Painful intercourse (dyspareunia)

Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.

Entry pain

Pain during penetration may be associated with a range of factors, including:

Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding.

Certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.

Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).

Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.

Vaginismus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.

Congenital abnormality. A problem present at birth, such as the absence of a fully-formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could be the underlying cause of dyspareunia.

Deep pain

Deep pain usually occurs with deep penetration and may be more pronounced with certain positions. Causes include:

Certain illnesses and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.

Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy, can sometimes cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotional factors

Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Emotional factors include:

Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.

Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.

History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse, but if you have been abused, it may play a role.

Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.