Why pain occurs during intercourse – causesdyspareunia

Update: December 2018


  • What can a doctor ask when taking history and setting
    causes of pain?
  • Withчины появления dyspareunia
  • Manifestations of dyspareunia
  • Psychological causes of pain
  • Diagnostic methods
  • Dyspareunia treatment

Intimate relationships between a man and a woman are considered
an integral and important part of a fulfilling life. Regular sex
important not only for feeling physical satisfaction, but also for
psychological comfort. But sex is not always
bring pleasure, especially if someone of the partners feels
the discomfort.

A common occurrence typical of women is considered painful.
sexual intercourse that does not allow to get the desired pleasure that
negatively displayed on a personal relationship with a partner and
psychological status.

Pain when сексуальном контакте или медицинским термином –
dyspareunia, can occur in women of any age and
manifest at any stage of sexual intercourse. Such a symptom may have
different localization, nature and intensity.

Therefore, why pain occurs during intercourse, can say
Only a doctor after receiving all the results of the survey. Sometimes
causes of pain during intercourse are pretty commonplace and is
just in the wrong position of the body, vaginal dryness or in
psychological discomfort next to an inexperienced partner.

Систематическое же проявление dyspareunia часто может
signal a number of reproductive or genitourinary diseases
systems that are infectious or non-infectious

What can a doctor ask when taking history and setting
causes of pain?

History taking The nature of the pain
  • Are there other sexual disorders –
    lack of orgasm, reduced lambing (low moisture in the phase
  • What were the attempts at treatment?
  • Is there a discharge, an unpleasant smell and a change in their color?
  • Были ли ранее обнаружены ИППП (половые infections), в том числе
    herpes and papilomavirus man?
  • Was there an aggravated obstetric history: trauma, childbirth with imposition
    forceps, episiotomy (perineal tissue incision)?
  • Have there been any surgery on the urinary organs or abdominal
    cavities, radiation and chemotherapy?
  • Anamnesis of gynecological chronic diseases, were there
    previously established diagnoses – salpingitis, endometriosis, uterine myoma,
    chronic pelvic pain, etc.?
  • What is now used contraception and what was used
    previously (any intrauterine devices, caps, diaphragms, gels,
    sponges, foam)?
  • Are there any skin diseases – psoriasis, eczema, other
  • Are there any abnormalities in the urinary system
    urethritis, cystitis, or colon diseases, syndrome
    irritable bowel?
  • Is there diabetes or Behcet’s syndrome?
  • Is there an increased sensitivity to topical products?
    lotions, creams, ointments, as well as colored toilet paper, wet
    napkins, intimate hygiene?
  • What a pain – before the act at the entrance or deep when moving, after
    an act?
  • If deep, it is localized on the right, left, or both.
    parties, which began?
  • Is it itchy, burning?
  • Is the pain strong, sharp, aching or burning?
  • Generalized pain (independent of partner, situation) or
    situational (depends on the partner, or occurs when certain
    circumstances, depends on the menstrual cycle)?
  • Positional – depends on the posture?
  • Has been throughout sex or appeared
  • Is there addiction to drugs or alcohol?
Collection of psycho – social information
  • Was there such a problem in a relationship with another partner
  • Did you discuss the problem with your partner?
  • Have joint actions been taken to resolve
  • Was there a history of beatings or rape?
  • Are there any other stressful factors?
  • Are there anxiety disorders, depression and other

Withчины появления dyspareunia

Withчины, которые вызывают боль и дискомфорт при сексуальном
contact, you can clearly distinguish between two large groups:

  • Diseases половой сферы или мочевыводящей системы
    infectious and non-infectious nature.
  • Psychological problems that are associated with fear
    the occurrence of pain after a failed sexual experience.

Before establishing the true cause, it is important to ensure that
Does a woman have enough sexual
excitation. Insufficient arousal is possible with instability.
relationships, conflict between partners, lack of possession of receptions
and technique of foreplay and games. Unfortunately, it is very
a vicious circle is quickly formed, which includes
psychological aspects and at first insufficient lambing
(lack or weak moisture) only happens when 
inappropriate technique of sex and then it repeats and becomes
the expected component of sexual intercourse.

Diseases при болезненном половом акте

Pain when сексе может являться признаком самых разных
pathological conditions occur in any anatomical region
genitalia, have a different etiology. Below consider a few
major and common diseases of infectious and
non-infectious that can cause pain
intimate relationships.

Infectious diseases:

  • Vaginitis – an acute or chronic inflammatory process
    activity in the vagina. The causative agent of the disease are chlamydia,
    gonococci, trichomonads, mycoplasmas, fungi, as well as non-specific
    pathogenic microorganisms. Often the disease can occur on
    background of constant hormonal disorders.
  • Endometriosis – pathology of the mucous lining of the uterus – endometrium,
    in which its particles can appear in unusual places: in
    muscle and serous layer of the uterus, in the ovaries or on their surface,
    peritoneum or even in the walls of internal organs.
  • Urethritis – an inflammatory process that occurs in the tissues
  • Cystitis – inflammation of the bladder.
  • Chronic endometritis, salpingitis (inflammation of the appendages),
  • Adhesions in the small pelvis – develop after being transferred earlier
    acute or chronic inflammation in the abdominal

Non-communicable diseases and conditions of the body:

  • Injuries, postpartum breaks or postoperative sutures.
  • Venous congestion – develops with irregular sexual
    contact or abstinence from intimate relationships when
    there is stagnation of blood in the bloodstream of small organs
  • Insufficient lambing (disturbance of the excitation phase) –
    young women, it is due to the inactivity of the arousal phase,
    женщин в климактерическом периоде  — дефицитом
  • Vaginal atrophy – more common after stopping
    menstruation during menopause and is a dry
    vaginal mucous membranes on the background of the constant shortage of genital
  • Uterus retroversion (uterus bend, posterior deviation) – anomalous
    the position of the uterus relative to other organs localized in the small
  • The weakening of the tone of the pelvic floor – leading to the prolapse of the uterus.
  • Cysts and fibroids – benign or malignant
    neoplasms with localization in the reproductive organs of small

Anatomical incompatibility or size mismatch –
quite rare because the vagina is enough
extensible, and in addition to the clinical case of gigantism in a man – with
a normal phase of arousal in a woman of pain during intercourse from
Size mismatch should not be. Those. vagina “does not hurt”
since it is expandable, the cervix also “does not hurt” (even if there is
erosion), because the cervix has no nerve endings.

Manifestations of dyspareunia

Dyspareunia may occur immediately before sexual intercourse.
act, at the time of the first penetration of the penis into the vagina,
during his movements, as well as after the completion of the frictions. Considering
features of every woman’s body, painful sensations
perceived differently: sometimes burning, discomfort, tingling,
acute or sharp pain (see lower abdominal pain in women).

Chronic pains of low and medium intensity are characteristic of
diseases of non-infectious nature. If during intercourse
there is a sharp pain, this may indicate a pathology
uterus, ovaries and their appendages acute inflammatory

If the cause of the pain is psychological
factors, the pain may have different localization and intensity
and disappear without a trace when you change the situation or sexual

Superficial pains – at the entrance

Pain at the beginning of sex occurs as a complication of various
diseases of the vestibule and lips, can be combined with vaginismus,
insufficient moisture or agitation. Pain when
early sexual intercourse may indicate a bacterial or fungal
vaginitis (see symptoms of thrush in women), mucosal atrophy,
vulvodynia or vulvar dystrophies occur on the background
genital herpes. The doctor may notice cracks during the examination.
and ulcers in the run-up to the vagina. In the presence of herpetic eruptions
pain is relieved after successful treatment of the infection. With
palpation of the bladder and pain along the urethra
indicates urethritis of various etiologies (see urethritis in women:
symptoms, treatment).

Deep pains

Deep pain during sex is described by women as “something
driven in. ” The most common cause is spikes,
endometriosis, stagnation of blood in the pelvis, at least – inflammation
appendages, endometritis, even more rarely – weakening of the pelvic floor tone and
abnormal location of the uterus (retroversion). Diseases
urinary system (see cystitis in women: symptoms, treatment)
in addition to the main symptoms (see frequent urination, burning and
pain, pain when urinating, pressure above pubis) are complemented
painful sensations during sex. The same applies to diseases
intestinal irritable bowel syndrome, inflammation of the colon and
pr may be accompanied by pain during intercourse.

In women of menopausal age, atrophic changes and
lack of arousal, vaginal dryness (see syndrome
Шегрена или сухой синдром),  затрудняют фрикции при движении
penis, causing pain both at the entrance and inside. I.e cavity
the vagina does not expand and does not lengthen in response to arousal,
unpleasant sensations intensify, especially with certain poses
or penis pressure on the cervix.

Depending on the location of the pain, causes may be

With входе во влагалище Deep pain And at the entrance, and deep pain
  • Urethritis
  • Vulvodinia
  • Vaginismus
  • Vaginitis (colpitis)
  • Vulvar vestibulitis
  • Lack of arousal and hydration
  • Adhesions in the pelvis
  • Endometriosis
  • Inflammatory processes in the pelvis, endometritis
  • Pathology of the urethra and appendages
  • Uterus retroversion
  • Venous congestion in the pelvis
  • Chronic cervicitis
  • Vaginal atrophy (vaginal dryness)
  • After childbirth and injuries, surgical interventions
  • Not enough lambing
  • Sjogren syndrome

Pain during sex after pregnancy

Withчины послеродовых болей остаются неясными. According to one
in 40% of women, the pain was non-localized, in 45%
Patients – pain at the entrance, in some places in the suturing gaps,
Moreover, according to the complaints of the patients there are almost no differences – the first were
childbirth or second. Pain in the act is noted 25% of women after cesarean
cross-section and 40% of lactating women. After giving birth within six months
non-localized pains stop, in other cases
soreness may persist for up to a year.

Psychological causes of pain

In addition to gynecological diseases provoking dyspareunia,
This process can develop at a subconscious level, when
a woman for some psychological reason refuses
sexual contact.

  • Fear of sexual intercourse

A common cause of pain is defloration, which
characterized by a sense of fear of sexual intercourse. Pain when
defloration occurs as a result of strain hymen when
first sexual contact. Withчиной такого нарушения может
to be fear of a partner or cruelty on his part, fear
pregnancy, lack of love and other factors that do not allow
woman completely relax. Overcome the fear of defloration
only the woman herself is capable, although much depends on the behavior
men If you yourself cope with this condition is not
it turns out, it is recommended to seek help from a sexologist
a psychologist or a professional psychologist.

  • Vaginismus

Also the cause of the pain may be vaginismus – a condition that
often attributed to the complication of defloration, when a woman is long
period of time cannot cope with fears associated with
previous sexual relations. With вагинизме происходит резкое,
involuntary and uncontrollable painful spasm
vaginal muscles, which does not allow to fully complete sexual

  • Pain during intercourse during pregnancy

Some women feel pain during intercourse during
of pregnancy. This condition often appears at the level of subcortical
brain centers when due to penetration of the penis
in the vagina develops fear of harm to the fetus or cause
какие-либо осложнения of pregnancy. Many doctors believe that
dyspareunia – a characteristic condition for gynecological
diseases and is not directly related to pregnancy.

  • Inferiority complex, self-doubt, in his

Often figure flaws, obesity, other physical
deficiencies lead to psychological complexes and thoughts in women
о своей не sexuality, непривлекательности для partner. what
naturally reflected on sexual life, can lead to
inadequate phase of excitement and pain during

Diagnostic methods

To diagnose the causes of dyspareunia can be at the reception
gynecologist, urologist, sexologist or psychotherapist. initially
the doctor collects a history of the woman in which the patient describes
main complaints, symptoms and conditions of pain. With подозрении
for the presence of gynecological diseases, the doctor may prescribe
laboratory and diagnostic examinations:

  • Clinical or detailed blood and urine tests.
  • The study of the pelvic organs using ultrasound
  • Screening for infections, including those transmitted by
    unprotected sex.

The results of the examination will help the doctor confirm or
disprove the organic nature of the state associated with that or
another disease. If the apparent causes of dyspareunia are not
comes to light, then it is a psychological variation

Differentiation of disorders in which pain occurs with

Diagnosis Symptoms Withчины Research data Evaluation of further action
Dyspareunia of unknown etiology Pain at the beginning of intercourse or deep pain Unknown No signs of other disorders. psychological examination needed
Vulvodinia (боль в области вульвы) complaints of burning, irritation at the entrance, lack of effect from
treatment, pain when riding a bicycle, in a sitting position (when
pressure on the vulva)
infections, irritants or pain of unknown etiology pain on palpation, erythema on the skin or no change, with
the presence of ulcers, pigmentation or nodules – then you should look for another
careful inspection, biopsy of suspicious sites,
colposcopy, acetic acid application to open areas
Vulvar vestibulitis (вид вульводинии) Itching, dull aching pain, burning sensation, pain at the entrance, inflammation
of the vestibular zone of the vulva
Unknown Flat erythema without ulcers, with clear edges or blurred, with
touching with a cotton swab sharp pains
see above
Vaginismus pain at the entrance, difficulty in inserting a finger, a tampon,
penis, muscle spasm at the entrance to the vagina
Unknown, психологические причины или рефлекторная реакция
difficulty with the introduction of the mirror, with palpation – vaginal
important patient history, psychological and physical
Violation of natural moisture when excited, atrophy
pain and difficulties with the introduction of the penis, irritation, friction,
vaginal dryness
surgery, problems of onset of arousal,
недостаток  эстрогенов, уменьшение выделения естественной
lubrication and stretching of the vagina
during the examination, special attention is paid to the fullness of the labia,
the integrity of the mucosa, the presence of cracks, the determination of how easy
injured mucosa, the presence of pubic alopecia
discuss the role of preliminary games, sensations in the phase
Endometriosis матки, спаечный процесс menstrual pain, deep pain during adhesions – infectious diseases, operative
intervention, with endometriosis – unclear reasons
appendages and uterus inactive, presence of nodules Laparoscopy
Diseases придатков матки Deep pain, часто локализуется только справа или слева genital infections, ovarian cyst (see follicular cyst
ovary, ovarian cyst- symptoms)
appendages inactive, enlarged, painful Laparoscopy
Abnormal location of the uterus, uterine fibroids, weakening tone
pelvic floor
Deep pain special anatomical location of the uterus increase or descent of the uterus, Try to change poses during intercourse (posture woman
Venous congestion pain after intercourse, in the pelvis, deep pain Unknown, у женщин с варикозным расширением вен выше риск
developmental stagnation
Without features According to the characteristics of pain
Cystitis, urethritis, interstitial cystitis frequent urination, feeling of pressure over
infections and unclear etiology Painful sensations on bladder palpation and
urine sowing, urinalysis
Endometritis, pelvic inflammatory disease, chronic
Deep pain infections cervix easily injured, the presence of discharge, the uterus
painful, cervical dislocation
бактериальный посев, анализы на infections, кольпоскопия,

Dyspareunia treatment

Treatment of pain and discomfort during sexual intercourse is carried out in
depending on the reasons that provoked their appearance. With
inflammatory processes that cause dyspareunia, the doctor prescribes
drug treatment, which is aimed at the complete elimination
focus of the disease. With заболеваниях, таких как эндометриоз, миома или
hand ovaries, often appointed surgical intervention.
Dyspareunia occurs on a psychological level, requires
consultation with a sexologist or psychologist.

Systematically painful intercourse cannot be left without
close attention, also should not engage in self.
Only a qualified and experienced doctor will be able to determine why
there is pain during intercourse, to conduct a full treatment, to give
helpful recommendations that will allow a woman to return to
comfortable sex life.

Considering большое количество и разнообразие причин,
promoting dyspareunia, every woman should remember
what not to forget about your health and wait for the pain in
sexual contacts will take place independently. The earlier happens
seeking help from specialists, the more effective the treatment will be
or elimination of the factor that provoked this pathological

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