Dyspareunia, also known as painful intercourse, is a persistent genital pain experienced within the pelvis or in the genital area during or after sex. Both men and women are affected by dyspareunia, but it is more common in women. The pain is also experienced internally in the uterus, vagina, or pelvis and externally on the vulva.

Dyspareunia affects about 20% of American women once in their lifetime, says the American Academy of Family Physicians (AAFP). The global prevalence of dyspareunia in women is estimated to be 3-18% [1].

Causes Of Dyspareunia:

There are many factors that contribute to dyspareunia in women. Some women experience painful intercourse due to emotional factors, while others experience it due to physical problems. The following are some physical causes of dyspareunia:

• Vaginismus - contraction of muscles of the vaginal wall
• Uterine fibroids
• Cystitis
• Endometriosis
• Urinary tract infections (UTIs)
• Vaginal infections
• Vulvodynia - pain in the vulva
• Genital injury, such as female genital mutilation (FGM)
• Vaginal dryness
  

Psychological causes include:

• Stress and anxiety cause spontaneous contraction of muscles of the vaginal wall, leading to painful sex.
• Depression or fear contribute to vaginismus and vaginal dryness and inhibit sexual arousal [2].
  

Symptoms Of Dyspareunia:

Symptoms associated with painful intercourse are mentioned below:

• Discomfort in the vagina
• Aching, burning sensation on the vulva and in the vagina
• Irritation or a feeling of stabbing pain
  

Pain during/after intercourse occurs:

• Deep in the pelvis during intercourse
• After pain-free intercourse
• During penetration
• In the urethra, bladder, and vagina [3].
  

Who’s At The Risk?

Postmenopausal women experience dyspareunia more often. According to the American College of Obstetricians and Gynecologists (ACOG), more than 70% of women experience painful intercourse once in their lifetime.

You’re at increased risk of experiencing dyspareunia if you:

• Are postmenopausal
• Have a bacterial or viral infection
• Take medications that cause vaginal dryness
  

Diagnosis:

The patient’s medical history and pelvic examination can diagnose the cause of dyspareunia. During a pelvic exam, the doctor checks for the signs of structural abnormalities and infection, such as:

• Endometriosis
• Uterine fibroids
• Genital warts
• Inflammation or infection of the vagina
• Vaginal dryness
  

Treatment Options:

Treatment options for relieving pain during intercourse are medications and counseling:

1. Medication: If the cause of painful intercourse is an underlying health condition, the doctor may recommend:

• Topical or injectable corticosteroids
• Antifungal medications
• Antibiotics
  

Low estrogen levels often cause vaginal dryness that results in painful intercourse. Topical estrogen, estrogen tablets, and rings can relieve the pain.

2. Counseling: Counseling may be helpful if emotional abuse and trauma are the causes of dyspareunia. Emotional consequences of painful intercourse can be overcome by counseling [4].

FAQs:

1. What does dyspareunia feel like?
Some women describe the pain as throbbing, sharp pain, and some describe it as menstrual cramps.

2. Can we refer to dyspareunia as a sexually transmitted disease (STD)?
No, dyspareunia cannot be described as an STD. However, STDs, vaginal yeast infections, and urinary tract infections can cause pain during and after sex.

3. What is the best treatment option for painful intercourse?
Medications are the best option for relieving pain during intercourse. Topical estrogen or ospemifene (estrogen-free) can lubricate the vagina to overcome vaginal dryness, which contributes to dyspareunia.

References:

1. Mitchell KR, Geary R, Graham CA, Datta J, Wellings K, Sonnenberg P, et al. Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey. BJOG 2017;124:1689–97. doi.org
2. Hill DA, Taylor CA. Dyspareunia in Women. Am Fam Physician 2021;103:597–604. doi.org
3. Caruso S, Monaco C. Dyspareunia in Women: Updates in Mechanisms and Current/Novel Therapies. Curr Sex Heal Reports 2019;11:9–20. doi.org
4. Steege JF, Zolnoun DA. Evaluation and Treatment of Dyspareunia. Obstet Gynecol 2009;113.