Painful Sexual Intercourse in Female: Causes and Treatment

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The symptoms are significantly more common in women than in men. The pain can primarily be on the external surface of the genitalia or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

Causes

Physical causes of painful intercourse tend to differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.

Entry pain

Pain during penetration may be associated with a range of factors, including:

• Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding. In addition, certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
• Injury to the vulva or vagina, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, a tear from childbirth (female circumcision), or a congenital abnormality or from a cut (episiotomy) made in the area of skin between the vagina and anus during labor.  .
• Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem. 
• Vaginal infections. These conditions are common and include yeast infections.
• Vaginismus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.

Deep pain

Deep pain usually occurs with deep penetration and may be more pronounced with certain positions. Causes include:

• Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.
• Surgeries or medical treatments. Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes cause painful intercourse. In addition, medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful. 
• Problems with the cervix (opening to the uterus). In this case, the penis can reach the cervix at maximum penetration. So problems with the cervix (such as infections) can cause pain during deep penetration.
• Problems with the uterus. These problems may include fibroids that can cause deep intercourse pain.
• Endometriosis. This is a condition in which the tissue that lines the uterus grows outside the uterus.
• Problems with the ovaries. Problems might include cysts on the ovaries.
• Pelvic inflammatory disease (PID). With PID, the tissues deep inside become badly inflamed and the pressure of intercourse causes deep pain.
• Ectopic pregnancy. This is a pregnancy in which a fertilized egg develops outside the uterus.
• Menopause. With menopause, the vaginal lining can lose its normal moisture and become dry.
• Intercourse too soon after surgery or childbirth.
• Sexually transmitted diseases. These may include genital warts, herpes sores, or other STDs.

Emotional factors

Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Emotional factors include:

• Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
• Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
• History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse, but if you have been abused, it may play a role.

Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.

Symptoms

If you experience painful intercourse, you may feel:

• Pain only at sexual penetration (entry)
• Pain with every penetration, even while putting in a tampon
• Pain with certain partners or just under certain circumstances
• New pain after previously pain-free intercourse
• Deep pain during thrusting, which is often described as "something being bumped"
• Burning pain or aching pain

Treatment

Some treatments for painful sex in women do not require medical treatment. For example, painful sex after pregnancy can be addressed by waiting at least six weeks after childbirth before having intercourse. Make sure to practice gentleness and patience. In cases in which there is vaginal dryness or a lack of lubrication, try water-based lubricants. If vaginal dryness is due to menopause, ask a health care professional about estrogen creams or other prescription medications. Other causes of painful intercourse may also require prescription drugs.

For cases of sexual pain in which there is no underlying medical cause, sexual therapy might be helpful. Some individuals may need to resolve issues such as guilt, inner conflicts regarding sex, or feelings regarding past abuse.

When to see a doctor

Call a doctor if there are symptoms such as bleeding, genital lesions, irregular periods, vaginal discharge, or involuntary vaginal muscle contractions. Ask for a referral to a certified sex counselor if there are other concerns that need to be addressed. If you are experiencing painful intercourse, talk to your doctor. Treating the problem can help your sex life, your emotional intimacy and your self-image.