intercourse pain

Intercourse pain (dyspareunia)

Intercourse pain defination

Intercourse pain is persistent or recurring vaginal pain that occurs immediately before, during, or after intercourse.

Pain during intercourse can occur for many reasons – ranging from physical to psychological problems. Many women experience pain during intercourse at some point in their lives.

Talk to your doctor if you feel pain during intercourse.

Treatment focuses on the cause, which may help end or reduce this common problem.


If you have painful intercourse, you may feel any of the following:

  • Pain during penetration only (entry)
  • Pain while inserting anything, such as putting on the tampon that is sometimes used during menstruation
  • Pain only in specific circumstances
  • Recent pain, after a period of painless sex
  • Deep pelvic pain associated with pushing during sex, often described as “something to bump”
  • The feeling of burning or soreness

When should you see a doctor?

Talk to your doctor if you feel pain during intercourse. Treating the problem may help improve your sexual and emotional life and your self-image.

The reasons

The physical causes that lead to the occurrence of intercourse pain vary, depending on the nature of the pain: does it occur during penetration or occurs during deep thrust. There are psychological factors associated with many types of sexual pain.

1- Penetration pain

Penetration pain may be associated with some factors:

  • Dryness: often caused by a lack of foreplay. Dehydration is also caused by a sudden drop in estrogen levels after menopause, as well as after childbirth and during breastfeeding. In addition, some medications suppress sexual desire and arousal that may cause dryness (low secretion) and painful intercourse, including antidepressants, high blood pressure medications, sedatives, histamine inhibitors, and some birth control pills.
  • Injuries, wounds, or irritations: These include injuries or irritations caused by an accident, pelvic surgery, female circumcision, episiotomy to facilitate childbirth, or congenital anomalies.
  • Infections, infection, or skin disease: An infection in the genitals or urethra may cause pain during intercourse. Eczema or other skin conditions of the genitals may also be causing the problem.
  •  Vaginal spasms: involuntary contractions of the muscles of the vaginal wall that make penetration attempts very painful.

2- deep pain

Invariably, deep pain occurs with deep insertion and may be severe with some positions.

Some reasons:

  • Some diseases such as endometriosis, pelvic infections, uterine prolapse, inverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids, and ovarian cysts.
  • Surgeries or medical treatments. Scars resulting from surgeries performed in the pelvic area, including Hysterectomy, which may sometimes cause painful intercourse.
  • Medical treatments for cancer, such as radiation therapy and chemotherapy, may cause changes that make intercourse painful.

Emotional factors

Emotional factors are deeply associated with sexual activity and may play a role in any type of sexual pain.

Emotional factors, including:

  • Psychological problems: Anxiety, depression, concerns about physical appearance, fear of intimacy, or relationship problems, all of the above may reduce the level of excitement and cause a feeling of discomfort or pain.
  • Tension: Your pelvic floor muscles contract as a result of the stresses of your life. Which may lead to pain during penetration.
  • Exposure to sexual harassment: Most women who suffer from intercourse pain have not been sexually harassed in the past, but if you have been sexually harassed before, it may play a role in the occurrence of intercourse pain.

Sometimes, it can be difficult to determine whether intercourse pain is due to a psychological or physical cause.

The initial pain may cause a fear of recurring pain, making it difficult to relax, leading to more pain. When you feel any pain in your body, you avoid the activities associated with that pain.

Preparing for your appointment

If you experience frequent pain during sex, the first step in treatment is to see your doctor. Primary care physicians, obstetricians and gynecologists, and urologists often ask questions about sex and intimacy as part of the medical visit regimen.

You can take the opportunity to discuss your complaints. Your regular doctor may diagnose and treat you, or refer you to another specialist to do so.

What you need to do to prepare for a doctor’s discussion:

  • Make notes about your sexual problems, including when and how you usually feel about them.
  • Make a list of your major medical conditions, including any conditions for which you’re being treated and the names of all medications you use and vitamins or supplements you take.
  • Think about the questions you would like to ask the doctor and write them down. Bring a notepad and pen to jot down any information the doctor says while discussing your questions.

Basic questions to ask the doctor:

  • What are the possible causes of the problem?
  • What lifestyle changes can be made to improve my condition?
  • What treatments are available?
  • What books or reading materials do you suggest? Do you suggest any websites?

Questions your doctor may ask

Your doctor will ask you about your symptoms and will assess your hormonal status. Questions the doctor may ask include:

  • Do you have any sexual concerns?
  • Do you suffer from any pain during intercourse?
  • When did the pain start?
  • Where do you feel pain?
  • Do you feel pain every time you have sex or in specific situations?
  • Are you able to discuss your concerns with your husband?
  • Are there any other non-sexual activities that cause you pain?
  • How much do your sexual fears bother you?
  • Do you also feel vaginal irritation, burning, or itching?
  • Have you ever been diagnosed with a gynecological disease or have you ever had reproductive surgery?
  • What medications and vitamins do you take?

Examinations and diagnosis

A medical evaluation for intercourse pain includes:

  • Medical history: Your doctor may ask you when the pain began, and in particular, he will ask you when the pain occurs, how you feel, and whether the pain occurs in all situations. The doctor may also inquire about your sexual history, surgical history, and births. Don’t let shyness stop you from giving candid answers. These questions are key to identifying the cause of the pain.
  • Clinical examination: During the examination of the genitals, the doctor can determine the presence of any skin infections, infections, or anatomical problems. He or she may identify the location of the pain by gently pressing the pelvic muscles and reproductive system. Also, a visual examination of the vaginal cavity may be done using a device called a colposcope. Some women with painful intercourse also feel discomfort during a gynecological exam, no matter how gently the doctor examines them. You can terminate the examination at any moment if the examination is painful.
  • Additional examinations. If your doctor or midwife suspects certain causes of intercourse pain, he or she may order a pelvic ultrasound.

Treatments and medicines

Treatment options vary, depending on the cause of the pain.

1- Medicines

If an infection or condition is present that’s causing the pain, treating the cause may solve the problem. Changing medications that cause dryness (reduced vaginal secretion) may also help relieve these symptoms.

Most intercourse pain in postmenopausal women is due to dryness caused by a lack of vaginal secretions as a result of low estrogen levels. Often, they can be treated with a prescription: a cream, tablets or flex rings that release very small amounts of estrogen directly into the vagina.

2- The treatment

Several treatment methods may help, including the following:

  • You can learn exercises to relax the vaginal muscles to help reduce pain. Your therapist may recommend pelvic floor exercises (Kegel exercises) or other methods to reduce pain during intercourse.
  • Sexual counseling or therapy. If your sex has been painful for a long time, you may experience a negative emotional response to sexual arousal, which may persist even after treatment. If you and a partner stop having intercourse because of painful intercourse, you need to communicate more with your partner to restore intimacy. Talking with a counselor or sex therapist may help resolve these issues.

3- Lifestyle and home remedies

You and your partner can reduce the pain by trying or trying some simple changes:

  • switch modes. If you feel sharp pain while pushing, your penis may be too close to your cervix, or may be pressing on your pelvic floor muscles causing cramping pain, then changing positions may be helpful. Try to be above your husband during sex. In most cases, women are more in control through this position, as you can control the depth of penetration that suits you.
  • communication. Talk about what makes you happy and what annoys you. If you want your husband to be slow, say so.
  • No hurry. The more foreplay, the more it helps to stimulate the natural secretions. You may be able to reduce pain by delaying penetration until you feel fully aroused.
  • Use of lubricants. Using a personal lubricant may make sex less painful. Look closely at the labels or ask your doctor to suggest a product for you to try. Some women, when they use a laxative gel that contains glycerin, may develop vaginal yeast infections