Pain During Intercourse: Causes, Treatments, and How to Regain Comfort

In short: Pain during intercourse is a common problem with physical and psychological causes. Physical causes include vaginal dryness from lack of oestrogen, vaginal and urinary infections, adhesions, endometriosis, fibroids, vaginismus (involuntary tightening of the pelvic floor muscles), pain at the vaginal opening and some skin conditions of the vulva. Psychological causes include anxiety and stress. Treatment depends on the cause: hormones, antibiotics or antifungals, laparoscopy, moisturisers or psychological support.

Pain during intercourse, also known as dyspareunia, is a common problem affecting many women. It can have physical, psychological, and social dimensions, and it may put a strain on the relationship between partners. The good news is that with the right diagnosis, this pain can often be managed and treated effectively.

• Causes of pain during intercourse:

Physiological causes:

• Vaginal dryness: due to estrogen deficiency after menopause, during breastfeeding, or due to certain medications
• Vaginal infections
• Urinary tract infections
• Cervical or pelvic infections
• Internal scarring and adhesions due to previous surgeries
• Endometriosis
• Uterine fibroids

• Vaginismus (involuntary tightening of the pelvic floor muscles around the vaginal opening), vulvodynia/vestibulodynia (pain at the vaginal entrance without a visible cause), and vulval skin conditions such as lichen sclerosus

Psychological reasons:

• Anxiety or tension about sexual relations
• Previous sexual trauma
• Weak attraction or communication with partner

How is it treated?

First, the underlying cause must be identified through a proper medical evaluation, and treatment will be prescribed accordingly.

1- If the cause is estrogen deficiency (after menopause or during breastfeeding), the first choice is low-dose vaginal estrogen (cream, tablet or ring), which is safe for long-term use; other options include vaginal DHEA (prasterone) or ospemifene. Hormone therapy by mouth or skin patch may be added if the woman also has other menopausal symptoms.

2- Appropriate treatments for vaginal infections: antibiotics, antifungals.

3- Appropriate treatment for urinary tract infections (antibiotics).

4- Prescribing antibiotics to treat pelvic inflammatory disease, which may require hospitalization and intravenous antibiotics.

5- Performing a laparoscopic procedure to release adhesions.

6- Treating endometriosis with hormonal pills or surgically removing endometriomas.

7- Removing uterine fibroids.

Moisturizers and lubricants can be used during sexual intercourse to relieve dryness and painful friction.

A topical anesthetic gel can be applied to the vaginal opening half an hour before intercourse to relieve pain caused by penile penetration, especially for newlyweds.

How can pain during intercourse caused by psychological factors be treated?

• Consult a psychologist or sex therapist
• Relaxation exercises

• Pelvic floor physiotherapy and the gradual use of vaginal dilators, which are very effective for vaginismus

• Enhancing sexual communication techniques
• Adjustments to the relationship, such as:
• Gradually increasing foreplay and arousal before penetration
• Using comfortable positions to reduce pain

If the pain is accompanied by bleeding or abnormal discharge, this requires immediate medical attention. If you are experiencing persistent or worsening pain during intercourse, you do not have to simply live with it — speaking with a gynecologist can help identify the cause and guide you toward the right treatment plan for your situation.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist