Pain with intercourse (dyspareunia) is pain or discomfort in a woman's labial, vaginal, or pelvic areas during or after sexual intercourse. The word dyspareunia comes from early Greek language, and its meanings include "difficulty mating" or "badly mated."  The causes of dyspareunia may be easily discovered and treated.

Pain During Intercourse Causes

The prevalence of such pain seems to be increasing over time. Possible reasons for this apparent increased prevalence include the following:

• Changes in sexual behavior

• An increase in sexually transmitted diseases

• Increased willingness to discuss sexual behavior

Pain During Intercourse Symptoms

Symptoms of pain related to intercourse can occur when entry is attempted or during or immediately following sexual intercourse.

• The most common symptom is pain on entry.

• The second most common symptom is deep pain.

• Other symptoms include feelings of muscle spasms, cramps, or muscle tightness.

Pain during intercourse may be described as primary or secondary, as complete or situational, and as superficial-entrance or deep thrust types.

• Primary pain with intercourse is pain that has existed for the woman’s entire sexual lifetime.

• Secondary pain develops after a symptom-free period of time.

• Complete pain means the woman experiences pain in all situations of intercourse.

• Situational pain occurs with a particular partner or a certain type of stimulation.

• Superficial-entrance pain is noticeable at penetration.

• Deep thrust pain is located at the cervix or in the lower abdominal area and is noticeable during or after penetration.

A woman may perceive pain during intercourse even without any physical cause. Sexual pain without an apparent physical cause may be a mental health issue.

When to Seek Medical Care

A woman should always consult a health care provider if she is experiencing new or worsening pain, bleeding, or discharge following intercourse.  Pain related to intercourse is a condition most appropriately checked by a primary health care provider or a women’s health specialist (gynecologist). Other specialists, such as a psychiatrist or psychologist and a urologist, may also be consulted depending on the underlying cause.  Pain during intercourse is generally not an emergency. A woman should seek care in a hospital's emergency department if she experiences any of the following symptoms:
 

• New onset of pain or pain more severe than previous episodes and that lasts more than just a few minutes

• Bleeding following pain, particularly new or severe pain

• Nausea, vomiting, or rectal pain following intercourse

• New discharge

Exams and Tests

A health care provider asks about the woman’s history of pain during intercourse. A thorough history and an extensive physical exam often reveal the most probable cause of this pain.
 

• A medical history identifying pain at the vaginal opening may suggest one of the following:

  • Inadequate lubrication during the arousal phase (may be associated with hormonal changes or medications)

  • Inflammation at the vulvar opening

  • Painful spasms of the vagina that prevent intercourse
     

• Pain located in the entire vaginal area may indicate conditions such as vulvar muscle degeneration, chronic vulvar pain, or a vaginal infection (fungal, parasitic, or bacterial).

  • At times, a specific area of discomfort may be identified that might suggest another cause for the pain, such as inflammation of the urethra (the tube through which urine exits the body).

  • Deep thrust pain feels to the woman as if her partner is bumping into something during thrusts. This type of pain may suggest pelvic causes, such as endometriosis, adhesions, the uterus tilting the wrong way, or sagging of the ovaries or fallopian tubes.

  • Pain in the middle of the pelvis may suggest an origin in the uterus. Pain on one or both sides of the pelvis is more suggestive of pain originating from the fallopian tubes, ovaries, and ligaments.
     

• A health care provider may perform an extensive physical exam of the woman’s pelvis, abdomen, and lower back to better understand both her anatomy and the location of her pain. The exam may also allow the woman to better guide the doctor to the location of the discomfort. Part of this exam includes a rectal exam or rectovaginal exam. The exam may include a Pap Smear, the collection of vaginal or cervical fluids for culture, an analysis of urine (urinalysis), and other laboratory tests.
   

• A health care provider may recommend special tests, such as a pelvic ultrasound or a CT scan or an MRI of the pelvis.
   

• The doctor may perform a urethrogram, a cystogram (for viewing inside the bladder), or both, or the woman may be referred to a specialist (urologist) for these procedures.