What Is Painful Intercourse (Dyspareunia)?
Dyspareunia is pain felt before, during or after sexual intercourse. It may be felt at the vaginal entrance, on the vulva or deeper in the pelvis. People describe it as burning, stinging, tightening or pressure. There is not always a single cause, so where the pain occurs and when it began are important clues.
You do not have to put up with recurring or severe pain. A respectful, private conversation about your symptoms is the first step towards understanding the possible causes.
Is the pain at the entrance or deeper inside?
Pain at the entrance may feel like burning or stinging on contact. It can be associated with vaginal dryness, irritation, infection, vulvar skin conditions, sensitivity around the vaginal opening or involuntary tightening of the pelvic floor muscles.
Deeper pain may be more noticeable in certain positions or with deeper penetration. Endometriosis and other pelvic conditions may need to be considered. The location of pain alone cannot establish a diagnosis, and both types of pain can occur together.
What might cause painful intercourse?
- Vaginal dryness associated with menopause, breastfeeding or other hormonal changes.
- Vaginal infections, irritating products or vulvar skin conditions.
- Vulvodynia or marked sensitivity at the vaginal entrance.
- Pelvic floor tension or involuntary muscle tightening during penetration.
- Changes after childbirth, endometriosis or other pelvic conditions.
Because the same symptom can have different causes, choosing a medicine or procedure based on symptoms alone may not address the problem.
How is it assessed?
Your clinician may ask how long the pain has been present, exactly where it is felt, whether it occurs every time, whether it varies with your menstrual cycle, and whether you have dryness, discharge, bleeding or urinary symptoms. Childbirth history, medicines and treatments already tried can also be relevant.
Examination is planned around your symptoms and comfort. If needed, assessment of the vulva and pelvic floor, infection tests or an ultrasound may be suggested. Each step should be explained, and you can say if you are uncomfortable or want to pause.
How is treatment planned?
Treatment depends on the cause; there is no single approach that suits everyone. Options may include a suitable lubricant or moisturiser for dryness, treatment for a confirmed infection, pelvic floor physiotherapy for muscle tension and psychosexual support when helpful. Hormonal options for menopause-related symptoms, or further investigation of deeper pelvic pain, can be discussed with your clinician.
Continuing penetration despite pain may make symptoms worse. While waiting for assessment, it may help to avoid activities that trigger pain, avoid perfumed products that cause irritation and note when your symptoms occur.
When should you seek medical advice?
Arrange a gynaecological assessment if pain is frequent, severe or affecting intimacy. Do not delay seeking advice if you also have bleeding after sex, unusual discharge, fever or lower abdominal pain. Seek urgent medical attention for sudden severe pelvic pain or heavy bleeding.
Frequently Asked Questions
Is painful intercourse only psychological?
No. Physical causes such as infection, dryness, skin conditions or pelvic floor dysfunction are also possible. Anxiety and previous painful experiences can coexist with physical causes and should be considered without dismissing the pain.
Will the examination necessarily be painful?
The extent of the examination depends on your symptoms. You can explain what feels uncomfortable beforehand and ask for a pause or for the examination to stop.