Sexual Pain and Discomfort

For some women, sexual intercourse can be uncomfortable or even painful. Sexual pain and discomfort can occur due to age and changes that occur during menopause, or because of other medical conditions. The impact of painful intercourse (dyspareunia) can negatively impact both partners, including limiting sexual frequency and enjoyment.

At The University of Kansas Health System, our specialists are highly trained at identifying anatomic and physical changes that could be contributing to painful intercourse. There are often simple solutions that can help dramatically reduce sexual discomfort. Our doctors have treated hundreds of women with intercourse-related vaginal pain and help them restore their intimacy and sexual life.

Pain with intercourse can occur for many reasons:

• Anatomic changes of the pelvic floor muscles from prior surgeries or injury can contribute to vaginal muscles that are not appropriately tensing/relaxing and supporting the pelvic floor.
• Hormonal changes can result in atrophy of the vaginal tissue. The vaginal lining becomes thinner, and at the same time, the ability for the tissue to create natural lubrication declines.
• Infection or inflammatory conditions of the vulva, vagina or bladder can create very sensitive skin and discomfort during intercourse.
• Neurologic changes due to nerve injury or spine disease can contribute to abnormal nerve or muscle responses, making intercourse painful.

Dyspareunia symptoms can include:

• Burning or aching sensation in the vagina
• Pain during sexual intercourse
• Pain that continues after intercourse
• Pain that occurs at any penetration of the vagina, including tampon insertion
• Pain upon initial sexual penetration

Women are at a greater risk for painful intercourse if they experience:

• Certain skin disorders
• Cystitis
• Endometriosis
• Pelvic pain
• Uterine fibroids
• Vaginal dryness
• Vaginismus (when the muscles of the vagina contract spontaneously and painfully)
• Vaginitis (vaginal inflammation)
• Vulvodynia (pain in the vulva area)
• Yeast infections or urinary tract infections

Psychological factors, including stress and relationship problems, can also contribute to pain and discomfort during intercourse.

To diagnose dyspareunia, your doctor will take a complete medical history, including a history of your current symptoms. If a pelvic exam can be performed without causing additional pain, your doctor can evaluate whether anatomical irregularities, infection or skin irritation could be contributing to your sexual discomfort. Your doctor may also schedule an ultrasound to confirm or rule out possible causes for your painful intercourse.

The medical management of painful intercourse can include oral or topical medications with highly proven results and sexual function improvement. If loss of libido and emotional or relationship issues are contributing factors, your doctor may also recommend coordination with a sexual therapist.

If painful intercourse is due to the vaginal muscles being too taut or tense, physical therapy as well as trigger point injections (vaginal muscle injections) may be used to help relieve or manage the discomfort. Multiple research studies, including randomized clinical trials performed by our physicians, have proven the efficacy of these treatments.