Painful Intercourse (Dyspareunia)

Diagnosis

A medical evaluation for dyspareunia typically begins with a detailed assessment of your symptoms and health history. Your healthcare professional may ask when the pain started, where it occurs, what it feels like and whether it happens with every partner or in every sexual position. Questions about sexual history, childbirth and any past surgeries help identify possible causes. Providing honest answers is important because these details often offer valuable clues.

A pelvic exam is usually part of the evaluation. During this exam, your healthcare professional checks for signs of skin irritation, infection or anatomical problems. Gentle pressure may be applied to the genitals and pelvic muscles to help locate the source of the pain. A visual exam of the vagina also may be included. A speculum is used to separate the vaginal walls, though some people may feel discomfort during this part of the exam. You can ask to pause or stop the exam if it becomes too painful.

If certain causes are suspected, other tests such as a pelvic ultrasound may be recommended.

More Information

Pelvic exam
Ultrasound

Treatment

Treatment for dyspareunia depends on the underlying cause of the pain. When an infection or specific medical condition is responsible, managing that condition may resolve symptoms. If medications contribute to vaginal dryness, changing or adjusting them may help.

Medications

For many postmenopausal women, low estrogen levels can lead to vaginal dryness and painful intercourse. Topical estrogen applied directly to the vagina often improves lubrication and reduces discomfort.

Ospemifene (Osphena) is an FDA-approved medication for moderate to severe dyspareunia related to lubrication issues. It acts like estrogen in the vaginal tissue. However, it may cause hot flashes and carries risks such as stroke, blood clots and endometrial cancer.

Prasterone (Intrarosa) is another option. This medication comes as a capsule inserted into the vagina daily to help improve comfort during intercourse.

Other treatments

Some nonmedication therapies may also help relieve dyspareunia:

• Desensitization therapy. This involves learning vaginal relaxation techniques that can reduce pain.

• Counseling or sex therapy. If sex has been painful for a long time, you may have negative emotional responses or anxiety around sexual activity, even after treatment. Couples who have avoided intimacy may also benefit from strategies that improve communication and rebuild closeness. Counseling or sex therapy can help address these issues.

• Cognitive behavioral therapy. This approach can help change negative thought patterns and behaviors related to sexual pain.

These combined treatment strategies aim to reduce discomfort, improve sexual function and support emotional well-being.