Dyspareunia (Painful Intercourse)

What is dyspareunia?

Pain during sex, or dyspareunia, is persistent or recurring pain just before, during or after sex. Dyspareunia is more common in people assigned female at birth (AFAB), but anyone can experience painful sex.

People AFAB can have pain externally in the vulva — to the labia (lips of the vagina) or at the opening of the vagina. Some feel the pain internally in places like the:

• Pelvic floor muscles.
• Skin of the vaginal canal.
• Uterus.
• Ligaments supporting the uterus.
• Lower abdomen.

People assigned male at birth (AMAB) can feel pain on the head of the penis, on the shaft, in the testicles or in the pelvis.

It’s a common condition that can have negative emotional and psychological effects. In addition to the physical pain, couples may experience loss of intimacy or strain in their relationships.

Your healthcare provider may refer you to a gynecologist who specializes in sexual health. They can determine appropriate treatment based on your symptoms and the underlying condition causing you pain.

Are there different types of dyspareunia?

The location of the pain can help determine what type of dyspareunia you’re experiencing:

• Entry pain (intraoital or superficial dyspareunia): This pain is felt at the entrance to your vagina during initial penetration. Causes could include changes in hormones, vulvar or vagina dryness, chronic irritation, infection and injury.
• Positional pain: This type of pain is usually related to your pelvic floor muscles, vaginal dryness or infection.
• Deep pain (collision dyspareunia): This is pain that occurs in deep penetration. It may feel worse in certain sexual positions. This type can happen due to conditions affecting your bladder or bowel, pelvic floor dysfunction, endometriosis or pelvic congestion syndrome.

Pain during intercourse can also be described as primary, secondary, complete or situational:

• Primary pain is pain you’ve had since becoming sexually active.
• Secondary pain develops after experiencing pain-free sex.
• Complete pain means you feel pain every time you have sex.
• Situational pain is when the pain only happens at certain times.

How common is dyspareunia?

Pain during sex is more common in people AFAB, affecting 3 in 4 people with a vagina at some point in their lives.

Up to about 28% of all people in the United States will experience painful sex at least once. This number may be a low estimate as many people don’t seek help for painful sex because it’s a sensitive topic.

What age is it most likely to occur?

Anyone of any age can experience painful sex. But it’s more likely to affect people AFAB who are past menopause (the average age of menopause is 51). This is mainly due to a decrease in estrogen, a hormone that helps with lubrication and other aspects of your vaginal health.

Don’t assume painful sex is just part of getting older, though, because that’s not always the case. 

What are the symptoms of dyspareunia?

If you have pain during sex, you may feel:

• Sharp pain during penetration or at entry (even when using a tampon).
• Deep pain during thrusting.
• Throbbing or aching after intercourse.
• Pelvic cramping.
• Muscle tightness or spasms.
• Bladder pain.

What does dyspareunia feel like?

The most common symptom is pain with intercourse that occurs at your vaginal opening or deep in your pelvis. It can be a distinct pain in one area, or it may affect your entire genital region. There can be feelings of discomfort, burning or piercing pain.

Does dyspareunia cause bleeding?

Dyspareunia doesn’t necessarily cause bleeding. Any bleeding that occurs during sexual intercourse is likely due to an underlying medical issue that isn’t always related to the pain. Seek an appointment with a provider if you’re having bleeding with sex. It could be normal, or it could be sign of an infection or underlying condition. Rarely, bleeding after sex is related to cancer.

What causes dyspareunia?

In many cases, you can experience pain during sex if there isn’t sufficient vaginal lubrication. But you can have painful intercourse because of infection, trauma or injury, or because of a medical condition.

Medical conditions

• Endometriosis: A condition in which tissue similar to the lining of your uterus is in the wrong place (like your fallopian tubes or abdomen).
• Skin disorders affecting your genitalia: Any type of itchy skin disorder like dermatitis can make sex painful.
• Pelvic floor dysfunction: Problems with the muscles and ligaments in your pelvic floor can lead to pain during sex.
• Bowel problems: Conditions that cause inflammation in your bowels can make sex painful This includes conditions like irritable bowel syndrome (IBS), ulcerative colitis and Crohn’s disease.
• Bladder problems: Conditions that affect your bladder like chronic UTIs, urinary frequency and interstitial cystitis (IC) can make sex painful.
• Hormonal changes: Hormonal changes, especially those that come during perimenopause, can make sex painful.
• Nervous system concerns: Things like a pinched nerve in your back, pudendal nerve concerns and nerve inflammation can cause pain during sex.
• Breastfeeding: Hormonal changes associated with breastfeeding can lead to painful sex.
• Pelvic floor dysfunction: Your pelvic floor muscles may tighten up due to pain, which could lead to further dysfunction and more pain.
• Vulvodynia: A condition that causes chronic pain in the vulvar area.
• Genitourinary syndrome of menopause (GSM): Your vaginal lining can lose its normal moisture and thickness and become dry, thin and inflamed.
• Vaginismus: Involuntary spasm of your vaginal muscles, often caused by fear of being hurt or prior trauma.

Trauma or injury

• Intercourse too soon after surgery or childbirth.
• Injury to the vulva or vagina: These injuries may include a tear from childbirth or from a cut (episiotomy) in your perineum (area of skin between the vagina and the anus) during a vaginal delivery or a straddle injury.

Infection

• Vaginal infections: These conditions are common and include yeast infections or bacterial vaginosis.
• Sexually transmitted infections (STIs): These may include genital warts, herpes or other STIs.
• Infections: Infections in your uterus or vagina.

Who is at risk for dyspareunia?

Pain during sex is more common in people AFAB, especially people who have reached menopause. But it can affect people AMAB, too. It also happens to people of all ages and backgrounds. The pain is often due to physical factors or medical conditions, but it can also be psychological or due to a mental health condition.

What are the complications of this condition?

The possible complications of painful sex are:

• Relationship problems: Lack of intimacy with your partner can lead to stress or strain in your relationship, leaving one or both of you feeling frustrated or disconnected. You may also find yourself not looking forward to sex or intimacy due to fear of the pain.
• Anxiety or depression: Chronic pain and being unable to do what you want to do can make you feel sad, depressed or anxious.
• Unresolved medical conditions: If an underlying condition is causing painful sex, not treating that issue could lead to complications of that specific condition. For example, if pain is due to an STI, infertility can be a serious complication of untreated STIs.

How is dyspareunia diagnosed?

Your healthcare provider can diagnose the underlying cause of pain during sex with a thorough health history and physical examination. The physical exam could include checking your pelvis, abdomen, vagina and uterus.

What tests are done to diagnose dyspareunia?

To locate the source of the pain and diagnose any medical conditions, healthcare providers may perform the following:

• Pelvic exam: Your healthcare provider may also collect a sample of vaginal fluid and pee to test for signs of infection. Sometimes, your provider will perform a rectal exam.
• Ultrasounds: Transvaginal ultrasound can get a better view of your reproductive system.
• Laparoscopy: In rare cases, laparoscopy is used if other tests are inconclusive.

How do I talk to my doctor about painful sex?

Talk openly with your healthcare provider about any pain during sexual intercourse. It’s normal to feel slightly embarrassed about discussing a sensitive topic like sex. But know that your provider has heard it before and is there to help you.

Some questions your healthcare provider may ask you are:

• Where’s the pain occurring?
• How often does the pain occur?
• How long have you been having painful intercourse?
• What does the pain feel like?
• What medications are you taking?
• Have you had any prior surgeries in the area?
• Have you been treated for any conditions that affect your genitals?

How is dyspareunia treated?

There are many approaches your healthcare provider can use to treat your symptoms, but it depends on the cause. For example, if pelvic floor dysfunction is causing the pain, physical therapy may be the first treatment your provider suggests.

Some treatments for sexual pain require prescription medication. If vaginal dryness is due to menopause, ask your healthcare provider about estrogen creams, tablets, rings or other medications.

Are there medications to take for dyspareunia?

Yes, medication can help with dyspareunia depending on the cause. If vaginal dryness due to low estrogen is the cause of your painful sex, topical estrogens can be applied to your vagina. The U.S. Food and Drug Administration (FDA) approved a drug called ospemifene for dyspareunia due to menopause. Your provider can also prescribe medication to treat pain due to infection or underlying medical conditions.

How can you treat dyspareunia naturally?

Applying a water- or silicone-based lubricant to your vagina, vulva and labia is helpful when dryness is the main cause. Those who have pain during sex should stop using vaginal perfumes, bubble baths or scented sanitary pads and fragranced toilet paper or wipes.

How do I manage symptoms of dyspareunia?

There are some things you can do on your own to manage the pain you feel during or after sex:

• Use a water- or silicone-based lubricant to help with vaginal dryness.
• Try sexual activities or positions that don’t cause pain.
• Take an over-the-counter (OTC) pain reliever before sex.
• Find time to relax and de-stress before having sex.
• Apply ice packs to the vulva after sexual intercourse.

Is there anything I can do to reduce my risk of dyspareunia?

There’s usually not much you can do to reduce your risk of dyspareunia. It’s often something you have no control over. Some of the factors within your control are having safe and protected sex and maintaining good hygiene.

How long can dyspareunia last?

How long dyspareunia lasts varies depending on the underlying cause of the pain and the treatment. The treatment may work well right away, or it may be trial and error until you find the right treatment. All of this can affect how long you live with painful sex.

The good news is that you can often find relief and recover. Whether it’s medication, pelvic floor therapy, surgery or using lubrication — your healthcare provider can find a treatment that can improve or eliminate dyspareunia.

When should I contact my healthcare provider?

Contact your healthcare provider if you have symptoms like:

• New or worsening pain during sex.
• Bleeding.
• Genital lesions.
• Irregular periods.
• Abnormal vaginal discharge.

What questions should I ask my healthcare provider?

Painful sexual intercourse can be physically and emotionally difficult. Some questions you may ask your healthcare provider are:

• What’s causing my pain?
• What treatments are available?
• Is there anything I can do to decrease my pain?
• How long will it take to feel better?

A note from Cleveland Clinic

Pain during sex can lead to physical discomfort, emotional distress and loss of intimacy. You don’t have to live with the pain. The pain isn’t just part of life or a part of getting older. If having sex hurts you, contact your healthcare provider. It might be an uncomfortable topic, but knowing the underlying cause of your pain is important. Your provider can recommend treatment so you can enjoy a fulfilling sex life again.