Dyspareunia is the medical word for persistent or recurrent pain with sexual intercourse.  This affects 10 to 20% of American women.  Dyspareunia can be deep or superficial.  Sexual pain can cause relationship distress, decreased quality of life, anxiety and depression. 

What are the risk factors for dyspareunia? 

• younger age
• white race
• lower socioeconomic status
• just had a baby
• perimenopausal
• postmenopausal
• depression
• anxiety
• low sexual satisfaction
• history of sexual abuse
• irritable bowel
• fibromyalgia

What will your doctor do?  She will take a thorough history.  When did it start? What makes it worse? Is the pain superficial or deep? What has helped in the past?  A physical exam should be done to visually examine the external genitalia and to perform an internal vaginal exam.  Expect to show your physician where the pain occurs.

What are common reasons of sexual pain?  Inadequate lubrication, vaginal atrophy, pelvic floor dysfunction, vaginismus (spasms of the vaginal walls), endometriosis, or vulvodynia. 

What is vulvodynia?  This is chronic genital pain lasting at least 3 months.  Pain can be triggered by touch like when inserting a tampon or attempting sexual intercourse or it can be unprovoked.  This can have generalized pain or localized.  The pain may feel like burning, aching, tearing or stabbing. 

What is vaginismus?  Vaginismus is an involuntary contraction of the pelvic floor muscles with attempted vaginal penetration.  This often leads to fear or anxiety about penetration causing more pelvic floor constriction.  Some patients have incidents before the pain such as traumatic sexual experiences or medical conditions and some have no antecedent risk factors. 

What can you do about sexual pain?  Make a log of the associated symptoms with sexual pain.  See your physician. Be prepared to discuss frankly about your condition and to have a physical exam.  Multidisciplinary treatment of this condition may include psychotherapy, sexual therapy, cognitive behavior therapy, vaginal lubricants, sequential vaginal dilators, or botox injections.