Diagnosis

A medical evaluation for dyspareunia usually consists of:

  • A thorough medical history. Your doctor may ask when your pain began, exactly where it hurts, how it feels, and if it happens with every sexual partner and every sexual position. Your doctor may also inquire about your sexual history, surgical history and previous childbirth experiences.

    Don't let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your pain.

  • A pelvic exam. During a pelvic exam, your doctor can check for signs of skin irritation, infection or anatomical problems. He or she may also try to identify the location of your pain by applying gentle pressure to your genitals and pelvic muscles.

    A visual exam of your vagina, using an instrument called a speculum to separate the vaginal walls, may be performed as well. Some women who experience painful intercourse are also uncomfortable during a pelvic exam, no matter how gentle the doctor is. You can ask to stop the exam at any time if it's too painful.

  • Other tests. If your doctor suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound.

Treatment

Treatment options vary depending on the cause of the pain.

Medications

If an infection or medical condition contributes to your pain, treating the cause might resolve your problem. Changing medications known to cause lubrication problems also might eliminate your symptoms.

For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina.

The Food and Drug Administration approved the drug ospemifene (Osphena) to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining, but doesn't seem to have estrogen's potentially harmful effects on the breasts.

Drawbacks are that the drug might cause hot flashes, and it carries a risk of stroke, blood clots and cancer of the lining of the uterus (endometrium).

Another drug to relieve painful intercourse is prasterone (Intrarosa). It's a capsule you place inside the vagina daily.

Other treatments

Certain nonmedication therapies also might help with dyspareunia:

  • Desensitization therapy. You learn vaginal relaxation exercises that can decrease pain.
  • Counseling or sex therapy. If sex has been painful for some time, you might have a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you might also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.

    Cognitive behavioral therapy can also be helpful in changing negative thought patterns and behaviors.

Lifestyle and home remedies

You and your partner might be able to minimize pain with a few changes to your sexual routine:

  • Change positions. If you have sharp pain during thrusting, try different positions, such as being on top. In this position, you might be able to regulate penetration to a depth that feels good to you.
  • Communicate. Talk about what feels good and what doesn't. If you need your partner to go slow, say so.
  • Don't rush. Longer foreplay can help stimulate your natural lubrication. You might reduce pain by delaying penetration until you feel fully aroused.
  • Use lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one you like.

Coping and support

Until vaginal penetration becomes less painful, you and your partner might find other ways to be intimate. Sensual massage, kissing and mutual masturbation offer alternatives to intercourse that might be more comfortable, more fulfilling and more fun than your regular routine.

Preparing for your appointment

Talking to your doctor is the first step in resolving painful intercourse. Your regular doctor might diagnose and treat the problem or refer you to a specialist.

What you can do

To prepare for this discussion with your doctor, make a list of:

  • Your sexual problems, including when they began and how often and under what conditions they occur
  • Your key medical information, including conditions for which you're being treated
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

Some questions to ask your doctor include:

  • What could be causing my problem?
  • What lifestyle changes can I make to improve my situation?
  • What treatments are available?
  • What books or other reading materials can you recommend? What websites do you recommend?

What to expect from your doctor

Your doctor might ask you questions, including:

  • How long have you had painful intercourse?
  • Where do you feel the pain?
  • Does the pain occur every time you have sex or only in certain situations?
  • How is your relationship with your partner?
  • Are you able to discuss your sexual concerns with your partner?
  • Do any nonsexual activities cause you pain?
  • How much distress do you feel about your sexual concerns?
  • Do you have vaginal irritation, itching or burning?
  • Have you ever been diagnosed with a gynecological condition or had gynecological surgery?
Jan. 12, 2018
References
  1. Rezaee R, et al. Approach to the woman with sexual pain. https://www.uptodate.com/contents/search. Accessed Oct. 31, 2017.
  2. Frequently asked questions. Gynecologic problems FAQ020. When sex is painful. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/When-Sex-Is-Painful. Accessed Oct. 31, 2017.
  3. Dyspareunia. The Merck Manual Professional Version. http://www.merckmanuals.com/professional/gynecology_and_obstetrics/sexual_dysfunction_in_women/dyspareunia.html?qt=dyspareunia&alt=sh. Accessed Oct. 31, 2017.
  4. Barbiere R. Differential diagnosis of sexual pain in women. https://www.uptodate.com/contents/search. Accessed Oct. 31, 2017.
  5. Alligood-Percoco NR, et al. Risk factors for dyspareunia after first childbirth. Obstetrics & Gynecology. 2016;128:512.
  6. Archer DF, et al. Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone). Menopause: The Journal of the North American Menopause Society. 2015;22:950.
  7. Ospemifene oral. Facts & Comparisons. http://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_dfc/5548487. Accessed Nov. 3, 2017.

Painful intercourse (dyspareunia)