Painful Sexual Intercourse (Dyspareunia)

Diagnosis

Dyspareunia typically is diagnosed based on your symptoms. Your medical and sexual history and your physical examination will help your doctor to determine the cause of your symptoms.

Distinguishing pain that occurs with touching the genitals or early penetration from pain that occurs with deeper penetration is a clue to the cause of your symptoms. Therefore, your doctor will ask you questions about the exact location, length and timing of your pain. He or she also will ask you:

• If there was ever a time you had painless intercourse, or if you have always had dyspareunia

• If you have enough natural lubrication, and if your symptoms improve if you use commercially available lubricants

• About your sexual history (to help assess your risk for sexually transmitted infections)

• If you have ever been sexually abused, or had a traumatic injury involving your genitals

In addition:

• If you are middle-aged, your doctor will ask whether you are experiencing irregular periods, hot flashes or vaginal dryness, symptoms suggesting that you may have atrophic vaginitis.

• If you are a new mother, your doctor will ask whether you are breastfeeding your baby, because breastfeeding also can lead to vaginal dryness and dyspareunia

During the physical examination, your doctor will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), genital warts and scarring. Your doctor also will do an internal pelvic examination to look for abnormal pelvic masses, tenderness or signs of endometriosis. He or she also may suggest that you speak with a counselor to determine whether a history of sexual abuse, trauma or anxiety may be contributing to your symptoms.

Expected Duration

How long your symptoms last depends on the cause. If you have vaginal dryness from inadequate lubrication, the symptoms will improve rapidly if you use a commercially available lubricant or if you are more aroused before intercourse. If you have vaginal dryness from atrophic vaginitis, your symptoms will improve with an estrogen cream placed in the vagina. You should discuss this with your physician. Oral estrogen therapy can increase the risk of breast cancer and heart disease, but vaginal formulas are considered safe for most people. If you have a urinary tract or vaginal yeast infection, the dyspareunia typically goes away within one week of antibiotic or antifungal therapy. If you have a sexually transmitted disease, you may need longer, more intensive treatments with antibiotics to clear the condition. Skin diseases, usually will improve with the use of steroid creams, but often require long-term treatment. If you have had symptoms of dyspareunia for months or years, and psychological factors play a role, you may need prolonged counseling before your symptoms are relieved.