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Symptoms and Signs of Painful Intercourse (Sex)

Doctor's Notes on Painful Intercourse (Sex)

Painful intercourse is the experience of discomfort or pain during sex. The medical term for painful intercourse is dyspareunia. It can occur due to involuntary contraction of the vaginal muscles in women, a condition known as vaginismus. Painful intercourse can also be a symptom of sexually-transmitted diseases or abnormalities or tumors of the female genital tract. Lowering of estrogen levels in perimenopause and after menopause can result in insufficient lubrication and painful intercourse along with certain medications.

Associated symptoms can include vaginal dryness, burning, itching, bleeding, or discharge. Other signs and symptoms depend upon the cause and can include lower abdominal or pelvic pain, fever, mood swings, anxiety, headache, sleep disturbances, and abdominal tenderness.

Medical Author:
Medically Reviewed on 3/11/2019

Painful Intercourse (Sex) Symptoms

Symptoms of pain related to sexual intercourse can occur when entry is attempted or during and/or immediately following sexual intercourse.

  • The most common symptom is pain on entry (intromission). The pain may be described as sharp or burning.
  • The second most common symptom is deep pain.
  • Other symptoms include feelings of muscle spasms, pelvic cramping, or muscle tightness.

Pain during intercourse may be described as primary or secondary; as complete or situational; and as superficial-entrance or deep thrust types.

  • Primary pain with intercourse is pain that has existed for the woman's entire sexual lifetime.
  • Secondary pain develops after a symptom-free period of time.
  • Complete pain means the woman experiences pain in all times during intercourse.
  • Situational pain occurs with a particular partner or a certain type of stimulation.
  • Superficial-entrance pain is noticeable at penetration.
  • Deep thrust pain is located at the cervix or in the lower abdominal area and is noticeable during or after penetration.

A woman may perceive pain during intercourse even without any physical cause. Sexual pain without an apparent physical cause may have a psychological origin.

Painful Intercourse (Sex) Causes

A health care professional 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 professional 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 is one of the most common causes of problems of sexual dysfunction. The prevalence of such pain seems to be increasing over time. Possible reasons for this apparent increased prevalence include the following:

  • Changes in sexual behavior
  • An increase in the frequency of sexually transmitted diseases
  • Increased willingness to discuss sexual behavior and dysfunction
  • Due to thinning and dryness of the vaginal walls after menopause, some women report that sex is more painful than prior to menopause.
  • Vulvodynia is a condition that causes chronic pain in the vulvar area that is not related to a known cause. Women with vulvodynia may experience pain with sexual intercourse.
  • Other conditions that can cause painful intercourse include
    • injuries or irritation of the vagina due to any cause,
    • infections,
    • vaginismus (muscle spasms of the vaginal wall muscles),
    • urinary tract infection, and
    • skin conditions that affect the genital areas.

Female Sexual Dysfunction Treatment for Women's Sexual Disorders Slideshow

Female Sexual Dysfunction Treatment for Women's Sexual Disorders Slideshow

Sexual dysfunction is a common concern shared by many women. Problems may occur during any phase of the sexual response cycle (excitement, plateau, orgasm, and resolution) that prevent a woman from experiencing sexual satisfaction. Many women are reluctant or embarrassed to discuss their sexual problems, but it's important to tell your doctor what you are experiencing since most cases of sexual dysfunction can be treated.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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