Dyspareunia (Painful Intercourse)

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Updated on February 4, 2025
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Dyspareunia (pronounced: dis-pahr-OON-eeuh) is the medical term for painful sexual intercourse. This pain can happen before, during, or after sex, depending on its cause. You can treat dyspareunia with the help of a healthcare provider, who can prescribe medications and other treatments to decrease your pain.

Overview

What Is Dyspareunia?

Dyspareunia describes genital, vaginal, or pelvic pain right before, during, or after sexual intercourse.

 This pain can feel sharp, throbbing, cramping, or burning.
Dyspareunia happens most often in women, and about 3 out of 4 people with vaginas experience this type of pain at least once in their lives.

The group at highest risk for dyspareunia is women who have passed menopause (around age 50).

How Dyspareunia (Painful Sex) Affects the Body
A dyspareunia (painful sex) diagnosis may involve any or all of these symptoms. 
But painful sex can happen because of anything from your feelings about sex to medical conditions.

If you feel pain during sex, you may find it hard to share that with your partner. In fact, one study of almost 400 women found that about half didn’t tell sexual partners about their dyspareunia.

 But even if you don’t loop your partner in right away, it’s important to share your symptoms so you can get some relief.

Signs and Symptoms of Dyspareunia

Dyspareunia symptoms can vary based on its type. These types fall under two categories: where and when you feel pain.

Sexual intercourse can cause pain in a few different places:

  • Entry pain: Felt at the vagina’s opening when penetration first happens
  • Positional pain: Felt in some sexual positions, but not others
  • Deep pain: Felt during deep penetration, and can be worse in some sexual positions
Providers may also label dyspareunia based on the history and timing of your pain:

  • Primary pain: You have felt pain during sex since you became sexually active
  • Secondary pain: You begin to feel sexual pain after a period of pain-free sex
  • Complete pain: You feel pain every time you have intercourse
  • Situational pain: Sexual pain only happens in certain times and situations
Sexual pain can come with a wide range of physical sensations, and dyspareunia symptoms can include the following:

  • Sharp or deep pain during thrusting
  • Throbbing and aching to the pelvic region or genitals hours after intercourse
  • Cramping in your pelvic area
  • Pelvic floor muscle tightness or spasms
  • Pain in the bladder
  • Burning or piercing pain during penetration
  • Pain when inserting a tampon
Dyspareunia can affect any area in the pelvis, including the pelvic floor muscles, uterus, vagina, vulva, bladder, lower back or abdomen, and tissues surrounding your pelvic organs.

Causes and Risk Factors of Dyspareunia

Dyspareunia can have many causes, including medical conditions, trauma or injury to the pelvic area, or psychological factors surrounding sex.

Medical Conditions

Pain during sexual intercourse can be a symptom of these medical conditions:

  • Skin disorders: Such as contact dermatitis
  • Vulvodynia: A pain disorder that affects the vulva
  • Cysts: Fluid-filled growths in the pelvic area
  • Endometriosis: Tissues similar to the uterus lining appearing in other places (like the abdomen)
  • Pelvic inflammatory disease: Infection of the vagina, uterus, fallopian tubes, or ovaries
  • Genitourinary syndrome of menopause (GSM): Thinning, inflammation, and dryness of the vaginal lining
  • Hormonal changes: Perimenopause and menopause-related estrogen drops and hormonal changes from breastfeeding
  • Nerve problems: Pinched or inflamed nerves in the back or pelvic area
  • Vaginitis: Inflammation of the vagina caused by bacterial, viral, or yeast infection
  • Vaginismus: Vagina muscle tightening
  • Vaginal dryness: Lack of lubrication leading to irritation. Sometimes extending foreplay can help.

  • Pelvic floor dysfunction: Tight ligaments and muscles in the pelvic floor (around the vagina)
  • Bowel conditions: Like irritable bowel syndrome
  • Bladder conditions: Like urinary tract infections
Several medical conditions can cause vaginal dryness, which can lead to painful sex. These include having your ovaries removed, some tumors, diabetes, and treatment for cancer.

 Medications can also lower lubrication, including some for depression, high blood pressure, allergies, and birth control.

Trauma or Injury

Any injury or trauma to the pelvic area can cause painful sex, including the following:

  • Pelvic surgery: Like hysterectomy or ovary removal
  • Childbirth: From unhealed tearing or stretching while giving birth
  • Accidents: Any injury to the vulva, vagina, or pelvis
  • Female genital mutilation: Also known as female circumcision or cutting, in which the clitoris and labia are removed or altered for cultural or religious reasons

Psychological Factors

Sometimes, psychological factors can lead to dyspareunia. These can include a lack of desire or arousal because of several issues, including:

Your mental and emotional state can play a big part in your ability to become aroused, and can lead to painful sex.

Emotional and Psychological Impact

Dyspareunia can cause more than physical pain. Discomfort during sex often leads to lower desire and less sex, which can put a strain on your quality of life and relationship.

 Sexual issues can also prompt lower self-confidence, self-image, and self-esteem.

 Sometimes these issues can even turn into depression and anxiety.

 But once you address the cause of these issues with a healthcare provider, you may soon have less painful and more fulfilling sex.

How Is Dyspareunia Diagnosed?

A healthcare provider can diagnose the cause of dyspareunia through several methods.

Medical History First, your provider may ask when and where you feel pain. They may want to know if sexual pain happens with some partners and positions but not others. If these questions make you feel uncomfortable, remember their answers will help your provider solve this puzzle and start you on the path to recovery.

Pelvic Exam To rule out some medical causes of dyspareunia, your provider may do a pelvic exam. During this exam, your provider may observe your genitals and may also look inside your vagina. They may try to find the painful areas by pushing gently and asking for feedback.

Pelvic Ultrasound If your provider thinks your pain may come from something inside your pelvis, like endometriosis or a cyst, they may want to do an ultrasound to see that area. This ultrasound can be done through the skin of your lower abdomen, or through a wand inserted in the vagina.

Laparoscopy Rarely, your provider may not see the cause through an ultrasound but still suspects the pain is coming from an internal problem. In that case, they might recommend a minimally invasive surgery to investigate.

It can feel difficult to bring up sexual pain with a healthcare provider, but whatever you tell them will help. Remember: They have heard it all. And the more they know, the better they can direct your care.

Treatment and Medication Options for Dyspareunia

Depending on its cause, you can treat dyspareunia with medications, natural remedies, mental health therapy, or surgery.

 The best treatment will address all aspects of your pain: physical, emotional, and behavioral.

Medication Options

The cause of your sexual pain will direct whether medications may help you. Some common medication options for dyspareunia include:

Therapies

Various therapies can help rewrite the script on your sexual pain and the emotions that cause or come with the experience.

Physical Therapy A physical therapist uses pelvic floor therapy to help you learn to relax your pelvic muscles.

 These exercises can also retrain how your brain responds to sensations in that area, leading to less pain.

Vaginal Dilators Your therapist may also recommend vaginal dilators to gently stretch your vaginal tissue. These dilators start small (about 12 millimeters wide) and progressively get bigger as you’re able to insert them.

Sex Therapy If your sexual pain comes from an emotional response, a sex therapist can help you unravel those feelings. They can also help you work through any relationship issues with your partner and help you get back to sexual intimacy.

Cognitive Behavioral Therapy In cognitive behavioral therapy (CBT), a mental health professional helps you change negative thought and behavior patterns around sex. This therapy can also lessen fear and anxiety surrounding sex and sexual pain.

Surgery

Surgery provides another option if your pain is caused by scar tissue from an injury or previous surgery.

 You can also have your vagina surgically widened if your pain comes from vaginal tightness. But surgical options are more rare, and often only considered after you’ve tried other therapies.

Lifestyle Changes for Dysparuenia

For less painful sex, you can adjust some habits around the act:

  • Use lubricants: Lubricants with a water or silicone base can keep your vulva and vagina from becoming too dry during sex.
  • Avoid irritants: Use lubricants, soaps, and sanitary pads with no added perfumes.
  • Practice relaxation techniques: Take some time before sex to relax and calm your body. You can try activities like meditation, massage, or deep breathing exercises to help.
  • Take it slow: Longer foreplay can help your body prepare for penetration with less pain.
  • Try different positions: Avoid positions that hurt more than others.
  • Communicate: Throughout a sexual encounter, talk to your partner about what feels good and what’s hurting — never hesitate to ask for a break or change.
  • Use ice after sex: If soreness in your vulva lingers after intercourse, a wrapped ice pack to the area can help lessen inflammation and pain.
If you’re working through some therapies and don’t feel ready for intercourse yet, you can still experience sexual pleasure as well as intimacy with your partner. Oral sex, mutual masturbation, and other nonpenetrative sex options can fulfill you and keep you close to your partner while avoiding pain.

Prevention of Dyspareunia

Dyspareunia can’t always be prevented, but you can do a few things to make sex less painful and more pleasurable. Visit a healthcare provider on the schedule they recommend to stay up-to-date on wellness exams and important tests like pap smears.

Use condoms during sex to protect against sexually transmitted infections and keep your genital area clean.

 Use plenty of lubrication during sexual encounters to prevent friction and irritation.

You can also use stress management techniques like regular exercise, mindfulness, and journaling to prevent muscle tightness.

How Long Does Dyspareunia Last?

Dyspareunia can resolve quickly or may persist for years, depending on its cause and how quickly you can get treatment. For example, your prognosis will be short if sexual pain comes from vaginal dryness, and you can resolve it by using lubrication the next time you have sex.

But if painful sex comes from a medical condition or psychological issues, it may take longer to address. Whatever the cause, it’s important to let a healthcare provider know what’s going on. This is especially true if you experience any of these symptoms:

  • New pain during sex
  • Sexual pain has gotten worse
  • Bleeding during or after intercourse
  • Unusual vaginal discharge
  • Sores on your genitals
  • Irregular periods

The Takeaway

  • Dyspareunia is pain in the vaginal or pelvic region that happens right before, during, or after sexual intercourse.
  • Medical and psychological conditions, including hormonal changes, injury, anxiety, or stress, can cause dyspareunia.
  • You can treat dyspareunia with medications, physical therapy, counseling, and through some lifestyle modifications.
  • It can feel awkward to speak to a healthcare provider about sex, but it’s important to share your symptoms so your provider can help you make a plan for pain relief.

Common Questions & Answers

What is dyspareunia?
Dyspareunia is pain during sex, including just before, during, or after penetration.
Dyspareunia can be caused by medical conditions like menopause and skin disorders, psychological issues like depression and anxiety, and injury or trauma to the pelvic area.
The best treatment for dyspareunia depends on what’s causing it. These could include medications, physical therapy, counseling, or lifestyle changes.
Dyspareunia can feel sharp, throbbing, aching, or burning on the vulva or inside the vagina or pelvis.
Dyspareunia can last years without treatment, but can also be resolved quickly with the right intervention.

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Kara Smythe, MD

Medical Reviewer

Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.

She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.

Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.

When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.

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Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.

McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.

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Resources
  1. Painful Intercourse (Dyspareunia): Symptoms and Causes. Mayo Clinic. February 16, 2024.
  2. Tayyeb M et al. Dyspareunia. StatPearls. June 5, 2023.
  3. Dyspareunia (Painful Intercourse). Cleveland Clinic. July 25, 2024.
  4. When Sex Is Painful. American College of Obstetricians and Gynecologists. February 2024.
  5. Carter A et al. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations With Lack of Pleasure in a Nationally Representative Sample of Women in the United States. Journal of Sexual Medicine. December 2019.
  6. Hill DA et al. Dyspareunia in Women. American Family Physician. May 15, 2021.
  7. Painful Intercourse (Dyspareunia): Causes. Mayo Clinic. February 16, 2024.
  8. Hrelic DA et al. Dyspareunia: Etiology, Presentation, and Management. The Nurse Practitioner. November 2023.
  9. Painful Intercourse (Dyspareunia): Diagnosis and Treatment. Mayo Clinic. February 16, 2024.
  10. Moraczewski J et al. Tricyclic Antidepressants. StatPearls. August 17, 2023.
  11. Krychman M et al. Vaginal Dilators: A guide for health care professionals. Contemporary OB/GYN Journal. November 4, 2020.
  12. Donders G et al. Long Term Outcome of Surgical Treatment of Central Introital Dyspareunia. Journal of Clinical Medicine. April 7, 2022.
  13. Dyspareunia (Painful Intercourse). Cleveland Clinic. July 25, 2024.
  14. Dyspareunia. American Academy of Family Physicians. July 5, 2022.
  15. Stress Management and Emotional Health. Cleveland Clinic. April 27, 2021.