(Painful Sexual Intercourse)
Dyspareunia refers to pain in the pelvic area. It occurs during or after sexual intercourse. This can occur in both men and women. It is more common in women.
The cause is believed to be physical factors at least 75%-80% of the time.
Some pain occurs first at entry but decreases over time. This is often caused by not having enough lubrication. This is often due to a lack of sexual arousal and stimulation. It can also be due to some medications. Antihistamines can cause dryness. Frequent douching can cause problems as well.
Other causes in women include:
- Postpartum period after childbirth
- Vaginal infections such as yeast vaginitis
- Postmenopausal atrophic vaginitis—irritation of the vaginal mucosa due to lack of estrogen
- ]]>Herpes]]> or ]]>genital warts]]>
- ]]>Pelvic inflammatory disease]]> —deep infection of the pelvic organs
- ]]>Urinary tract infection]]>
- Orthopedic problems affecting the pelvic bones
- Retroversion (abnormal orientation) of the uterus
- Chronic constipation
Psychological factors are not often involved, but may be associated with:
- Previous sexual trauma (rape or abuse)
- Feelings of guilt
- Negative attitudes toward sex
The most common causes of pain in men are:
Pain that occurs while obtaining an erection may be associated with:
Factors that increase your chance of dyspareunia include:
- Being postmenopausal
- Taking medications that produce a vaginal dryness
In men and women:
- Viral or bacterial infections
Pain associated with dyspareunia may:
- Occur during or after sex
- Be itching, burning, stabbing, or aching
Be located in the:
- Occur during all phases of sexual contact or only with deep thrusting
- May also occur with tampon use—fabric absorbs natural vaginal lubricant
Female Reproductive System
The diagnosis is often made based on your symptoms. Your doctor will take a medical and sexual history. A physical exam will be done.
Your doctor will check your vaginal wall to look for:
- Signs of dryness
- Genital warts
Your doctor will also perform an internal pelvic exam to look for:
- Abnormal pelvic masses
- Signs of endometriosis
For men and women:
- Your doctor may suggest more tests. They may include cultures to find infections. Imaging studies like ultrasound may also be used.
- You may be referred to a counselor. This will help to determine whether psychological issues may be a cause.
- Women may use lubricants]]> . They may also use creams with that have estrogen. Some medications may also be given by your doctor.
- Infections may be treated with antibiotics or antifungal medicine.
- Viral infections like herpes and genital warts will also need to be treated.
- Endometriosis may be treated with medications. In some cases, surgery may be done.
To treat prostatitis and urethritis, the doctor may recommend:
- Antibiotic treatment
- Sitz baths
- Avoiding alcohol and caffeine—may be helpful for prostatitis
Sometimes surgery may be done to treat foreskin and other erectile problems.
When no physical cause of the pain can be found, sex therapy may be helpful. Some concerns need to be worked through in counseling. These may include:
- Inner conflict
- Unresolved feelings about past abuse
- Need for self-punishment
- After birth, gentleness and patience should be used. Wait at least six weeks before sexual relations.
- Good hygiene and routine medical care can help.
- Safe sex will reduce the risk of STDs.
- Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
- The use of a water-soluble lubricants like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant. It is not water soluble. This may encourage vaginal infections.
American College of Obstetricians and Gynecologists
Sex Information and Education Council of Canada (SIECCAN)
Sexuality and You
Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician . 2001;63(8):1535-1544.
Griffith's 5-Minute Clinical Consult . Lippincott Williams & Wilkins; 2001.
Kistner's Gynecology & Women's Health . 7th ed. Mosby, Inc.; 1999.
Lightner DJ. Female sexual dysfunction [review]. Mayo Clin Proc. 2002;77:698-702.
Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm . Last accessed on November 24, 2007.
Last reviewed January 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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