It is believed that dyspareunia is caused by organic (physiological) factors at least 75% to 80% of the time. Pain that occurs initially at entry but decreases over time is commonly caused by inadequate lubrication.

This is frequently due to a lack of sexual arousal and effective stimulation, and sometimes due to medication that decreases vaginal lubrication (such as antihistamines).

Psychological factors are infrequently involved and will most commonly be associated with previous sexual trauma (rape or abuse), feelings of guilt, or negative attitudes toward sex.

Women more at risk for dyspareunia include those who are on medications that produce a general drying effect on body secretions and those who are postmenopausal (and who have vaginal dryness due to low estrogen level).

Other causes in women include vaginitis (vaginal infections), endometriosis, cystitis or urethritis, orthopedic problems, retroversion of the uterus, and chronic constipation.

In men, the most common causes of pain that occur at the time of ejaculation are prostatitis and urethritis. This is often associated with a recent reduction in the frequency of sexual activity.

Pain that occurs while obtaining an erection may be associated with inflammation of the foreskin, loss of elasticity of the foreskin, trauma to the penis, infections (such as herpes) or genital warts, genital allergies or irritations, or curvature of the penis caused by Peyronie's disease.

PREVENTION:
Good hygiene and routine medical care will help to some degree. Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina. The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant since it is not water soluble and may encourage vaginal infections.

COMPLICATIONS:
Eventually dyspareunia inhibits sexual interest as well as responsiveness. In some cases vaginismus may occur, causing the vaginal muscles to involuntarily contract and clamp down as a self-protective way of avoiding the anticipated pain.

• aggressive or impatient partner
• premature lovemaking following surgery (episiotomy) or child birth
• menopause, because of decreased levels of female hormones (vaginal lining loses its normal moisture and becomes dry)
• hemorrhoids
• genitourinary tract infections (such as a bladder infection)
• vulvar vestibulitis (inflammation of the vestibule of the vagina -- the area of the perineum that is between the labia minora including the opening of the vagina and the urethra) is one of the most common causes of dyspareunia in women, and is commonly overlooked
• herpes sores (see genital herpes)
• endometriosis

The nature of treatment and the outcome depends on the cause of the pain.

WOMEN
For painful intercourse in women after pregnancy, gentleness and patience should be exercised. Wait at least 6 weeks before resuming sexual relations after childbirth.

For painful intercourse in menopausal women, use lubricants and estrogen-containing creams or medications as prescribed. (See also: menopause, non-medical alternatives to ERT).

For painful intercourse caused by endometriosis, medications are available. Surgery, which might give total relief, may also be an option.

For painful intercourse due to other complications, diseases, or psychological factors, see your health care provider. Vulvar vestibulitis generally requires surgical intervention, but may be treated very successfully.

MEN
For painful intercourse caused by penile skin infections, use antibiotics as prescribed.

For painful intercourse caused by herpes, follow your health care provider's recommendations.

For painful intercourse caused by prostatitis, sitz baths may help. Avoid alcohol and caffeine. Antibiotics, as prescribed by the doctor, will help fight infection. Prostatitis and urethritis can be treated quite successfully.

When no organic cause of the pain can be found, sex therapy may prove beneficial. Occasionally, variables (such as guilt, inner conflict, unresolved feelings about past abuse, and the need for self-punishment) may be involved and need to be worked through in therapy.

• home remedies are not satisfactory
• other symptoms are associated with the painful intercourse
• the problem is physical and not behavioral (If behavioral, seek counseling as a couple.)

Your medical history will be obtained and a physical examination performed.

Medical history questions documenting painful intercourse in detail may include:

• Time pattern
  • When did it develop?
  • Is intercourse painful every time that it is attempted?
  • Has intercourse always been painful?
• Quality
  • Is it painful for your spouse, also?
  • Does the pain occur during entry?
• Location
  • Specifically, where is the pain? (labia, vagina, entire pelvic area etc.)
• Aggravating factors
  • What are your attitudes towards sex? (Note: many questions may be asked by the health care provider to determine your general and specific attitudes.)
  • Has there been a significant traumatic event in the past (rape, child abuse, or similar)?
  • What medications are being taken?
  • What illnesses, diseases, and disorders are being treated?
  • Has there been a significant emotional event recently?
• Relieving factors
  • What have you done to try to make intercourse less painful?
  • How well has it worked?
• Other
  • What other symptoms are present?

Unless the problem is obviously caused by the physical symptoms of one person, the couple involved should see the doctor together. Physical examination may include a pelvic examination (for women), a prostate examination (for men), and a rectal examination. If a physical problem is suspected, appropriate tests will be ordered.

Antimicrobial or anti-inflammatory medications may be administered.