PAINFUL INTERCOURSE

Dyspareunia is pain that happens just before, during, or after sex. It can happen in males and females, but is more common in females.

In females, pain can affect the vulva, which is the area around the opening of the vagina. Or the pain can be inside the vagina or in the lower belly (figure 1). Males can have pain in the penis, testicles, belly, and sometimes the rectum.

There are many possible causes.

In females, common causes include:

• Childbirth – Sex can be painful for several weeks or months after giving birth.
• Endometriosis – In this condition, tissue that normally grows inside your uterus grows outside it. This can cause pain in the belly during sex.
• Vaginal dryness – This can be caused by:
  • Menopause – This is the time in life when you stop having monthly periods. At menopause, the vagina and tissues around it can get dry and thin. This can make sex hurt.
  • Not being aroused or “excited” before sex
• Conditions that cause long-lasting pain in the vulva, bladder, or pelvis – These can include:
  • A condition called “vulvodynia” – This is pain in the vulva.
  • A condition called “interstitial cystitis/bladder pain syndrome” – This condition causes bladder pain and other symptoms.
  • A condition called “chronic pelvic pain” – This is pain in the area below the belly button that lasts 6 months or longer.
• An infection in the vagina or bladder
• Skin problems around the vagina
• Bad feelings about a partner or relationship – Feeling bad about your partner or about yourself can make sex painful.
• A painful experience in the past – This could be a past experience of sex or a medical exam that hurt. It could even be pain from using a tampon.
• Birth control pills – Some people who take birth control pills start having pain during sex.

In males, common causes include:

• Infections – These can include:
  • An infection in the prostate – The prostate is a gland that makes some of the fluid that is released during sex. Infections in other parts of the body can also make sex hurt.
  • Infection with a disease spread through sex, such as gonorrhea.
• Skin problems
• Bad feelings about a partner or relationship – Feeling bad about a partner or about yourself can make sex painful.

Yes. If sex is painful, see your doctor or nurse. Some people feel embarrassed bringing this up, but this is something your doctor or nurse can help you with.

Your doctor or nurse will decide which tests you should have based on your age, other symptoms, and individual situation. They will do an exam and ask you about your symptoms.

Here are some common tests doctors use to find the cause of dyspareunia:

• Urine tests – These can look for a bladder infection.
• Tests on a sample of fluid from the vagina – These can look for an infection in the vagina or cervix.

Treatments for females include:

• Antibiotics or antifungal medicines – These can help if the pain is caused by an infection in the vagina or bladder.
• Creams or gels to keep the vagina moist – These include:
• Vaginal lubricants, which are used during sex
• Vaginal moisturizers, which are used several times a week
• A prescription cream to treat vaginal dryness or a skin condition
• Gels or ointments to numb the vagina before and after sex.
• Physical therapy to loosen the muscles around the vagina.
• Counseling – This can help if pain is caused by bad feelings about sex, a relationship, or yourself.
• Surgery – In a few cases, pain is caused by a growth inside the body. Doctors might do surgery to take out the growth.

Treatments for males include:

• Medicines to treat infection or other conditions that cause pain – These can include antibiotics and other medicines.
• Treatment for skin problems
• Counseling – This can help if pain could be caused by feeling bad about sex, a relationship, or yourself.