Dr. M.J. Bazos MD, Patient Handout
Dyspareunia: Painful Sex for Women

What is dyspareunia?

Dyspareunia (say: “dis-par-oon-ya”) is painful sexual intercourse for women. It can have many causes. Talk to your doctor if you have this problem because there are effective treatments for many of the causes.

What are some of the causes of dyspareunia?

Any of the genital parts can cause pain during sex. Some conditions affect the skin around the vagina. Some women have a viral infection or vaginal yeast infections, but sometimes the cause is unknown. The pain from these conditions is usually felt when a tampon or penis is inserted into the vagina. Sometimes, even sitting or wearing pants can cause discomfort.

Vaginismus (say: “vag-in-is-mus”) is a spasm of the muscles around the vagina. In some women, the pain of the spasms is so severe that penile penetration is impossible. Vaginal dryness can also cause painful sex. This dryness may be caused by menopause and changes in estrogen levels, or from difficulty becoming aroused. Sometimes the pain occurs when the penis is in the vagina. Women report the feeling that “something is being bumped into.” The uterus may hurt if there are fibroid growths, the uterus is tilted or if the uterus prolapses (falls) into the vagina. Certain conditions or infections of the ovaries may also cause pain, especially in certain sexual positions. Past surgeries may leave scar tissue that can cause pain. Because the bladder and intestines are close to the vagina, they may also cause pain during sex. We know that the mind and the body work together. This is seen with sexual problems. Often the problem that first caused the pain may go away, but you may have learned to expect the pain. This can lead to further problems because you may be tense or you may be unable to become aroused. The problem can then become a cycle and you are caught in the middle.

Negative attitudes about sex, misinformation about sex and misinformation about the functions of the woman’s body are often associated with some types of pain. Is painful sex all in your head? No! But it is important to discuss feelings and difficulties with your partner and your doctor.

How can my doctor tell what is causing my pain?
Your doctor may ask you to describe your pain, when it began and any associated problems, and may ask you to describe what you have tried in the past. For example, is it painful every time you try to have sex? Are there other problems associated with sex? These are some of the questions that your doctor will need to discuss with you. Your doctor may want to examine your genital area.

What will the exam be like?
During the exam, your doctor may apply a cotton-tipped swab to the area to see if the area around the vagina is painful. A gentle exam of the vagina and cervix is done with a speculum, 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 than usual speculum (child-sized) to decrease the discomfort. Or, your doctor may delay the exam until the pain is under better control. It is important to talk to your doctor before the exam so you know you can stop the exam if it causes too much pain. Discuss this with your doctor ahead of time. Many women find it useful to hold a mirror during the exam to see the appearance of their genital structures.

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

Will I need any tests?
If your symptoms and exam suggest an infection, you may need to have tests done to look for yeast or bacteria. If there is no infection, your doctor may do some other tests, such as urine or allergy tests.

Endometriosis Association: www.endometriosisassn.org
Interstitial Cystitis Association: www.ichelp.com
National Vulvodynia Association: www.nva.org
The Vulvar Pain Foundation: www.vulvarpainfoundation.org