Your Pain During Intercourse Could be Dyspareunia

Nobody is alone when it comes to experiencing pain or burning during penetrative sex. Statistics vary with different sources but indicate that many women experience dyspareunia, the medical term for painful intercourse.

Anywhere from 10 percent to 28 percent of women experience painful sex at some point, whether long term or occasionally, according to StatPearls, a healthcare education resource. Some research says it's even more common: nearly 3 out of 4 women, according to the American College of Obstetricians and Gynecologists (ACOG).

Pinning down exact numbers can be difficult for a couple of reasons. The first is a lack of reporting, but also because doctors sometimes use the term "dyspareunia" differently.

"At times, medical professionals will use the term as a diagnosis," said Alexander Lin, M.D., a board-certified OB-GYN and a medical director of women's health at Northwestern Medicine in Illinois. "At other times, dyspareunia will be used to describe a symptom for an underlying condition. Ultimately, it just depends on the context."

Overview and types of dyspareunia

"Dyspareunia is a medical term which means pain with vaginal penetration," Lin explained, adding that the genital pain can happen just before, during or after intercourse.

Two primary types of dyspareunia are recognized: superficial and collision.

Superficial dyspareunia can also be described as entry pain. You might feel pain, burning or stinging around the vaginal opening or perineum at the moment of penetration. Sometimes the pain subsides after a moment, but it can continue throughout the sexual activity.

Collision dyspareunia, sometimes called deep pain, can be described as a sudden or aching discomfort that is felt internally. The pain often worsens with deeper penetration. Women describe it variously as cervical pain, lower abdominal pain or lower back pain.

While categorizing your dyspareunia can be helpful to pinpointing the cause, it's important to remember that some people experience both types of dyspareunia. Others experience different types at different times or with different partners.

What causes dyspareunia?

A doctor has to consider many factors when diagnosing dyspareunia, according to Lin. Sometimes there's a clear physical reason for dyspareunia, while other times a combination of physical and emotional factors causes the pain.

Physical factors

Pain during penetrative sex can happen for many reasons, and the discomfort is often the result of multiple causes.

Superficial pain can be linked to many external or surface causes, including the following:

• Lack of lubrication. Penetrative sex causes friction. In some cases, painful intercourse is simply the result of dryness.
• Injury or irritation. Any injury or irritation immediately in or around the vulva (vaginal opening) can make intercourse painful.
• Infection. From urinary tract infections (UTIs) to sexually transmitted infections (STI), the inflammation from infection can cause pain during sex.
• Vaginismus. This condition refers to the involuntary tensing of the vaginal muscles, which interferes with the ability to have penetrative sex and often causes pain when sex is attempted.

Lin listed the following direct causes or underlying conditions that can cause deep pain:

• Endometriosis. About half of the women with endometriosis experience deep dyspareunia. Endometriosis causes abnormal tissue to develop in the pelvic region. Pain occurs during deep penetration when this tissue is bumped, stretched or tugged.
• Pelvic organ prolapse. Prolapse occurs when pelvic muscles don't properly support the adjacent organs, including the uterus, bladder or even the top of the vaginal canal. Sex could hurt if the drooping organ is bumped during penetration.
• Pelvic floor dysfunction. Pelvic floor muscles that are too weak or tight can lead to painful sexual intercourse.
• Pelvic infections. Pelvic inflammatory disease (PID), in particular, is known to cause deep pain during sex.
• Ovarian cysts. In some cases, painful intercourse is a symptom of ovarian cysts. Some cysts have a risk of bursting and require medical attention.
• Fibroids. An estimated 20 percent to 70 percent of women develop fibroids at some point. There is a link between fibroids and deep dyspareunia, but exactly which comes first or how they relate isn't fully understood, according to research published in the Journal of Sexual Medicine.
• Interstitial cystitis. Also known as bladder pain syndrome (BPS), interstitial cystitis (IC) is a chronic condition characterized by bladder pressure and pain. It can also cause pelvic pain and dyspareunia.
• Hormone imbalances. From menopause to breastfeeding, conditions that cause estrogen to drop can result in dyspareunia, Lin said. Low estrogen can cause your vaginal lining to become thin, dry and inflamed.

Emotional factors

Sexual intercourse isn't just a physical act. For most people, sex evokes and is motivated by emotion. Mental and sexual health are often deeply intertwined.

"When patients complain of dyspareunia, socioemotional causes should always be considered," Lin said.

The most common of those socioemotional causes include the following:

• A history of abuse. "Especially in cases where patients have an extreme aversion to being touched in the genital area or cannot tolerate initial penetration, even with a well-lubricated cotton swab, a history of abuse may be the underlying cause," Lin explained.
• Relationship problems. Stress and distrust can make you tense up and experience painful sex with your partner. "Even in cases where the relationship issue may be simply waning interest, the lack of arousal and natural lubrication can cause dyspareunia," Lin said.
• Prior experience with painful sex. Any previous experience with dyspareunia can cause you to tense your pelvic floor muscles in anticipation of more pain. In this case, the tension causes pain even if the original cause has been resolved.

When to see a doctor

Sex shouldn't hurt. If you're experiencing pain before, during or after intercourse, talk to an OB-GYN or your primary care doctor. Diagnosing and treating the cause of dyspareunia might take some time and patience, but your physical, emotional and sexual health are worth the effort.

In the meantime, remember that penetrative sex isn't the only form of intimacy. You and your partner can still enjoy other sensual and intimate activities together.

If you suspect the pain might be intertwined with stress, anxiety, relationship issues or a history of abuse, there's no shame in stepping back from sexual activity while you sort through your emotions. Don't hesitate to seek help from a doctor or therapist.

If you're at a loss about how to take the first step, recognize that telehealth can be an easier entry point into a relationship with a new medical professional. Video visits and phone appointments might be less stressful for many people, and more physicians and therapists have added them as a service. Giddy telehealth makes it easy to get connected to a qualified healthcare professional who can help with a variety of conditions, psychological and physical.