Why Is Sex Painful

Pain during sex or afterward is called dyspareunia. Women can experience it in the vulva, labia, vagina, cervix, uterus, or pelvis. It’s a common condition that can make sex less enjoyable, cause adverse psychological and emotional effects, and strain relationships.

Fortunately, healthcare providers can typically identify its causes and recommend effective treatments.

Men can also experience dyspareunia. However, this article addresses the many types of dyspareunia in women (vaginal pain during sex, abdominal pain after sex, etc.), including the causes, diagnosis, and treatment of dyspareunia.

Types of Dyspareunia

Pain during or after sex can occur in many areas, but doctors divide it into entry pain (intraorbital or superficial dyspareunia) and deep pain (collision dyspareunia).

Entrance dyspareunia occurs at the opening of the vagina during initial penetration. Injury, infection, and lack of lubrication are common causes. Deep pain is felt in the lower abdomen or cervix and is more common in certain sexual positions that result in deeper penetration. Prior surgery and specific medical conditions are usually the cause of deep pain.

Doctors also classify dyspareunia as primary, secondary, complete, or situational. Primary pain is something you’ve experienced since you became sexually active, whereas secondary pain develops after having had pain-free sex. Complete pain means you experience pain every time you have sex, while situational pain only occurs for you in specific scenarios.

What Causes Pain During or After Sex?

Several conditions can cause pain during or after sex, including:

• Vaginal infections like yeast infections
• Vaginal atrophy caused by hormonal changes or menopause that reduces moisture and causes tissue to be thin and inflamed
• Sex too soon after childbirth
• Urinary tract infections (UTIs)
• Skin problems in or around the genitals
• Endometriosis (uterine tissue growing outside the uterus)
• Herpes sores, genital warts, or other sexually transmitted infections (STIs)
• Pelvic inflammatory disease
• Excessive tightness in pelvic floor muscles
• Fibroids and other issues in the uterus
• Ectopic pregnancy (a fertilized egg develops outside the uterus)
• Infections or other problems with the cervix
• Vulvodynia, which causes chronic pain in the vulva
• Ovarian cysts and other conditions affecting the ovaries
• Injury to the vagina, vulva, or surrounding areas, including tears in the perineum or episiotomy during childbirth
• Vaginismus (a spasm of vaginal muscles caused by fear of being hurt by sex)
• Prolonged or vigorous intercourse
• Allergic reaction to sexual lubricants, condoms, or other products
• Low self-esteem, depression, anxiety, or having been the victim of sexual abuse

How Is the Cause of Painful Sex Diagnosed and Treated?

Doctors diagnose dyspareunia using various procedures and tests. This typically starts with a physical examination that may include a pelvic exam, Pap test, and rectal exam. Your doctor may also ask for urine and vaginal fluid samples to check for infections.

An imaging procedure called transvaginal ultrasound may be used to assess your reproductive system. And in rare cases, your doctor may recommend a laparoscopy. It’s a procedure where a thin tube with a camera is passed through a small incision in your abdomen to enable your doctor to check various areas and organs, including your uterus, ovaries, and fallopian tubes.

Treatment for dyspareunia varies based on the cause. It may involve:

• Using lubricants
• Using estrogen creams, rings, or oral medication to address vaginal dryness
• Sexual therapy if no medical cause is identified

You might also consider taking these steps:

• Talk with your partner about what you’re experiencing.
• Have gentler intercourse.
• Use sexual positions that don’t cause pain.
• Take time to relax before having sex.
• Use over-the-counter pain relievers as directed before or after sex.
• Apply an ice pack to your vulva after sex.

Talk with Your Baptist Health Doctor About Painful Sex

Sex should be pain-free. Experiences like vaginal pain after sex, IUD pain during sex, pelvic pain after sex, uterus pain after sex, etc., aren’t something you should expect or tolerate. The knowledgeable and compassionate professionals in our women’s services group can help you identify and address the issues causing you pain so you can enjoy intimate time with your partner.  Reach out to a Baptist Health provider today.