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Painful Intercourse: Dyspareunia

Painful intercourse or dyspareunia occurs in many women at some point in their lives.

It is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you're experiencing painful intercourse. Treatments focus on the underlying cause which can be physical or psychological.



Superficial dyspareunia: Pain only at the time of penetration
Pain with coitus, or even when putting in a tampon
Pain with certain partners or just under certain circumstances
New pain after previously pain-free intercourse
Deep pain during thrusting, often described as a stabbing pain
Burning pain or aching pain after intercourse

Possible Causes

Insufficient lubrication: Not enough foreplay. Drop in estrogen levels after menopause, after childbirth or during breastfeeding
Certain medications inhibit desire or arousal such as antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.

Injury, trauma or irritation: Injury or irritation from an accident, pelvic surgery, female circumcision, episiotomy or a congenital abnormality.
Inflammation, infection or skin disorder can cause a superficial pain at the beginning of the intercourse


Vaginismus: Involuntary spasms of the muscles of the vaginal wall which often can be a protective measure to avoid pain

Deep pain: Occurs with deep penetration and may be more pronounced with certain positions.

Pathological causes: Such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, cystitis, irritable bowel syndrome and ovarian cysts.

Surgeries or medical treatments: Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes cause painful intercourse. In addition, medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotional factors, sexual abuse and psychological problems: Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.

Stress: Pelvic floor muscles tend to tighten in response to stress in life. This can contribute to pain.


Tests and diagnosis

A thorough medical history, pelvic examination, vaginal swabs, pap smear and pelvic ultrasound +/- colposcopy might enable  identification of a possible cause.



Medications: estrogen cream, ordinary vegetable oil is the best lubricant (most other lubricants have alcohol/preservatives which may act as an irritant)
Therapy: Desensitization therapy + counselling or sex therapy
Drugs: Depending on the underlying problem; antibiotics,  Amitryptyline 2% cream vaginally or some anti-epileptic drugs may be used.
Laser: a non-invasive treatment for reshaping and revitalizing of scar tissue and atrophic mucosa of the vagina.

Reversal of the scar
Laparoscopy: excision of endometriosis, removal of ovarian cyst, adhesiolysis, removal of the fibroids, etc.


Some tips and home remedies

Switch positions: changing positions may help. Being on top of your partner during intercourse may regulate penetration to a depth that feels good to you.
Communicate: what feels good and what doesn't? If you need your partner to go slow, say so.
Don't rush: longer foreplay stimulates your natural lubrication delaying penetration until you are aroused.
Use lubricants: olive oil and vegetable oil are most effective, cheap and readily available (plus, they have the added benefit of being common household products)


Coping and support

Until vaginal penetration becomes less painful and bothersome, you and your partner might find other options to be more comfortable, more fulfilling and more fun than your regular routine. Sensual massage, kissing and mutual masturbation can all be good alternatives to intercourse.

If you have any questions, please contact Dr. Goncalves,

Penticton Obstetrician and Gynecologist.

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