A Look at the Different Causes of Dyspareunia (Painful Sex)

By October 4, 2017General

Dyspareunia is the term used to describe pain before, during or after vaginal intercourse, or more simply, painful sex. It can be very stressful for women, resulting in a loss of interest in sex, which can put stress on a relationship and affect mood.
causes of Dyspareunia

Dyspareunia (painful sex) can present as either superficial pain or deep pain. Here’s a look at the different possible causes of dyspareunia.

Painful intercourse can be caused by a wide range of issues and conditions, both psychological and physiological, and many women experience it at some point in their lives.

Pain can occur in the vagina, clitoris or labia, depending on the underlying cause. It is often treatable, so if you are experiencing painful sex, don’t hesitate in seeing your gynaecologist for help.

Let’s take a look at the common causes of dyspareunia.

Entry Pain or Superficial Pain

Lubrication – A lack of lubrication is one of the most common causes of dyspareunia. Insufficient fluid causes the vagina to feel dry, resulting in pain when penetration is attempted. This is occasionally due to not enough foreplay.

A drop in estrogen levels after menopause, after childbirth or during breastfeeding may also be the reason. Certain medications can also cause low arousal levels, which can result in dryness. These include antihistamines, some birth control pills, and some medications for high blood pressure.

Irritation or injury – Irritation due to an infection (like an UTI or STI) or skin disorder (such as eczema or thrush) can cause pain during intercourse. The same goes for a pre-existing injury or trauma, such as surgery.

Increased sensitivity of the genital area to pain – Provoked vestibulodynia (PVD) is a chronic pain disorder in the vagina, causing constant pain of varying intensity. It can be caused by hormonal changes, infections, and tight pelvic floor muscles.

Allergies – An allergic reaction to contraceptive foams, lubrication or to latex condoms can result in pain during intercourse.

Vaginismus – Involuntary spasms of the muscles of the vaginal wall (vaginismus) surrounding the vagina can make penetration very painful. The way that vaginismus manifests itself varies from women to women. Some are able insert to smaller objects, like a tampon or finger, while others find it impossible to have sexual intercourse.

Congenital abnormality – Some kinds of congenital problems present from childbirth, such as an abnormal partition within the vagina or an imperforate hymen, can cause dyspareunia.

Hymen – An intact hymen (the small membrane of skin that surrounds or partially covers the external vaginal opening) can be painful when broken during first intercourse.

Size disparity – A large disparity in size between the penis and vagina can cause pain during intercourse.


Deep Pain

Infection – An infection of the cervix, uterus, or fallopian tubes – pelvic inflammatory disease – can cause pain during deeper penetration.

Conditions – Gynaecological conditions such as endometriosis, fibroids, ovarian cysts or tumours, uterine prolapse, and cystitis can cause pain during intercourse. Dyspareunia may be a symptom of one of these conditions, which is why you should see your gynaecologist if you are experiencing painful sex.

Surgery or Medical Treatment – Adhesions in the pelvic region, which can form after an infection, surgery, or radiation therapy for cancer, can result in painful sex.

Emotional Factors

Emotional factors also may play a role in causing painful sex. Anxiety, depression, concerns about physical appearance, fear of intimacy, stress or relationship problems can contribute to a low arousal and a result in pain due to lack of lubrication or vaginismus.

Sometimes, physical issues and become intertwined with psychological issues, with one impacting the other, making it hard to distinguish the underlying cause of dyspareunia.


Treatment of dyspareunia will, of course, depend on the underlying issue, ranging from physical treatment to psychological treatment, medication, and education. If you are experiencing painful sex it is important to seek help right away.

Dr Bevan Brown is one of the most trusted gynaecologists in the Hills District of Sydney. If you would like to book an appointment, please get touch in today. We will strive to give you guidance and compassionate care in every way possible.