From the Guidelines
Dyspareunia (painful intercourse) can be caused by a combination of physical and psychological factors, including vaginal dryness, infections, inflammatory conditions, endometriosis, pelvic inflammatory disease, and structural issues. The most recent and highest quality study, 1, suggests that physical causes such as vaginal dryness due to hormonal changes, infections, and inflammatory conditions can contribute to dyspareunia. Some of the key physical causes of dyspareunia include:
- Vaginal dryness due to hormonal changes (menopause, breastfeeding, or certain medications)
- Infections (yeast infections, bacterial vaginosis, STIs)
- Inflammatory conditions (lichen sclerosus, lichen planus)
- Endometriosis
- Pelvic inflammatory disease
- Vaginismus (involuntary tightening of vaginal muscles)
- Structural issues like vaginal scarring from childbirth or surgery Psychological factors such as anxiety, depression, stress, past sexual trauma, or relationship problems can also contribute significantly to dyspareunia, as noted in 1. Treatment depends on the underlying cause and may include:
- Lubricants or moisturizers for dryness (water-based products like K-Y Jelly or Replens)
- Topical estrogen for postmenopausal women (creams like Estrace or Premarin applied 2-3 times weekly)
- Antibiotics for infections
- Pelvic floor physical therapy for muscle-related issues
- Counseling or sex therapy for psychological causes It's essential to consult a healthcare provider for proper diagnosis since effective treatment depends on identifying the specific cause of the pain, as emphasized in 1. Additionally, changing sexual positions to reduce deep penetration and ensuring adequate foreplay can help manage symptoms while addressing the underlying cause. The use of vaginal dilators, as mentioned in 1, can also be beneficial in managing vaginismus and vaginal stenosis. Overall, a comprehensive approach that addresses both physical and psychological factors is necessary for effective management of dyspareunia.
From the Research
Causes of Dyspareunia
Dyspareunia, or painful intercourse, can be caused by a variety of factors, including:
- Superficial pain, causing pain with attempted vaginal insertion
- Deep pain, which can be caused by conditions such as endometriosis, pelvic floor dysfunction, and vaginismus 2
- Inadequate lubrication, which can lead to discomfort and pain during intercourse 2
- Vaginal atrophy, which can cause pain and discomfort during intercourse, especially in postmenopausal women 2
- Postpartum causes, such as episiotomy or vaginal tears, which can lead to pain during intercourse 2
Endometriosis and Dyspareunia
Endometriosis is a common cause of dyspareunia, with up to 90% of women with endometriosis experiencing pelvic pain, including dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia 3
- The presence of nodules in the retrocervical region is strongly associated with dyspareunia in women with endometriosis, with an odds ratio of 5.3 (95% CI 2.2-12.5) 4
- Bladder and pelvic floor tenderness, as well as painful bladder syndrome, are also associated with the severity of deep dyspareunia in women with endometriosis, regardless of the stage of the disease 5
Other Causes of Dyspareunia
Other causes of dyspareunia include:
- Vulvodynia, a condition characterized by chronic pain in the vulva 2
- Pelvic floor dysfunction, which can cause pain and discomfort during intercourse 2
- Vaginismus, a condition characterized by involuntary muscle spasms in the vagina, which can make intercourse painful or impossible 2
- Genito-pelvic pain penetration disorder, a condition characterized by persistent or recurrent difficulties with one or more of the following: vaginal penetration during intercourse, marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts, marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration, and marked hypertonicity or overactivity of the pelvic floor muscles during attempted vaginal penetration 6