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Sexual intercourse - painful

Definition

For both men and women, pain can occur in the pelvic area during or soon after sexual intercourse. It can happen at any time during sex -- for example, at the time of penetration, erection, or ejaculation -- or after sexual activity.

Eventually, ongoing pain may cause a person to lose interest in any sexual activity.

The medical term for this is dyspareunia.

Alternative Names

Painful sexual intercourse; Dyspareunia

Causes

• A diaphragm that does not fit properly
• Endometriosis
• Genital irritation from soaps, detergents, douches, or feminine hygiene products
• Hemorrhoids
• Herpes sores, genital warts, or other sexually transmitted infections (STIs)
• Intercourse too soon after surgery or childbirth
• Menopause
• Ovarian cysts
• Prostatitis -- inflammation of the prostate
• Reaction to the latex of a diaphragm or condom
• Sexual abuse or rape
• Urinary tract infections
• Use of certain medications
• Vaginal dryness or too little lubrication (for example, from not enough foreplay)
• Vaginal infection
• Vaginismus

Home Care

For painful intercourse in women after pregnancy:

• Wait at least 6 weeks after childbirth before resuming sexual relations.
• Be gentle and patient.
• Use lubrication as needed.

For vaginal dryness/inadequate lubrication:

• Try water-based lubricants.
• If you are going through menopause and lubricants don't work, talk to your doctor about estrogen creams or other prescription medications.

For painful intercourse caused by prostatitis:

• Soak in a warm bath.
• Drink plenty of fluids, but avoid alcohol and caffeine.
• Take acetaminophen or ibuprofen.
• Take antibiotics as prescribed.

For hemorrhoids, try stool softeners. Antibiotics may be required for urinary tract infections, sexually transmitted infections, or vaginal infections.

Other causes of painful intercourse may require prescription medications or, rarely, surgery.

Sex therapy may be helpful, especially if no underlying medical cause is identified. Guilt, inner conflict, or unresolved feelings about past abuse may be involved which need to be worked through in therapy. It may be best for your partner to see the therapist with you.

When to Contact a Medical Professional

Call your doctor if:

• Home remedies are not working.
• You have other symptoms with painful intercourse, like bleeding, genital lesions, irregular periods, discharge from penis or vagina, or involuntary vaginal muscle contraction.

If you have been sexually assaulted, report the crime to the police and go to the emergency room immediately. Get a trusted friend to accompany you. Do NOT change, bathe, shower or even wash your hands before the ER evaluation. The temptation to do so will be great, but it is important to not lose any evidence in order to help find, charge, and convict the suspect.

What to Expect at Your Office Visit

Your doctor will take your medical history and perform a physical examination.

Medical history questions may include:

• When did the pain begin or has intercourse always been painful?
• Is intercourse painful every time that it is attempted?
• Is it painful for your partner as well?
• At what point during (or after) intercourse does the pain begin? Upon entry/penetration? During ejaculation?
• Where, specifically, is the pain?
• Does anything make the pain better?
• Do you have any other symptoms?
• What are your attitudes towards sex in general?
• Have you had a significant traumatic event in the past (rape, child abuse, or similar)?
• What medications do you take?
• What illnesses, diseases, and disorders are you being treated for?
• Have you had a significant emotional event recently?
• Have you ever had pain-free sex with this partner? With any partner?

It may be best to see the doctor together with your partner. 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.

Antibiotics, painkillers, or hormones are amongst the treatment options that may be considered.

Prevention

• Good hygiene and routine medical care will help to some degree.
• Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
• The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not compatible with latex condoms (it causes them to break), it is not water soluble, and it may encourage vaginal infections.
• Practicing safe sex can help prevent sexually transmitted infections.

References

Bhasin S, Basson R. Sexual dysfunction in men and women. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 19.

Shafer LC. Sexual disorders and sexual dysfunction. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 36.

Clayton AH, Hamilton DV. Female sexual dysfunction. Psychiatr Clin North Am. 2010 Jun;33(2):323-38.

Heidelbaugh JJ. Management of erectile dysfunction. Am Fam Physician. 2010 Feb 1;81(3):305-12.

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