Pain with Intercourse/Arousal

Pain with intercourse is present in almost all patients with chronic pelvic pain.

It is the most common symptom for which patients visit our office. Understandably, a lack of intercourse may cause a loss of intimacy, often leading to significant anxiety, mental health issues, and emotional suffering. One of the most important parts of my job is helping people get their sexual health back and have pain-free intercourse.

Certain characteristics related to sexual activity allow for differentiation between the causes of pain with sexual intercourse:

Pain with sexual arousal, sexual pain, or foreplay may be caused by pudendal neuralgia or pelvic congestion.

Pain with entry or painful intercourse/painful sex may be caused by pelvic floor muscle spasm.

Pain with deep thrust may be caused by endometriosis or adhesions.

Pain with deep thrust in patients who had a hysterectomy may be caused by neuroma of vaginal cuff.

Pain with intercourse in the rear entry (“doggy”) position is common in patients with interstitial cystitis/bladder pain syndrome.

Pain after intercourse, sometimes lasting for a few days, is difficult in patients with pelvic floor muscle spasm or pelvic congestion.

pain with intercourse

Frequently Asked Questions:

What is dyspareunia?

Dyspareunia is a medical term for painful sexual intercourse.

Pain with Intercourse is also known as dyspareunia.

Causes of Pain with intercourse or dyspareunia can be a symptom of several conditions, such as:
-Vaginal dryness
-Infections (STDs, yeast, bacterial vaginosis)
-Uterine fibroids
-Pelvic inflammatory disease
-Cervical or vaginal cancer
-Interstitial cystitis

What is vaginal atrophy?

Vaginal atrophy is a condition where the vaginal walls thin, become less elastic, and produce less lubrication, usually due to declining levels of estrogen during menopause. This can cause discomfort and pain with intercourse, urinary symptoms, and vaginal dryness.

What is vaginal dryness?

Vaginal dryness is a condition in which the vagina produces less natural lubrication, leading to discomfort and painful sexual intercourse. It can be caused by various factors such as menopause, hormonal changes, certain medications, and stress.

What is menopause?

Menopause is a biological process in which a woman’s ovaries stop producing eggs and her menstrual cycles end, typically occurring in the late 40s or early 50s. It marks the end of a woman’s reproductive years and the onset of various physical and hormonal changes.

What is a urinary tract infection?

A urinary tract infection (UTI) is an infection that occurs in any part of the urinary system (bladder, ureters, kidneys, and urethra) caused by bacteria. Symptoms can include frequent and painful urination, cloudy or strong-smelling urine, and lower abdominal pain. UTIs are common and can be treated with antibiotics.

Where are the pelvic floor muscles?

The pelvic floor muscles are a group of muscles that stretch like a hammock from the tailbone to the pubic bone and support the pelvic organs, including the bladder, uterus, and rectum. These muscles can be consciously controlled and play a role in bladder and bowel control, sexual function, and stability of the spine and hips.

What is sexual dysfunction?

Sexual dysfunction refers to a problem that occurs during any phase of the sexual response cycle and prevents an individual from experiencing satisfaction from sexual activity. This can include issues with desire, arousal, orgasm, or pain during intercourse. Sexual dysfunctions can be physical or psychological in nature and can impact an individual’s overall quality of life.

Is vaginal tissue the same as the endometrium?

No, vaginal tissue and endometrium are different tissues. The endometrium is the inner lining of the uterus that builds up and is shed each month as part of the menstrual cycle. The vaginal tissue is the tissue that lines the vagina and is more durable and less susceptible to changes than the endometrium. Endometriosis occurs when the endometrial tissue grows outside of the uterus, whereas vaginal tissue remains in its proper location.

What is endometriosis?

Endometriosis is a condition in which the tissue that normally grows inside the uterus (endometrium) grows outside of it, typically on the ovaries, fallopian tubes, and the tissue lining the pelvis. This tissue still responds to hormonal signals from the menstrual cycle and can cause pain, heavy periods, and infertility. It is a common gynecological condition, affecting about 1 in 10 women of reproductive age.

*Pelvic Surgery isn’t always necessary, and pelvic floor physical therapy may help with a medical condition concerning chronic pain in the pelvic muscle.




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