Dyspareunia: Causes & Treatments for Pain During Sex

Dyspareunia, or painful intercourse, is described as a persistent genital pain before, during, or after sex. While it might not seem common, most women will experience pain with sex at some point in their life. And because we know how uncomfortable it can be, we want to talk about the symptoms, causes, and treatment options that we can offer.

Symptoms of Dyspareunia

Of course, pain with sex might already seem like a symptom on its own, but not everyone experiences that pain in the same way. In fact, there are two different types of painful sex: Superficial dyspareunia and deep dyspareunia.


Superficial pain happens during entry or attempted penetration. This pain usually happens because of:

  • A penis that is too large for the vagina
  • An intact or thickened hymen
  • Pelvic floor muscle spasms, which causes the vagina to temporarily narrow
  • Sexual arousal disorders
  • Infections, such as genital herpes
  • Prolonged use of the “depo” birth control shot


Deep pains are usually felt at the top of the vagina during thrusting. This kind of pain has been described as burning, tearing, and aching. Deep dyspareunia can happen because of:

  • Pelvic disease, such as endometriosis
  • Ovarian cysts
  • Pelvic inflammatory disease, which can be caused by STIs like chlamydia.

Causes of Dyspareunia

Just like the feeling of painful sex varies from person to person, so do the causes. The causes are also often split up into entry pain and deep pain. Some of the causes of entry pain are lack of lubrication, vaginal spasms (vaginismus), inflammation, infections, skin disorders, or pelvic nerve damage. Deep pain can be caused by surgery, medical treatments, illnesses or conditions. Each of these causes can also come from a variety of sources.

Lack of Lubrication

One cause of a lack of lubrication is hormone changes after childbirth, menopause, breastfeeding, or injectable contraception. It can also come from a narrowed vaginal entrance or thin vaginal and vulva skin that happens after menopause, or lack of sexual arousal.

Vaginal Spasms

Spasms of the pelvic muscles make the vagina tight, which makes sex painful, or even impossible. These spasms can be caused by endometriosis, tight pelvic floor muscles, recurring genital or urinary tract infections, trauma during childbirth, and even stress or anxiety.

Inflammation, Infections, & Skin Disorders

The skin of the vulva is sensitive, and it can easily become irritated. The main causes of this irritation come from genital and urinary tract infections, as well as skin problems like eczema, psoriasis, and contact dermatitis.

Surgery & Medical Treatments

Certain surgeries and medical treatments can cause pain with sex. These include hysterectomies, vaginal prolapse repair, episiotomies, chemotherapy, and radiation therapy.


There are several illnesses that can contribute to painful sex. These illnesses include endometriosis, cystitis, IBS, pelvic inflammatory disease, uterine prolapse, hemorrhoids, ovarian cysts, and uterine fibroids.

Emotional Causes

In addition to physical causes, there are some emotional causes that can lead to pain with sex. If you’re feeling stressed, self-conscious, or anxious, it can affect your libido and cause sexual intercourse to feel uncomfortable. This can lead to even more anxiety when it comes to intimacy, which can make the pain continue to happen at different times.

Treatment Options for Dyspareunia

The treatment options for dyspareunia depend upon both the type of pain you’re experiencing as well as the causes.

Lack of Lubrication

If painful sex is caused by a lack of lubrication, your health care provider may recommend:

  • Hormone replacement therapy to help with hormone changes
  • Changing your contraceptive
  • Using lubricants or other gels
  • Speaking with a psychologist or sex therapist

Vaginal Spasms

Before being treated for spasms, your health care provider will have to find the cause. Then, they will be able to offer you treatment options like:

  • Pelvic floor exercises
  • Massage
  • Relaxation tips

Inflammation, Infections, & Skin Disorders

For irritated skin or infections, your health care provider might recommend:

  • Vaginal tablets
  • Oral medication
  • Ointments
  • Avoiding skin irritants found in soaps and sanitary products
  • Wearing loose clothes that allow airflow around the vulva

Surgery & Medical Treatments

Depending on the surgery or medical treatment you’ve received, there is a variety of options your health care provider might suggest. These include:

  • Pelvic floor exercises
  • Medication to reduce pain signals
  • Massage for soft tissues and the vagina
  • Tips for relaxation


Your doctor will need to determine the underlying physical cause before recommending more treatment. They might then suggest treatments like:

  • Pelvic floor exercises
  • Massage
  • Tips for relaxation
  • Medication to reduce pain signals
  • Antibiotics

Emotional Causes

If your health care provider doesn’t find any physical causes of your painful sex, they can help you find someone to speak to, whether it’s a psychiatrist or sex therapist.

How We Can Help

Our providers at Northern Colorado Women’s Wellness are very experienced and sympathetic towards our patients who are having pain with sex. We can help you discover the root of the problem, whether it’s an illness like endometriosis or a previous surgery like a hysterectomy. Whatever you need, we’ll be there to support you all the way.  Please remember that discomfort during sex is very common and not unusual – there is no reason to be embarrassed! Our providers will listen to you with compassion and without judgment, and help you to find the right solution for your specific situation.

If you’re experiencing pain with sex, don’t hesitate to get in touch with us.

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