Women's Pelvic Health and Reconstructive Surgery

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Painful Intercourse (Dyspareunia)

Dyspareunia or painful intercourse is defined as the complaint of persistent or recurrent pain or discomfort associated with attempted or complete vaginal penetration. It is a common problem for women at any age. Along with the other aspects of sexual dysfunction (decreased libido, decreased arousal, and orgasm difficulty), painful intercourse can be a significant cause of distress and embarrassment, and these issues can be detrimental to a woman's self-esteem and/or relationship.

The physicians and staff at University Women's Care are a team of caring professionals. Our providers have the expertise to treat even the most complex urogynecologic problems. We provide practiced, thoughtful care and work with patients to find the most appropriate diagnosis and treatment to meet each woman's unique personal needs.

Types of Dyspareunia

Painful intercourse is described by when symptoms began and where pain is located:

  • Primary Dyspareunia
    Painful intercourse beginning with the very first attempt at intercourse.
  • Secondary Dyspareunia
    Painful intercourse developing after a time of non-painful intercourse.
  • Entry Dyspareunia
    Pain or discomfort at or near the vaginal opening.
  • Deep Dyspareunia
    Complaint of pain or discomfort on deeper penetration (mid- or upper vagina).

Diagnosing Dyspareunia

There are many potential causes of painful intercourse, so diagnosis begins by considering when symptoms began and the location of the pain. Once these determinations have been made, other factors must be considered, including a woman's:

  • Age
  • Hormonal status
  • Current medications
  • Obstetrical history
  • Any prior surgeries or procedures

A physical examination is also very helpful in determining the cause of painful intercourse. This exam is often different from a more traditional annual gynecologic examination and only used when necessary.

Types of exams used in diagnosing dyspareunia: 

  • A vulvoscopy is a skin exam.
  • Various labs, tests, cultures, or biopsies can also be helpful for making a diagnosis.
  • In order to avoid causing patients any unnecessary discomfort, our physicians only perform speculum exams when absolutely necessary for diagnosis.

During exams, the physician looks at/for:

  • The quality or sensitivity of vaginal skin
  • Health of pelvic floor muscles
  • Degree of prolapse (if present)
  • Presence of a foreign body (i.e. vaginal mesh)
  • Scarring 

Treating Dyspareunia

When all of the available information has been gathered, a diagnosis more specific than “painful intercourse” can almost always be made. Treatment will be focused on the suspected cause(s) of the painful intercourse.

Some therapeutic options for treating causes of painful intercourse include:

  • Hormonal treatment to improve the quality of the vaginal skin
  • Medications (oral or topical) to treat inflamed nerve endings or painful muscles
  • Physical therapy directed at painful muscles
  • Trigger point injections to specific areas of muscle where pain is triggered
  • Nerve blocks to block pain signals and/or evaluate the possible effectiveness of surgical treatment
  • Surgery
The emotional impact dyspareunia can have on a woman and/or her relationship will be addressed as well. Our physicians discuss all possible diagnostic and treatment options with patients and, together, we make a treatment plan aimed at resolving the issue as quickly and safely as possible. If you are experiencing painful intercourse or sexual dysfunction, our team provides education and understanding about the problem, as well as support and a comprehensive treatment plan to address these complicated and difficult issues.

Request an Appointment

Our providers have the expertise to treat even the most complex urogynecologic problems with practiced, thoughtful care for the needs of our patients. The pelvic health program at UMMC sees patients by physician-referral and self-referral.

Healthcare Professionals

To refer a patient to the University Women's Care pelvic health program: