There are many causes for painful intercourse in women. For many, it is obvious. to themselves. Among the more common and obvious reasons are from thinning of the vaginal lining (called the mucosa) often from a drop in estrogen levels during menopause or after breast cancer treatment. Other causes include pelvic floor dysfunction, which is an unconscious tightening of the pelvic floor muscles or a lack of coordination in the use of these muscles. Less common causes include anatomical restrictions such as stenosis, webs or strictures. Most anatomical barriers can be corrected with time, patience and minor interventions. Below are some other considerations:
Pain during penetration might be associated with a range of factors, including:
- Not enough lubrication. This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breast-feeding also can be a cause.
Certain medications are known to affect sexual desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
- Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).
- Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.
- Vaginismus. These involuntary spasms of the muscles of the vaginal wall can make penetration painful.
- Congenital abnormality. A problem present at birth, such as the absence of a fully formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could cause dyspareunia.
Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain. Emotional factors include:
- Psychological issues. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
- Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
- History of sexual abuse. Not every woman with dyspareunia has a history of sexual abuse, but if you have been abused, it can play a role.