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Medical Author:

John G McManus Jr, MD

Coauthor:

Richard D Warren, MD

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Treatment of pain during intercourse depends on the cause.

• Entrance pain may be treated when the cause is identified.
• Atrophy (thinning of the vaginal walls): Entrance pain caused by atrophy is common among postmenopausal women who do not take hormone replacement medication. Blood flow and lubricating capacity respond directly to hormone replacement. The most rapid relief of atrophy comes from applying topical estrogen vaginal cream directly to the vagina and its opening. This cream is available by prescription only.
• Urethritis and urethral syndrome: With this condition, a woman may urinate frequently with urgency, pain, and difficulty, but a urinalysis can find no identifiable bacteria. These symptoms may be caused by chronic inflammation of the urethra (the tube through which urine exits the body) from muscle spasms, anxiety, low estrogen levels, or a combination of these causes. The doctor may dilate the urethra or may prescribe low-dose antibiotics. At times, antidepressants and antispasmodic medications to reduce muscle contractions in the bladder may also be prescribed.
• Inadequate lubrication: Treatment of inadequate lubrication depends on the cause. Options include water-soluble lubricants (for use with condoms; other types of lubricants may damage condoms) or other substances such as vegetable oils. If arousal does not take place, more extensive foreplay might be needed during sexual relations.
• Vaginismus: Painful spasms of muscles at the opening of the vagina may be an involuntary but appropriate response to painful stimuli. These spasms may be due to several factors, including painful insertion, previous painful experiences, previous abuse, or an unresolved conflict regarding sexuality. For a woman with vaginismus, her doctor may recommend behavior therapy, including vaginal relaxation exercises.
• Vaginal strictures (abnormal narrowing): Doctors commonly see vaginal strictures after pelvic surgery, radiation, or menopause. Passive dilation and estrogen are used to treat these strictures.
• Interstitial cystitis: This chronic inflammation of the bladder has no known cause; however, pain with intercourse is a common symptom. A health care provider may perform a cystoscopy (a procedure to look inside the bladder), or a urologist may distend (stretch) the bladder to examine the bladder wall. These procedures often work to clear the condition. Other treatments include bladder washings with dimethyl sulfoxide (DMSO) and prescriptions of imipramine (Tofranil).
• Endometriosis: Endometriosis occurs when the lining of the uterus is found outside the uterus. Pain during intercourse caused by endometriosis is not uncommon. Relief of this pain often indicates success in treating endometriosis.
• Vulvovaginitis (inflammation of the vulva and vagina): Whether recurrent or chronic, this problem is common despite the rise in the number of over-the-counter treatments.
• If not responsive to self-treatment with lubricating gels or initial treatment by a doctor, a woman may need a more thorough evaluation to identify the cause.
• A doctor may ask the woman if she uses antibiotic or antifungal medication or if she douches. If so, these practices should be stopped to help determine whether a specific disease-causing organism is present.
• Treatment is based on the presence of bacteria or other organisms. Often, no single organism is identified. The doctor may talk to the woman about proper hygiene.
• If recurring symptoms are shared with a sexual partner, both individuals should be tested for sexually transmitted diseases (STDs).
• A doctor considers the possibility of intermittent urethral infection with chlamydia, an STD, as well as a more obvious urinary tract infection, and then treats with the appropriate antibiotics.
• Pelvic adhesions (tissue that has become stuck together, sometimes developing after surgery): Pain with intercourse caused by pelvic adhesions can be relieved by removing the adhesions.
• Uterine retroversion: The health care provider may find physical causes of the pain, including ovarian cysts, pelvic inflammatory disease, endometriosis (uterine lining tissue out of place), or retroversion of the uterus (uterus is tilted backward instead of forward).

A doctor should be able to find the cause and to select proper treatment for pain experienced during intercourse. Sometimes, the doctor refers the woman to a specialist.

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