How Common Is Pain During Sexual Intercourse (Dyspareunia)?

Dyspareunia is the medical term for people who experience discomfort before, during or after sexual intercourse. While women experience dyspareunia more often, it can occur in men too. Despite how common this complaint is, pain or discomfort during sex should not be considered normal. Identifying the source of the pain may be challenging, but experienced clinicians can help reach the correct diagnosis.

How common is dyspareunia?

The American College of Obstetrics and Gynecologists reports that nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a frustrating long-term problem. Some people accept painful sex as normal, but it should not be. If these are minor issues you experience now and then, you can usually pinpoint the cause of the problem, such as the need for lubrication. Dyspareunia can cause barriers to the development of a healthy sex life, and it should be evaluated for treatable causes.

What causes dyspareunia?

Several conditions can cause painful sex. While the mind can play a role in the perception of discomfort during sexual intercourse (especially in those with a history of abuse or trauma), patients should not ignore this symptom. Many clinicians treat the symptom of pain instead of getting to the root of the problem, which may take multiple appointments and a dedicated physical examination.

The pelvic floor can play a significant role in the causes of dyspareunia. Many women (and men) have undiagnosed or under-treated pelvic floor dysfunction, which can prevent their ability to enjoy sexual intercourse. The term pelvic floor refers to the muscles that surround the organs in the lower part of the body also known as the pelvis. A physical examination may reveal pelvic floor dysfunction, tenderness to the vestibule (the part of the vulva between the labia minora) or vulva or signs of an infection, which can cause distress and discomfort with sexual intercourse.

While infections, such as yeast infections, urinary tract infections (UTIs) or sexually transmitted infections (STIs), can be a clear and treatable source of discomfort, hormonal imbalance is often neglected, especially in women. Both women who have gone through menopause and those on birth control often report vaginal dryness and discomfort with intercourse. Topical estrogen cream is a safe and effective treatment to restore the lost lubrication associated with estrogen deficiency. Women with a history of endometriosis (a disease in which tissue similar to the lining of the uterus grows in other places in the body) and interstitial cystitis (a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain) may also have symptoms of painful sex requiring pelvic floor physical therapy to assist with the relaxation of the pelvic floor. With time and commitment, this condition can be treated successfully or improved in most cases.

What are the symptoms of dyspareunia?

Symptoms include feelings of discomfort, burning or throbbing. Other symptoms can include:

• Pain in the vagina, bladder or urethra (the tube that carries urine from your bladder to the outside world).
• Sharp pain during penetration
• Pain after intercourse
• Pelvic cramping, including muscle tightness or spasms

How does dyspareunia affect men?

While pain during sex typically affects women more, it can happen to men too. Like women, men might experience pain during sexual intercourse if there is not enough lubrication. Painful sex can also be caused by:

• Sexually transmitted infections (STIs) – Infections under the foreskin, such as yeast infections, or STIs, such as gonorrhea or genital herpes, can cause sex to be painful.
• Peyronie’s disease – this condition causes the penis to curve, and it can cause discomfort
• Damaged foreskin – If the skin that covers the head of the penis is injured, rubbing or tearing can lead to pain during sex.
• Pain in the scrotum related to sexual encounters
• Pain with ejaculation

What treatment is available for dyspareunia?

Urologists, gynecologists, pelvic floor physical therapists and certified sexual therapists are available to help patients regain control of their bodies and restore the ability to achieve satisfactory sexual experiences with their partners. A typical treatment plan may include the following:

• Medication – If underlying infections cause the pain experienced during sex, your doctor may use medication to help treat the infections. This can include antibiotics, antifungal treatments, and topical or injectable corticosteroids. If your pain is due to vaginal dryness, your physician may want to consider topical estrogen or non-hormonal vaginal lubricants
• Pelvic floor physical therapy – If the pain you are experiencing during sex is related to your pelvic floor, a physical therapist can help identify areas of overactivity that may require relaxation or areas of weakness that require strengthening exercises.
• Consultation with a certified therapist – If the pain is related to psychological components, it is helpful to talk to a certified therapist who can help address previous trauma and work on effective coping strategies.

If you are experiencing painful sex consistently, you should talk to your doctor. We know topics around this can cause embarrassment for some, but your doctor has your best interest in mind. I urge all patients to find a doctor that they are comfortable with because discussing your health openly with your doctor is vital.