Family Health|Women
dyspareunia|gynecologic|painful sex|Pelvic Pain|women's health


Last Updated August 2023 | This article was created by editorial staff and reviewed by Kyle Bradford Jones, MD, FAAFP

What is dyspareunia?

Dyspareunia is painful sex for women. Also, it causes pain during tampon use. The pain can be felt in a woman’s genitals or deep inside her pelvis.

Symptoms of dyspareunia

The pain may feel sharp, burning, or like menstrual cramps. Pain during sex may feel like it is coming from deep inside the pelvis. Women often report the feeling that something is being bumped into inside them.

Dyspareunia can have many causes, including.

  • Infection (such as a yeast infection, urinary tract infection)
  • Injury to the vagina
  • Inflammation of the vagina. The inflammation can be so bad that wearing pants can cause pain.
  • Poorly fitted diaphragm or cervical cap. These are methods of birth control.
  • Muscle spasms around the vagina. For some women, the pain of the spasms is so severe that sexual intercourse is impossible.
  • Vaginal dryness. This dryness may be caused by menopause and changes in estrogen levels. Estrogen is a hormone. It could also be from a lack of foreplay before intercourse.
  • Abnormalities inside the uterus. These could include fibroid growth, if the uterus is tilted, or if the uterus prolapses (falls) into the vagina.
  • Certain conditions or infections of the ovaries
  • Past surgeries. This may leave scar tissue that can cause pain.
  • Endometriosis (scar tissue outside the uterus unrelated to surgery)
  • Pelvic inflammatory disease
  • Being tense during sex or being unable to become aroused

How is dyspareunia diagnosed?

During a visit with your doctor, they will ask you to describe your pain, where it is located, and when it began. They may also ask you to describe what you have tried in the past to relieve the pain. For example:

  • Have you tried a sexual lubricant or more foreplay?
  • Is it painful every time you try to have sex?
  • Are there other problems associated with sex?

Your doctor may want to examine your genital area or perform a pelvic exam. During a pelvic exam, your doctor may apply a cotton-tipped swab to the area around the vagina to see if it is painful. Your doctor will examine your vagina and cervix using a tool called a speculum. This helps the doctor gently open the area for the exam. It is similar to the way you get a Pap smear. For some women, this part of the exam may be painful. Your doctor may use a smaller speculum to decrease the discomfort. Your doctor may also delay the exam until the pain has decreased. It is important to let your doctor know if the exam becomes too painful.

During the final part of the exam, your doctor will feel your uterus and ovaries with one hand on the abdomen and finger(s) in your vagina. This is similar to exams performed during a pelvic exam.

If your symptoms and exam suggest an infection, your doctor may take a sample from your vagina or cervix to send to the lab. A urine test is another possible test. Your doctor may order a pelvic sonogram, CT (computed tomography), or X-ray test to look inside your pelvis.

Can dyspareunia be prevented or avoided?

Depending on the cause of your dyspareunia, it could be prevented through treatment. For example, if it is caused by vaginal dryness or lack of foreplay, it can be prevented through the use of a sexual lubricant.

Dyspareunia treatment

Treatments depend on what is causing your pain. They may include sexual lubricants (over-the-counter products), antibiotics for infections, a different type of birth control, or surgery.

Living with dyspareunia

Living with dyspareunia may be physically uncomfortable. However, it may affect your sexual relationship as well. Anticipating painful sex may cause you to avoid it. It may change the type of birth control you use (which may or may not be convenient for you).

Questions to ask your doctor

  • Could tampon use or overuse be causing my pain?
  • Does childbirth cause the pain?
  • Can hormone replacement therapy (HRT) help vaginal dryness?
  • Can the pain be related to ovarian or cervical cancer?
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