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Dyspareunia – Symptoms, Diagnosis, and Treatment

Pain during sex or dyspareunia can be an alarming occurrence, especially if it’s the first time it happens, or you have little experience with sex. People often associate painful intercourse with serious conditions and diseases, but that’s not always the case.

Dyspareunia refers to painful intercourse, and while the name might sound worrying and the experience uncomfortable, various causes, most of which are not serious, underlie this condition.

The most common reasons for dyspareunia can be common and solved quickly. Up to 20% of American women feel this pain, and it can affect both men and women.

The factors are varied, from physical to psychological, and treating dyspareunia focuses mostly on solving these factors.

What is dyspareunia?

Dyspareunia is simply painful intercourse caused by different psychological or medical factors. The pain can be focused on the outer genital surface, but it can also show deeper through the pelvis as a response to pressure on the cervix.

Dyspareunia can affect both men and women, and it can affect specific areas of the sexual organ as much as the entire surface, particularly in the vulva. To identify dyspareunia causes, it’s necessary to understand its location and duration.

Many factors can cause dyspareunia, including both physical and psychological agents, and the quality of one’s relationships can also play a role. Some people can even suffer from congenital dyspareunia, and menopause can result in painful intercourse for some women.

Treating dyspareunia requires identification of the causes, and most cases will be alleviated after treating the reason behind it. Dyspareunia can be caused solely by psychological factors even if the doctor can reproduce the pain during the examination.

Dyspareunia can affect up to 22% of women around the world.

What is dyspareunia?

Signs and symptoms

Pain during sex can be described in many ways. Understanding where the symptoms are manifesting and for how long it is necessary for treatment.

Some women identify the pain around the vaginal opening during penetration, and men often feel pain inside the foreskin, resulting from infections or small tearing. However, the pain can show up in different areas, and determining whether the pain is just on the surface or deeper is important to identify the cause.

Another relevant factor when deciding what causes dyspareunia is whether the pain has always been felt or if it’s a recent occurrence. Pain can also increase with time.

This discomfort can cause individuals to be distracted from the pleasure generated by intercourse, and it has negative effects on sexual arousal. If that’s the case, vaginal lubrication and dilation suffer and decrease.

In these instances, sex can become even more painful. Dyspareunia can breed psychological causes for painful sex. Even after the main causes of dyspareunia have been treated, people may still feel pain during sex just because they’re used to feeling afraid of having sex.

Additional symptoms can be revealed when examining the genitals. These can be lesions, skin thinning, ulcers, or discharge coming from infections. Examining a woman’s pelvis and cervix can also discover more symptoms like lesions and abnormal growths.

Who can suffer from dyspareunia?

Dyspareunia can affect both men and women, but the latter is more likely to experience it. Today, dyspareunia is among the most common complications after menopause.

Painful intercourse happens to most women, up to 75%, as stated by the ACOG (American College of Obstetricians and Gynecologists). Women can increase their risk of dyspareunia by taking medications, causing dryness in the vagina, developing infections or experiencing menopause.

Men can also expose themselves to this pain if they catch an infection or are too vigorous while having sex or masturbating.

What causes dyspareunia?

Dyspareunia can come from a plethora of different factors, from physical to psychological. These can vary based on when you feel them or the area in which you experience them.

During penetration

The most common cause for dyspareunia during penetration is lack of lubrication. This can be a consequence of skipping foreplay or general estrogen depletion, which usually occurs after childbirth (and during breastfeeding) or menopause.

Certain medications can also take a toll on sex drive and hormones, making sex painful. The most common ones are those related to mental conditions, birth control, and blood pressure.

Physical lesions and irritation can also make sex more painful. Surgery like c-sections and circumcision can create scar tissue, and if it’s not worked, it can cause prolonged dyspareunia.

Skin inflammation or infections can also cause dyspareunia if they occur in the genital area or urinary system. Eczema and yeast infections on the genitals are common causes.

Vaginismus is another cause of dyspareunia. It manifests as involuntary contractions of the vaginal muscles, making penetration a lot more painful.

Finally, congenital issues like incorrect formation of the vagina or obstruction of the vaginal opening can cause dyspareunia.

Pain During penetration

Intense pain

This type of pain can also occur during penetration, but it can be unbearable and worsen with certain positions.

Some diseases like endometriosis, haemorrhoids, irritable bowel syndrome, and pelvic inflammatory disease can cause this type of pain. Other factors include cysts, fibroids, uterus position, and prolapse.

In men, particularly, phimosis tends to be the cause of extreme pain. It’s an extremely tight foreskin, and pulling on it can result in pain.

Emotional factors

Emotions and sex share a deep connection, and any emotional disturbances or mental conditions can decrease sexual pleasure by reducing sexual arousal, lubrication, and causing involuntary spasms.

Psychological conditions like depression, self-esteem issues, anxiety, and relationship issues like fear of intimacy can significantly lower arousal, which often results in pain and discomfort.

Likewise, stress can tighten the pelvic muscles, and if one doesn’t take time to relax before engaging in intercourse, this can lead to cramps and general pain during sex.

Finally, sexual trauma, like past abuse or disastrous experiences, can cause dyspareunia. This isn’t a staple in all people, but it shouldn’t be discarded as a possible cause.

Emotional factors are difficult to determine since they might be a consequence of dyspareunia itself. For example, fear of experiencing pain during sex can continue even after treatment, and even when you have resolved the physical causes, fear and stress can still make sex painful.

Emotional factors for dyspareunia


Due to the several possible causes behind dyspareunia, diagnosis can be lengthy. Different criteria apply to different methods and classifications. For example, vaginismus, emotional causes, pelvic tensing out of anxiety or fear, and sex attempts all enter into the DSM-5.

Meeting the disorder’s criteria requires you to experience these symptoms for half a year at least, and the discomfort must be significant.

That’s the reason why differential diagnosis is so long. Doctors have to deal with both psychological and physical factors, and each category sports dozens of agents and can even overlap.

That’s why identifying the nature of the symptoms and how deep the pain is helps conduct this diagnosis.

Superficial pain often comes from inflammation, infection, anatomy, lesions, and psychological causes. However, if no visible findings emerge, you must employ additional diagnostic methods; conducting blood and swab tests becomes essential to identify hormonal or STI-related factors.

Deeper pain is related to complex causes like cysts, endometriosis, inflammatory conditions, or infections. Psychosocial causes can also be behind deep pain. Most of these cases require a specialist, as opposed to the other ones that can be performed by your GP.



Treatment will vary with the cause of your dyspareunia. You might even have to use different treatments simultaneously.


Infections require antibiotics, and if the drugs you’re already taking are causing vaginal dryness, then your doctor can offer alternatives.

Low estrogen levels can be treated with topical products. If menopause is causing dyspareunia, you can take ospemifene daily to reduce the consequences of menopause.

If the problems are psychological, then taking antidepressants or similar medication might be necessary; just beware that these can also cause dyspareunia on their own.

Lifestyle changes

You can also treat painful intercourse by evaluating and modifying the behaviors and habits that might be making sex uncomfortable.

For example, some people might change their sexual behaviour. Using lubricants can go a long way, and giving more priority to foreplay can increase arousal and thus, vaginal lubrication. It’s also paramount to keep communication constant to inform about any discomfort or changes that one might need. Choosing different sexual positions that are more comfortable is also an easy and effective solution.

Finally, keeping hygiene in check is critical to preventing infections, and regular STI screenings also help discard possible causes.


Kegels strengthen the pelvic muscles, and it’s a great way to help vaginismus.

You just need to tighten your muscles as if you were holding urine. Maintain this tension for a few seconds and relax them at the same time. Repeat several times, with up to 3 sets per day.

If tightening is the issue, then reverse Kegels help relax the same muscles.

Woman doing kegels to help with dyspareunia


There are several techniques that people can use to desensitize themselves to pain. Kegel exercises can fit this category. Desensitization therapy can help relax your vaginal muscles and make sex a lot less uncomfortable.


Taking a brief break from sex can help a lot if the cause behind dyspareunia is a lesion or physical trauma. Small tearing from friction goes away on its own after a few days, and taking up to a week’s break can surprise you by not feeling any pain after you resume your sexual activity.


Psychological factors usually require therapy or counselling, especially when it comes to trauma or conditions like depression or strong anxiety.

Even if the causes for your dyspareunia aren’t psychological, counselling can help with the emotional repercussions of finding sex not enjoyable.

Lastly, if the reason behind dyspareunia is relationship issues, couples’ counselling can help a lot in treating it.

Counselling about dyspareunia


Have a few questions about it? We have tried to answer them below.

Does dyspareunia go away?

It depends on the cause of your dyspareunia.

If it’s a physical lesion, it usually goes away on its own. However, other causes like infections and endometriosis require treatment through medication or surgery. Once the underlying reason has been resolved, the condition goes away.

If the pain persists after you treat the underlying cause, consider seeing a therapist, as leftover fear and anxiety might be causing it.

What does dyspareunia feel like?

Dyspareunia is simply pain. It can manifest in some genital regions, over the entire organ, or on the muscles and organs associated with sexual function.

Depending on the cause, it can feel like burning, stinging, or throbbing.

What does deep dyspareunia mean?

Deep dyspareunia primarily affects women and refers to pain that reaches the uterus, cervix, or any area around the pelvic zone, not merely the surface of the vulva.

How can you stop pain during sex?

If you are looking for an effective strategy, we recommend using natural aphrodisiacs like Spanish Fly Pro to help you out. With increased vaginal lubrication and libido levels, it helps you get right into the mood while ensuring you don’t have to worry about pain.

With absolutely no side effects, the new version of Spanish Fly brings with it some great benefits. You increase your appetite for sex and build a stronger relationship – just the way you want. You can use Spanish Fly Pro along with other forms of treatment too- to maximize the results.


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