Painful Intercourse – Diagnosis and Treatment
Diagnosis
Doctors follow several steps to find the main cause of painful sex. First, they take a detailed medical history.
They ask when the pain started, where it hurts, if it connects to certain activities, and whether it changes with different partners or positions. Doctors also ask about childbirth, surgeries, infections, or conditions like endometriosis, fibroids, or pelvic inflammatory disease.
A physical examination plays a key role. The doctor performs a pelvic exam and checks for skin changes, infection, scarring, or structural problems.
They gently press on the vulva, vaginal walls, and pelvic muscles to find the exact area of discomfort. Sometimes, the doctor uses a speculum to look for causes like vaginal atrophy, lichen sclerosus, cysts, or prolapse.
If needed, doctors order further tests such as a pelvic ultrasound to rule out ovarian cysts, fibroids, adhesions, or other issues. Lab tests can check for infections like yeast or urinary tract infections when symptoms suggest these problems.
Common causes considered:
| Cause | Related Symptoms |
|---|---|
| Endometriosis | Pelvic pain, deep dyspareunia |
| Vaginal atrophy | Vulvar pain, dryness |
| Infection (UTI, yeast, etc.) | Burning, irritation |
| Structural abnormalities | Bulging, pain with deep entry |
Patients help the process by sharing accurate information and speaking openly. This helps doctors find possible triggers, such as postpartum changes, sexual dysfunction, or chronic conditions like vulvodynia or irritable bowel syndrome.
Treatment
Medicines and Prescribed Treatments
Doctors choose different medicines based on the cause of pain. Treating infections or medical conditions often relieves pain.
Sometimes, stopping or changing medicines that lower lubrication can help. For people with reduced estrogen levels, such as postmenopausal women, doctors may suggest topical estrogen applied to the vagina.
This treatment helps relieve dryness and improves lubrication. Ospemifene is another medication that acts like estrogen in vaginal tissues and can ease moderate to severe pain from dryness.
Possible side effects include hot flashes and, rarely, serious risks like blood clots, stroke, or increased risk of uterine cancer. Prasterone is a capsule inserted into the vagina daily to help with symptoms.
| Medication | How It Works | Possible Risks |
|---|---|---|
| Topical estrogen | Restores moisture | Mild irritation |
| Ospemifene | Acts like estrogen locally | Hot flashes, blood clots |
| Prasterone | Hormone placed vaginally | Mild irritation |
Doctors may review medicines with patients, as antihistamines can cause vaginal dryness.
Additional Approaches
Non-medicine therapies provide more options. Pelvic floor physical therapy can relax tense muscles and improve function, especially for pelvic floor dysfunction or vaginismus.
Desensitization exercises help relax and stretch the vaginal muscles, making intercourse more comfortable. Counseling or sex therapy can support people whose pain affects their relationships or causes anxiety about sex.
Learning new communication skills and addressing emotions can improve intimacy. Sometimes, doctors may recommend surgery, but only if other treatments do not help.
Everyday Tips and Home Care
Simple changes in daily habits can help reduce pain during sex. Trying new sexual positions lets you find what feels most comfortable and may ease discomfort from deep or fast penetration.
Talking openly with your partner about comfort and pain is important. Increasing foreplay can boost natural lubrication.
| Method | Benefit |
|---|---|
| Use water-based lubricants | Helps with vaginal dryness |
| Extend foreplay | Boosts natural lubrication |
| Adjust positions | Reduces painful penetration |
| Practice good hygiene | Prevents irritation and dryness |
Use gentle, fragrance-free products to keep the vaginal area healthy. Sitz baths and managing constipation may also help.
During menopause or breastfeeding, extra moisture from lubricants often makes intercourse more comfortable.
Ways to Manage and Find Support
People can try other forms of closeness, such as kissing, sensual touch, or mutual touch, to stay connected. These activities may lower stress, anxiety, or low self-image.
Open conversations, support groups, or counseling can help with emotional issues like depression or relationship problems that often link to decreased libido.
Getting Ready for Your Visit
Steps You Can Take Beforehand
To make your appointment more helpful, bring a list with:
- Sexual Health Concerns: Note when the pain started, how often it happens, and any patterns you notice.
- Health History: List any past or current health problems, especially those related to reproductive health.
- Medications and Supplements: Write down all the medicines, vitamins, and supplements you take, including the dosages.
-
Questions for the Provider: Prepare questions like:
- What could be causing my symptoms?
- Are there changes I can make to help manage the pain?
- What treatment options are available?
- Are there any trusted resources for further reading?
This information helps your healthcare provider understand your situation.
| What to Bring | Why It’s Useful |
|---|---|
| Symptom list | Shows patterns and helps with diagnosis |
| Medication details | Avoids harmful interactions |
| Questions | Ensures you get the information you need |
What Your Doctor Might Discuss
The healthcare provider may ask detailed questions about:
How long the pain has lasted and when it happens.
Where the pain is and whether it is constant or comes and goes.
If the pain happens every time or only in certain situations.
Relationship dynamics and whether you can discuss sexual issues with your partner.
Whether other activities, like exercise or sitting, cause pain.
Additional symptoms, such as irritation, itching, or burning.
The doctor may perform a pelvic examination, possibly using a speculum. A gynecologist may also check for other issues.
Sometimes, the doctor may suggest a pelvic ultrasound to find underlying problems.
