Painful Intercourse (Dyspareunia)

Pain during first time sex is normal but if the pain persists every time a woman is having sex, she must consult an urologist right away.

Dyspareunia is a medical condition when a woman feels pain before or during or after intercourse. There can be various reasons for this issue including the structure of the vagina, infections, dryness etc.

Symptoms of Dyspareunia:

  1. Pain right at the time of penetration
  2. Pain during every penetration
  3. Prolonged pain after intercourse
  4. Pain when having hard sex.

Ignoring the problem can result in hurting your sex life and emotional trauma.

urologist for dyspareunia-pain-before-during-sex

Causes of Dyspareunia / causes for painful intercourse

Reasons for the pain differ with ‘when’ it is hurting, whether the pain is just at starting of penetration or during thrusting or persistent even after intercourse.

Pain during entry:

  1. Dry vagina – A woman’s vagina gets wet when aroused. This lubricates the vagina to enable smoother penetration of the penis. Not enough foreplay time can temporarily cause this condition. Dry vagina can also be present when the levels of estrogen drops during menopause period or when pregnant or during breast feeding.  Medications that are being taken such as Anti-histamines, anti-depressants, pills to control blood pressure etc can affect arousal and result in dry vagina.
  1. Injury – If your pelvis region is hurt due to an accident or if you had a female circumcision done or due to the cuts made during vaginal child birth – entry pain before sex can be a result of any of these conditions.
  2. Inflammation or infection – UTI, Urinary Tract Infection can cause pain during intercourse. Skin infections can also lead to irritation and pain when attempting to have sex.
  3. Vaginismus – This is a case when a woman experiences muscle spasms without her knowledge in the walls of the vagina. This tightens the vagina making entry of the penis painful.
  4. Birth defects – If the vagina is not well formed from birth (Vaginal Agenesis) or in case when there is a membrane that develops in the vagina that blocks the vaginal opening (Imperforate Hymen) can lead to Dyspareunia.

Pain during deep thrust

This kind of pain occurs when there is a deeper penetration of the penis into the vagina. This can be because of:

  1. Medical conditions inside the body such as:
    1. Endometriosis
    2. Pelvic Inflammatory Disease
    3. Uterine Prolapse
    4. Retroverted Uterus
    5. Uterine Fibroids
    6. Cystitis
    7. IBS – Irritable Bowel Syndrome
    8. Pelvic Floor Dysfunction
    9. Adenomyosis
    10. Hemorrhoids / Piles
    11. Ovarian Cysts
  2. Surgeries or Medical Treatments:
    1. Scarring from pelvic surgery such as hysterectomy
    2. Cancer treatment (radiation therapy, chemotherapy)

Emotional factors:

Emotions play an important part for sexual activities. Anxiety, depression, concerns about physical appearance (of the body and the vagina), fear can result in denting the arousal and not lubricating the vagina. Stress in personal life can also show up in bed. For some sexually abused women, their history may also haunt even though they are in a good relationship currently.


When you see a urologist or urogynecologist near you  with Dyspareunia problem, make sure you explain the problem and also give him/her more details about your sexual history and stress levels at work or home or if you have any emotional issues with your partner. This lets him/her make the right diagnosis and offer the right treatment.

Diagnosis of Dyspareunia

Along with knowing about your past relationships, stress levels etc, the urologist will also perform a pelvic exam to check for signs of infection on or in the vagina. A physical exam will also be performed to locate the exact point of pain by applying little pressure on the genitals and on the pelvic muscles.  He/she may also use a speculum to separate the vaginal walls when examining.  Finally, a pelvic ultrasound test may also be recommended.


Treatment of Dyspareunia

If the urologist determines that an infection is the cause of the pain, he/she may put you onto medication.  If the dryness is caused by the medicines that you are already using, he/she may provide you with alternate medicines.

If the dryness is caused due to menopausal conditions, estrogen capsules / lubricants may be prescribed. They may have side effects but a good urologist will explain what you can expect as side effects of using the pills or lubricants.

If there are any serious conditions that are causing pain (such as prior pelvic surgeries), further examination, tests may be conducted and appropriate routine will be followed.