7 Main Causes of Painful Intercourse

Sexual intercourse is meant to be enjoyed, not endured. Both partners are supposed to feel great pleasure during intercourse, but when it hurts, then there is a problem. It is important to identify the root causes of painful intercourse in order to find relief and enjoy a healthy sexual life.

Key points:

• Painful intercourse is genital pain that lasts or occurs repeatedly before, during, or after sexual intercourse.
• If you experience painful intercourse, you are not alone as it is quite a common challenge.
• Painful intercourse is not exclusively a women’s issue. It also affects men (39.5% of women and 2% of men).
• Pain during intercourse is mostly caused by physical factors, psychological factors or medical conditions.
• Some of the causes of painful intercourse for women include: vaginal dryness, lack of foreplay, Vaginitis, hormone imbalance, injury in genital area, trauma, Vaginismus, infection, certain medical conditions, etc.
• For men, painful intercourse can be caused by trauma, problems at birth, some health conditions such as inflammation of the glans penis, development of scar tissue in the penis, painful erection, inflammation of the urethra, prostatitis, and having a tight foreskin.
• Talk to an Expert Doctor on KompleteCare about painful intercourse and every other sexual health concern you have. Your privacy and confidentiality is guaranteed.

Painful intercourse can negatively affect individuals and couples, resulting in reduced sexual desire, sex, and sexual satisfaction. There are different factors that can cause painful intercourse. These factors can be physical or emotional. If this is your experience, this article will show you the different causes of painful intercourse and potential solutions.

What is painful intercourse?

Painful intercourse, known by the medical term dyspareunia, is genital pain that lasts or occurs repeatedly before, during, or after sexual intercourse. 

Painful intercourse is a common sexual problem. It can affect both men and women but is more common in women. According to reports, dyspareunia can affect 10 to 28% of the global population, with a prevalence rate of about 39.5% in women.

The pain is mostly caused by physical factors or medical conditions, but it can also be caused by psychological factors.

Symptoms of painful intercourse

Painful intercourse can manifest in different ways, but the primary symptom is pain, which you might experience as –

For women:

• A sharp pain at the entrance of the vagina during penetration. 
• Pain throughout with every thrust,

• Pain that occurs deep in the pelvic area during deep penetration
• Aching or throbbing pain that continues long after intercourse
• Cramping of the pelvic floor muscles

For the men

• Painful erection
• sharp, burning, or aching pain. It can occur at the tip of the penis, in the urethra, or the pelvic region. The pain may start before, during, or after ejaculation.
• The feeling of soreness and irritation of the genital area due to a rash on the penis.

Causes of Painful Intercourse:

Several factors can contribute to dyspareunia. Here are some of the common causes:

Physical Causes:

1. Vaginal dryness or inadequate lubrication: The vagina is naturally moisturized by fluid produced by the glands at the vaginal opening. This fluid is produced most often during sex. Insufficient fluids might cause friction during intercourse to irritate the wall of the vagina, resulting in pain.

Insufficient lubrication may be caused by: 

• lack of foreplay
• Drop in estrogen, which can be a result of childbirth, breastfeeding, and menopause.
• Certain medications, such as antidepressants, antihistamines, high blood pressure medication, sedatives, and certain birth control pills, can affect sexual desire or arousal. They can decrease lubrication, making sex painful.

2. Skin conditions: skin conditions like eczema, lichen planus and psoriasis, or contact dermatitis in the genital area can cause irritation and pain during intercourse.
3. Infections: Infections such as yeast infections, bacterial vaginosis, urinary tract infections, and sexually transmitted infections can cause irritation and inflammation of the genital area and contribute to painful intercourse.
4. Injury or trauma: dyspareunia can result from injuries to the genital area—the vulva, vagina, or pelvic floor muscles. Trauma caused by childbirth, pelvic surgery, female circumcision, or forceful sex can lead to pain.
5. Underlying medical conditions: endometriosis, uterine fibroids, irritable bowel syndrome, pelvic inflammatory disease (PID), cystitis adenomyosis, uterine prolapse, retroverted uterus, hemorrhoids, and ovarian cysts can contribute to painful intercourse. 

For the male, conditions such as balanitis (inflammation of the glans penis), Peyronie’s disease (development of scar tissue in the penis), priapism (painful erection), urethritis (inflammation of the urethra), prostatitis (inflammation of the prostate), and phimosis (tight foreskin) can cause pain during intercourse.

6. A problem at birth. Although they are the less common cause of dyspareunia, abnormalities at birth such as vaginal agenesis (not having a fully developed vagina) or imperforate hymen (having a hymen that blocks the vaginal opening) could cause painful intercourse.
7. Vaginismus: This is involuntary contraction of the pelvic floor muscle, which can lead to painful intercourse.

Emotional and Psychological Causes:

Emotional well-being is closely tied to sexual health. The emotional factors that can cause painful intercourse are:

• Fear, anxiety, or depression. They can affect sexual arousal and lubrication, leading to painful intercourse.
• Stress: can trigger the pelvic floor muscles to tighten, leading to pain.
• Relationship issues: communication problems, strained relationships, or fear of intimacy, probably due to past sexual trauma or abuse, can manifest as physical pain during intercourse.

How is painful intercourse diagnosed?

To determine the underlying cause of pain during intercourse, your doctor will have to:

• Take a look at your medical history, and ask you some questions about the nature of your pain and your sexual life. 
• Carry out some physical examinations to check your vagina, pelvis, abdomen, and uterus for infections, inflammation, irritation, or any abnormalities in the genital structure.
• Depending on the result of the physical examinations, your doctor may recommend further tests such as swabs, urine tests, blood tests, ultrasounds, or pelvic MMR to determine the root cause of your painful intercourse and decide on the best treatment plan to treat the problem.

The treatments for painful intercourse 

There are different treatment options available for achieving pain-free intercourse, and these treatment options depend on the cause. Here are some of the common treatment options you can use to manage painful intercourse:

• Topical estrogen creams, tablets, or vaginal rings can help restore lubrication if your vaginal dryness is caused by a drop in estrogen levels.
• Use lubricants to improve vaginal dryness, moisturize the vagina, and reduce friction. 
• Engage in foreplay to promote arousal and stimulate the production of natural lubricants.
• Apply topical medications to treat underlying skin conditions like vulvar dermatitis or eczema
• Treat infections with antibiotics or antifungal medications (be sure to get prescriptions for these to avoid antibiotic resistance). This can help reduce inflammation and pain.
• Depending on the severity, allow injuries to heal before engaging in sex and address issues with muscle strain or tightness by seeing a physical therapist.
• Managing underlying medical conditions like endometriosis or fibroids with medication or surgery 

To treat painful intercourse caused by Emotional and Psychological factors, you need to do the following:

• Communication: Discuss your needs and expectations with your partner; talk about what feels good and what doesn’t feel good about your sexual life. Be willing to try different positions to discover what you both enjoy and are comfortable with.
• Sex Therapy: Sex therapy can help resolve pain caused by stress, fear, anxiety, or feelings regarding past abuse that may be contributing to dyspareunia.

Other Therapeutic Approaches you can use:

• Relaxation techniques: engage in relaxation exercises like deep breathing or meditation to help reduce stress and anxiety and increase sexual arousal and lubrication.
• Pelvic floor therapy: weakness or tightness of the pelvic floor muscle can contribute to dyspareunia. Physical therapy can help strengthen and coordinate the muscles.
  

How to prevent pain during intercourse 

Although there is no specific way that has been proven to prevent dyspareunia, but you can do the following to reduce the risk of pain during sex and generally improve sexual health:

• Use a lubricant for sex when you experience vaginal dryness.
• Use a condom or any other form of protection to prevent and reduce the risk of sexually transmitted diseases (STDs). 
• Take enough time to engage in foreplay. This can encourage natural vaginal lubrication and make sex more comfortable.
• Couples should explore different sex positions to find out what positions are most comfortable for them.
• Give yourself time to heal if you just gave birth or if you have any injuries in your genital area. 
• Perform Kegel exercises regularly to strengthen the pelvic floor muscles, improve circulation, and potentially reduce pain during sex.

When should I see a doctor?

See or speak to a certified doctor if you experience:

• persistent pain that lasts for weeks or months
• pain that worsens with time
• bleeding after sex
• fever or unusual tiredness
• pain or other symptoms after sex, especially with a new partner.
• severe abdominal or back pain and cramps
• unusual vaginal discharge 
• problems achieving or maintaining an erection

 Frequently asked questions 

1. How long does it take to recover from dyspareunia?

The time it takes to recover from painful intercourse varies depending on the cause of the pain. Whether the treatment requires medication, topical creams, counseling, surgery, or lubrication, the good thing is that painful intercourse can be treated and cured once the cause is identified and treated.

2. Does dyspareunia cause bleeding?

No, painful intercourse doesn’t really cause bleeding. Although some people may experience spotting or light bleeding once in a while after sex, this may probably be due to an underlying medical condition. 

3. Where is pain during sex felt?

Pain can be felt in the vulva, in the vestibule (area surrounding the opening of your vagina) or within your vagina. The men may feel pain in the penis, and scrotum. Other sites where pain can also be felt during sex are the perineum, lower back, pelvic region, uterus, or bladder.

4. Can certain sexual positions cause painful intercourse?

Yes, women may experience pain when having intercourse in certain positions. Positions that can lead to deep penetration can cause pain to some women. Choose positions that allow you to control the depth of the penetration if you experience pain when having sex in positions that require a deeper penetration.

Conclusion

Painful intercourse is a treatable condition. Recognizing symptoms, identifying their causes, and seeking medical attention will not only improve sexual well-being; it will also save your relationship and promote your emotional and physical well-being.

So, whether the cause of the painful intercourse is physical or psychological, addressing the root cause is essential for an enjoyable and pain-free intimate life. Talk to a licensed doctor on KompleteCare about your sexual health concerns today.

References

1. American College of Obstetricians and Gynecologists. (n.d):  When Sex Is Painful | ACOG.
2. Women’s Health Partners, (2024);  Dyspareunia (Painful Intercourse) Causes, Symptoms & Treatments | Women’s Health Partners
3. Family doctor.org, (202);  Dyspareunia – Painful Sex | familydoctor.org
4. Muhammad Tayyeb and Vikas Gupta, (2023); Dyspareunia
5. Sunday Uchenna Asogwa, et al (2019); Prevalence of Dyspareunia and Its Effect on Sexual Life among Gynaecological Clinic Attendees in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

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