Sexual intercourse, painful

Alternative names:

painful sexual intercourse; dyspareunia

Home care:

The nature of treatment and the outcome depends on the cause of the pain.

WOMEN
For painful intercourse in post-pregnant women, gentleness and patience should be exercised. Wait at least 3 weeks before resuming sexual relations after childbirth.

For painful intercourse in menopausal women, use lubricants and estrogen containing creams or medications as prescribed (See also: menopause, non-medical alternatives to ERT).

For painful intercourse caused by endometriosis, medications are available. Surgery, which might give total relief, may also be an option.

For painful intercourse due to other complications, disease or psychological factors, see your health care provider. Vulvar vestibulitis generally requires surgical intervention, but may be very successfully treated.

MEN
For painful intercourse caused by penile skin infections, use antibiotics as prescribed.

For painful intercourse caused by herpes, follow your health care provider's recommendations.

For painful intercourse caused by prostatitis, sitz baths may help. Avoid alcohol and caffeine. Antibiotics, as prescribed by the doctor, will help fight infection. Prostatitis and urethritis can be quite successfully treated.

When no organic cause of the pain can be found, sex therapy may prove beneficial. Occasionally, variables such as guilt, inner conflict, unresolved feelings about past abuse, and the need for self-punishment may be involved and need to be worked through in therapy.

Call your health care provider if:

• home remedies are not satisfactory.
• other symptoms are associated with the painful intercourse.
• the problem is physical and not behavioral. If behavioral, seek counseling as a couple.

What to expect at your health care provider's office:

Your medical history will be obtained and a physical examination performed.

Medical history questions documenting painful intercourse in detail may include:

• time pattern
  • When did it develop?
  • Is intercourse painful every time that it is attempted?
  • Has intercourse always been painful?
• quality
  • Is it painful for your spouse, also?
  • Does the pain occur during entry?
• location
  • Specifically, where is the pain? (labia, vagina, entire pelvic area etc.)
• aggravating factors
  • What are your attitudes towards sex? (Note: many questions may be asked by the health care provider to determine what your general and specific attitudes are.)
  • Has there been a significant traumatic event in the past (rape, child abuse, or similar)?
  • What medications are being taken?
  • What illnesses, diseases, and disorders are being treated?
  • Has there been a significant emotional event recently?
• relieving factors
  • What have you done to try to make intercourse less painful?
  • How well has it worked?
• other
  • What other symptoms are present?

Unless the problem is obviously caused by the physical symptoms of one person, the couple involved should see the doctor together. Physical examination may include a pelvic examination (for women), a prostate examination (for men), and a rectal examination. If a physical problem is suspected, appropriate tests will be ordered.

Antimicrobial or anti-inflammatory medications may be administered.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to painful intercourse, you may want to note that diagnosis in your personal medical record.

Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director, Utah Health Informatics and adam.com editorial