Dyspareunia: Symptoms, Causes & Treatment

Dyspareunia is pain that occurs during sexual intercourse, but it can also happen before or after sex. It may feel like burning, throbbing, or pelvic pain, and is more common in women.

In women, it may be caused by vaginal atrophy during menopause or vaginismus. In men, it may be caused by prostatitis or Peyronie’s disease.

Treatment for dyspareunia is managed by a gynecologist or urologist and depends on the underlying cause. It may include Kegel exercises, cognitive behavioral therapy, medications, or, in some cases, surgery.

Common symptoms

The main symptoms of female dyspareunia are:

• Pain during penetration, either at the vaginal opening or deeper inside

• Burning or stinging

• Pain when using tampons or during a pelvic exam

• Throbbing pain that lasts for hours after vaginal intercourse

• Cramping pelvic pain during vaginal intercourse

Dyspareunia can also cause bladder pain, emotional discomfort, or anxiety during sex.

Symptoms of male dyspareunia

Symptoms of dyspareunia in men usually include penis pain or pain in the pelvic area during sex or shortly afterward.

Pain during ejaculation can also occur. This pain may be felt in the tip of the penis, testicles, perineum, suprapubic area, or abdomen, for example.

Confirming a diagnosis

Dyspareunia is diagnosed by a gynecologist or urologist. During the appointment, the doctor will ask about your symptoms, including when the pain started, how long it lasts, how intense it is, and where it occurs. A pelvic exam may also be performed.

To help identify the cause of dyspareunia, the doctor may perform a Pap smear or order imaging tests, such as a transvaginal ultrasound.

Possible causes

The main causes of dyspareunia are:

1. Vaginismus

Vaginismus is the involuntary tightening or spasm of the pelvic muscles in people with vaginas. Its exact cause is not fully understood, but it may be related to pelvic floor dysfunction and/or psychological factors, such as fear, anxiety, or past negative sexual experiences.

2. Vaginal dryness

Vaginal dryness, or reduced lubrication, is a common cause of dyspareunia. It can happen due to limited sexual stimulation, menopause, or medication use, making penetration more painful.

3. Hormonal changes

Hormonal changes during perimenopause or after menopause can also cause dyspareunia. This may happen due to reduced vaginal lubrication, vulvovaginal atrophy, or genitourinary syndrome of menopause.

According to the American College of Obstetricians and Gynecologists (ACOG), vaginal dryness is common during this stage and can cause burning, irritation, and pain during sex.

Hormonal changes after childbirth and during breastfeeding may also lead to dyspareunia.

4. Sexually transmitted infections

Dyspareunia may also be caused by sexually transmitted infections (STIs), such as genital herpes, gonorrhea, chlamydia, trichomoniasis, or pelvic inflammatory disease (PID), for example.

In these cases, dyspareunia may occur with other symptoms, such as bleeding during sex or yellow or greenish discharge that may have a foul odor.

5. Endometriosis

Endometriosis is another cause of dyspareunia in women. It occurs when tissue similar to the lining of the uterus grows outside the uterus, affecting areas such as the fallopian tubes, ovaries, bladder, or intestines.

6. Vulvodynia

Vulvodynia is chronic pain and discomfort in the vulvar area. It can cause dyspareunia and other symptoms, such as redness, irritation, or increased sensitivity in the vulva.

7. Psychological factors

Psychological factors can also contribute to dyspareunia. These may include a history of sexual abuse, very uncomfortable gynecological exams, excessive concern about sex, or negative experiences related to penetration.

8. Poorly fitted diaphragm or condom

A poorly fitted diaphragm or incorrectly placed male or female condom can also cause pain or discomfort during sex and lead to dyspareunia.

9. Injuries or trauma in the genital area

Dyspareunia can also be caused by injuries or trauma in the genital area. Examples include tearing during childbirth, episiotomy, or having sex too soon after delivery.

10. Vaginal infections

Some vaginal infections, such as vaginal yeast infections or bacterial vaginosis, can also cause discomfort or pain during sex and lead to dyspareunia.

These infections are often accompanied by symptoms such as white or grayish discharge, a foul odor, or intense itching.

Urinary tract infections (UTIs) can also cause pain or discomfort during sex.

11. Peyronie’s disease

Peyronie’s disease is a cause of dyspareunia in men. It occurs when rigid fibrous plaques develop in the erectile tissue of the penis, causing abnormal curvature.

12. Prostatitis

Prostatitis is another cause of pain during sex and male dyspareunia. It can cause pelvic pain or pain in the perineum, which is the area between the scrotum and the rectum.

13. Cancer treatment

Dyspareunia may also be caused by cancer treatment. In addition to emotional factors that may affect intimacy, radiation therapy to the pelvic area can cause tissue changes that make sex painful.

Treatment options

The main treatments for dyspareunia are:

1. Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) may be recommended by a healthcare provider when dyspareunia is caused by psychological trauma or to help relieve anxiety related to dyspareunia.

This type of treatment can help improve quality of life by creating strategies to cope with fear or anxiety related to sex, for example.

2. Medications

Medication may be recommended for dyspareunia caused by vaginal infections, prostate infections, or STIs. A healthcare provider may prescribe antibiotics or antifungal medications, depending on the type of infection.

In cases of dyspareunia after menopause, a gynecologist may recommend hormone replacement therapy (HRT)

3. Kegel exercises

Kegel exercises may be recommended by a healthcare provider for dyspareunia caused by pelvic floor dysfunction. These exercises help work the muscles in this area, reducing pain and discomfort during penetration.

4. Surgery

Surgery for dyspareunia may be recommended in cases of Peyronie’s disease to remove fibrous tissue and correct curvature. It may also be recommended in cases of endometriosis to remove areas of endometrial tissue outside the uterus, for example.

5. Self-care tips

Some daily measures that may help relieve dyspareunia pain include:

• Building connection and intimacy with a partner

• Getting to know your own body, your partner’s body, and your emotions

• Being physically and mentally rested

• Trying sex in a calm, quiet environment, away from stress

• Choosing a day for intimacy and preparing for it

• Using a personal lubricant before and during attempts

• Setting limits if the person does not feel comfortable

• Spending more time on foreplay

Feeling safe and comfortable with intimacy can help sex gradually become more positive, even if this process takes months or years.