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Painful Sex

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Understand your painful sex symptoms, including 9 causes & common questions.

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Symptoms of painful sex

Painful sex, or dyspareunia, is recurring genital pain that happens before, during or after sexual intercourse. Dyspareunia is often associated with woman; it is more common in the female population, but men can also experience symptoms of painful sex.

Common symptoms of painful sex in women

Symptoms associated with dyspareunia in women include:

  • Pain upon sexual penetration
  • Pain with any penetration: Such as putting in a tampon
  • Pain that worsens with deep thrusting
  • Burning or aching pain
  • Throbbing pain that persists after intercourse

Common symptoms of painful sex in men

Symptoms associated with dyspareunia in men include:

Such painful sex symptoms can be worrisome and often a topic that most men and women do not want to discuss, but in order to get the appropriate treatment, you should talk to your physician if you are experiencing any of these symptoms.

Causes of painful sex

Causes of painful intercourse range from structural problems to psychological concerns. Seeing your doctor promptly once you notice symptoms will allow you to get the appropriate diagnosis and care.

Inflammation-related causes:

Inflammation in the genital area in both men and women can often cause painful sex symptoms.

  • Infection: Bacteria and fungi that normally inhabit the vagina can overgrow and cause infection that can cause vaginal swelling and burning of the entire vaginal area. Furthermore, many sexually transmitted bacteria such as trichomoniasis and chlamydia can cause symptoms of pain during intercourse. Viral infections such as herpes can also cause similar symptoms and result in clusters of small, painful blisters that can swell and are painful upon contact.
  • Irritation: Eczema or other skin problems of the genital tract can become exacerbated by friction from sexual intercourse.

Hormonal causes:

Often, painful intercourse in women is triggered by hormonal imbalances and changes in the body.

  • Menopause: Menopause is the cessation of a women's menstrual cycle for at least 12 months. Women in their 40s to 50s experience symptoms such as vaginal dryness or thinning of the vaginal wall (atrophic vaginitis) that often results in dyspareunia.
  • Uterine conditions: Conditions of the uterus that occur as a result hormonal imbalances such endometriosis can result in dyspareunia.

Environmental/emotional causes:

Situations and factors in a person's daily life that reduce sexual desire or influence arousal can also result in dyspareunia.

  • Stress: During times of stress the body can tense up and lose its natural lubrication abilities.
  • Sexual abuse or history of sexual abuse: Sexual abuse is a serious and sensitive topic that can traumatize both men and women and influence sexual situations after the abuse.
  • Psychological issues: Depression, physical appearance concerns and problems with intimacy can result in discomfort and pain.
  • Medications: Some medications such as antidepressants, blood pressure medications and antihistamines are known to affect sexual desire and arousal.

This list does not constitute medical advice and may not accurately represent what you have.

Bacterial vaginosis

Bacterial vaginosis is an inflammation of the vagina due to overgrowth of the bacteria which are normally present.

It is not considered an STD (sexually transmitted disease) but nearly all cases are found in women after unprotected sexual contact, especially with multiple partners. Frequent douching is also a factor.

Male partners do not carry this condition, but it can spread between female partners.

Common symptoms include an itchy, foul-smelling discharge that may look grayish or greenish, as well as burning during urination. However, some women have no symptoms.

The greatest risks of bacterial vaginosis are secondary. The symptoms can be similar to actual STDs and so should not be ignored. This condition makes a woman more vulnerable to actual STDs, as well as to pelvic inflammatory disease and to infections following any gynecologic surgery.

Pregnant women with bacterial vaginosis are at risk for premature or low-birth-weight babies.

Diagnosis is made through symptoms, and/or pelvic exam and vaginal swab.

Treatment consists of oral medication, and sometimes a cream or gel that is inserted into the vagina.

Rarity: Uncommon

Top Symptoms: vaginal itch or burning, vulvovaginal odor, bloody vaginal discharge, white/gray vaginal discharge, thick vaginal discharge

Urgency: Primary care doctor

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Gonococcal cervicitis

Gonococcal cervicitis is an inflammation of the cervix – the passageway at the lower end of the uterus – caused by the bacteria Neisseria gonorrhoeae, or gonorrhea.

Gonorrhea is a sexually transmitted disease (STD) and spreads through unprotected sexual contact.

Symptoms include abnormal vaginal discharge, pain or discomfort during sex, and vaginal bleeding after sex. However, some women have few or no symptoms.

If not treated, gonococcal cervicitis can lead to further infection of the reproductive tract and to pelvic inflammatory disease, which can cause sterility.

Diagnosis is made after a cervical swab is taken and tested.

Treatment is through a course of oral antibiotics. Women diagnosed with gonococcal cervicitis should be further tested for other common STDs such as chlamydia and trichomoniasis, as they are often found at the same time.

The best prevention for gonorrhea is the use of a condom during sex, as well as testing of all sex partners so that they can be treated and not re-infect anyone.

Cervicitis in general can be prevented by not exposing the cervix to douching or other irritants.

Rarity: Uncommon

Top Symptoms: vaginal discharge, vaginal bleeding, painful sex, yellow pus vaginal discharge, heavy menstrual flow

Symptoms that never occur with gonococcal cervicitis: improving vaginal discharge

Urgency: Primary care doctor

Symptoms of menopause

Menopause is the name for the natural process by which the menstrual cycle (period) stops happening in a woman. Usually, the process is gradual (takes months or years) and occurs from the age of 45 to 55 years. Menopause is officially diagnosed once a woman stops having a period for 12 months continuously. A woman with menopause will notice a decrease in the number and regularity of her periods until they completely stop. In addition, she may notice a number of symptoms that occur as a result of decreased estrogen levels, such as hot flashes, changes in mood, sleep problems, vaginal dryness, changes in libido, and changes in sexual function. Certain medications exist that can decrease these symptoms.

Rarity: Common

Top Symptoms: fatigue, delay in or irregular periods, vaginal discharge, anxiety, trouble sleeping

Symptoms that always occur with symptoms of menopause: delay in or irregular periods

Urgency: Self-treatment

Pelvic inflammatory disease

Pelvic inflammatory disease, or PID, is the general term for a bacterial infection of a woman's reproductive organs.

PID is most often a complication of a sexually transmitted disease (STD) such as gonorrhea or chlamydia. However, it is possible to get PID from other causes.

Any woman can be affected. It is most often found in sexually active women under age 25, especially those who have had PID before, have multiple partners, and/or douche frequently.

Symptoms include fever, lower abdominal pain, foul-smelling vaginal discharge, pain and/or bleeding during sex, and pain on urination.

Untreated PID can cause infertility due to damaged tissue in the reproductive tract, as well as chronic pelvic and abdominal pain. Unprotected sex partners will be infected as well.

Diagnosis is made through symptoms, pelvic examination, vaginal and cervical swabs, and urine tests.

Treatment is with a course of antibiotics. Be sure to finish all of the medication as directed, even when you begin feeling better.

To prevent PID, have all partners (male or female) tested for STDs and avoid unprotected sexual contact.

Rarity: Common

Top Symptoms: fever, abdominal pain or unusual vaginal discharge, vaginal discharge, nausea or vomiting, vaginal bleeding, pelvis pain

Symptoms that always occur with pelvic inflammatory disease: fever, abdominal pain or unusual vaginal discharge

Urgency: In-person visit

Uterine fibroids

Uterine fibroids are benign growths in the wall of the uterus and most often appear during childbearing years. Fibroids are almost never associated with cancer.

Those at higher risk include black women and women who started their periods at a young age. Other risk factors are vitamin D deficiency, poor diet, obesity, drinking alcohol, and family history of fibroids.

Fibroids can cause pelvic pressure and pain, severe menstrual cramping, and heavy menstrual bleeding that leads to anemia. Quality of life is diminished due to the chronic pain and discomfort. Though fibroids don't always make it impossible to become pregnant, infertility and pregnancy loss may occur as well as pre-term delivery.

Fibroids can be diagnosed through a routine pelvic exam or ultrasound in a doctor's office.

A gynecologist can prescribe various medications to ease the symptoms and regulate the menstrual cycle. There are also a number of surgical techniques, some minimally invasive, to shrink or remove the fibroids while leaving the uterus in place. Hysterectomy, or removal of the uterus, is an option in some cases.

Rarity: Common

Top Symptoms: vaginal bleeding, pelvis pain, abdominal cramps (stomach cramps), painful periods, irregular period

Urgency: Primary care doctor

Ruptured ovarian cyst

It is normal for one of the two ovaries to create a small follicle each month. This follicle contains an egg cell that is released as part of the menstrual cycle.

In some cases, however, the egg cell fails to release. The follicle becomes overgrown and may eventually rupture, especially during sexual activity or strenuous exercise.

Symptoms of a ruptured ovarian cyst may be mild and only require over-the-counter pain relievers.

However, sudden severe pain on one side of the lower abdomen, especially with vaginal bleeding, may indicate internal bleeding and is a medical emergency. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history, physical examination, and ultrasound, as well as blood tests and urine tests to rule out any other cause for the symptoms.

Treatment may involve hospitalization for IV fluids and pain medications. Surgery may be done to control the bleeding and remove any clots, blood, or fluid in the abdomen.

Rarity: Rare

Top Symptoms: stomach bloating, pelvis pain, lower abdominal pain, being severely ill, severe abdominal pain

Urgency: Hospital emergency room

Lichen sclerosus

Lichen sclerosus is chronic skin condition in which a person forms patches of white, wrinkly, thin skin, often described as being like "cigarette paper." Most people with this condition will experience it on their anus and genital regions, and some will experience it on other parts of their body.

The primary symptom of lichen sclerosus is the presence of skin changes as well as bruising, bleeding, inflammation, itching and pain in the affected areas.

The condition slowly progresses over time without treatment. Lichen sclerosus is benign but can cause significant discomfort and disfigurement. Treatment options include topical and oral medications, phototherapy, and circumcision in men to remove damaged skin.

Rarity: Common

Top Symptoms: vaginal itch or burning, vaginal pain, painful sex, dry skin on the outside of the vagina, painful urination

Urgency: Primary care doctor

Chlamydia infection

Chlamydia trachomatis is a type of bacteria best known for causing the sexually transmitted infection known simply as chlamydia. It is among the most common sexually transmitted diseases (STDs), with more than a million cases reported each year in the U.S. alone.

However, the sy..

Atrophic vaginitis

Atrophic vaginitis is a common condition that may affect up to 47% of postmenopausal women. It occurs due to low levels of estrogen which can be caused by menopause, medical treatments, and hormonal conditions, among other things.

Symptoms of atrophic vaginitis include vaginal dry..

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Painful sex treatments and relief

When to see a doctor for painful sex symptoms

Since dyspareunia can be related to both physiological and psychological conditions, your physician may suggest a multifactorial approach to treating your painful sex symptoms.

Treatments for inflammatory causes of painful sex

For inflammatory painful sex conditions your doctor may suggest the following:

  • Antibiotics or antifungals: These medications will combat bacteria and fungi that may be contributing to your symptoms.
  • Dermatologic treatments: If your symptoms are related to a skin condition in your genital area, your doctor may prescribe topical steroids that reduce inflammation.
  • Sitz baths: These are warm-water baths with salt added. They are helpful in alleviating pain and discomfort, and kits can be bought at the pharmacy. You can sit in the bath several times per day for a week.

Treatments for hormonal causes of painful sex

For hormonal painful sex conditions your doctor may prescribe:

  • Estrogen therapy: This will restore imbalances in estrogen in women who are transitioning or have started experiencing symptoms of menopause. Estrogen therapy is often used to treat dryness from atrophic vaginitis.
  • Contraceptives: Birth control methods do a wonderful job in controlling hormone levels and preventing conditions such as endometriosis.

At-home treatments for painful sex symptoms

For environmental/emotional causes of dyspareunia, try some of these lifestyle and home remedies:

  • Change positions: Try multiple different positions during sexual intercourse in order to better regulate depth of penetration and recognize positions that cause you less pain.
  • Use lubricants: A personal lubricant can make sex more comfortable.
  • Communicate and don't rush: Communicate with your partner about any discomfort or pain you may be feeling. Also taking time during foreplay or delaying penetration until you feel completely aroused can help reduce pain.

FAQs about painful sex

Why does it burn while having intercourse?

A variety of factors can cause pain during intercourse. For men, pain in the penis during intercourse may be caused by an obstruction of the urethra. For women, vaginal pain during intercourse is more common. It may occur due to a lack of lubrication (e.g. caused by progestin-only pills), pre-existing inflammation of the vagina, or infections, including sexually-transmitted (STIs) and non-sexually-transmitted infections.

What causes stomach pain during sex?

In women, abdominal pain during sex can be caused by endometriosis, fibroids, infections, or if you are engaging in penetrative sex pressing on the cervix. Endometriosis is a disorder in which some of the lining of the uterus moves to other areas of the body and tends to grow and shrink in concert with the menstrual cycle. Fibroids can also cause pain in the uterus that can be manifested during sex.

Why do I have painful sex during my period?

Endometriosis is often worsened during the menstrual cycle. It occurs when the lining of the uterus spreads to other areas of the female genital tract. It can cause tender areas in the cervix or a tender uterus when disrupted by the uterus. It can be treated in a gynecologist's office with a routine cauterization of the tissue. It should be evaluated as other causes of pain during sex may be more dangerous.

What does it mean when you have pelvic pain after intercourse?

Pelvic pain after intercourse can be caused by straining of the pelvic muscles or bruising of the tissue surrounding the pelvis. This may be prevented by stretching. Bruising can be prevented by proper communication and altered positioning. Inflammation or fibroids can also cause pelvic pain.

Can STDs cause painful sex?

STDs (sexually transmitted diseases, also known as STIs or sexually transmitted infections) can cause painful sex. Gonorrhea, Chlamydia, and other STDs can cause painful sex from inflammation of the vaginal canal which is tender upon penetrative sex. The external vagina can also be affected by sore blisters during a herpes infection. Additionally, a long-standing infection can track into the uterus causing pelvic inflammatory disease.

Questions your doctor may ask about painful sex

  • Do you feel pain when you urinate?
  • When was your last menstrual period?
  • Do you bleed after having sex?
  • Do you use birth control beside condoms?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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