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Pain During Intercourse (cont.)

When to Seek Medical Care for Pain During Intercourse

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, psychologist or 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 onset or severe pain
  • Nausea, vomiting, or rectal pain following intercourse
  • A new discharge

Diagnosis of Pain During Intercourse

A health care provider should ask about a woman's history of pain during intercourse. A thorough history and an extensive physical examination 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 opening into the vagina
    • 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 dyspareunia refers to pain which occurs with deep repetitive vaginal penetration by her partner. A common complaint is that it feels as though her partner is "bumping" into something which causes pain with pelvic thrusting. This type of pain may suggest abnormalities of the pelvic organs, such as endometriosis, adhesions, or uterine prolapse.
    • Pain in the middle of the pelvis may suggest a uterine origin. Pain on one or both sides of the pelvis is more suggestive of pathology involving the fallopian tubes, ovaries, and ligaments.
  • A health care provider may perform an extensive physical examination 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 should include 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 the urine (urinalysis), and other laboratory tests.
  • A health care professional may recommend special radiological tests, such as a pelvic ultrasound or a CT scan or an MRI of the pelvis.
  • The doctor may perform a urethrogram (an X-ray procedure to provide an image of the urinary tract), a cystogram (an x-ray exam that images the urinary bladder), or both, or the woman may be referred to a specialist (urologist) for these procedures. Another diagnostic procedure that may be used to look for urinary abnormalities is a cystoscopy, in which the doctor uses a thin, lighted probe to see the interior lining of the bladder and urethra. Frequently, referral to a urologist may be necessary to accomplish these procedures.

Pain During Intercourse Home Remedies

Applying lubricating gels to the outer sexual organs, the vulva and labia, as well as using lubricating products in the vagina may be helpful to some women and ease pain during intercourse. Sex toys, such as vibrators or dildos, may also be useful. A woman should talk with her health care provider before attempting to use a vaginal dilator.

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