Dyspareunia: Pain during intercourse

Three out of four women, at some point in their lives, will feel pain during intercourse, a situation called dyspareunia. The cause may be a gynaecological problem such as endometriosis or ovarian cyst, but it can also be the result of a sexual dysfunction such as lack of desire or excitement.

The woman may detect pain at some point in the vulva, at the entrance of the vagina or deeper into the vagina, between the vagina and the anal (perineal), the uterus, low in the abdomen, low in the waist or bladder.

When pain occurs often, a gynaecological examination should be scheduled.

The following gynaecological diseases should be excluded, with the help of the medical history, clinical examination, ultrasound, and possibly laparoscopy:

• Dermatitis of the area, such as irritation from soaps, sanitary napkins, lubricants, fabrics, abrasions, Bartholin cysts, other skin or genital infections such as fungal vaginitis, chlamydia and genital herpes.
• Uterine fibroids and ovarian cysts.
• Salpingitis and inflammation of the internal genital organs in general.
• Endometriosis and post-operative adhesions.
• Tough and inelastic hymen.
• Vulvodynia, which is localised sensitivity to a particular area of the vulva, most commonly at the entrance of the vagina.
• Vaginismus, which is the reflex contraction of the muscles surrounding the entrance to the vagina.
• Hormonal changes, such as in the menopause or breastfeeding, where reduced estrogens result in dryness of the vagina.
• Episiotomy or perineal rupture following normal delivery may cause discomfort for a few months after giving birth

If a gynaecological condition is ruled out, the cause may be dysfunction in sexual desire and arousal, such as:

• Feelings of fear, shame, embarrassment, guilt create difficulty in relaxation and therefore in arousal.
• Fatigue and stress lead to decreased desire and thus stimulation.
• Disagreement between partners on sexual issues, anatomical incompatibility, non-coordination of sexual desire, and general problems in the relationship.
• Some medicines, such as some oral contraceptive or painkillers, can reduce sexual desire.
• Non-gynecological conditions such as arthritis, spastic colitis, constipation, diabetes mellitus, may cause sexual dysfunction.

General aid measures could include the use of lubricants, change of attitude during sexual intercourse, longer preparation time before penetration and genuine communication between partners.