Dyspareunia

Dyspareunia is persistent or recurrent pain in the genitals that occurs just before, during, or after sexual intercourse. It can be classified as superficial, involving pain at the vaginal opening or the vulva, or deep, involving pain felt in the pelvis during penetration or after intercourse.

Causes are varied and may involve physical, hormonal, infectious, or psychological factors. Local vulvar or vaginal conditions such as infections, vulvodynia, dermatitis, or lichen sclerosus can cause superficial pain. Vaginal dryness from menopause or lactation, medications, or hypoestrogenism can contribute. Deeper pain may reflect gynecologic diseases such as endometriosis, adenomyosis, pelvic inflammatory disease, ovarian cysts, or fibroids, as well as pelvic floor dysfunction. Psychological factors, including anxiety or a history of sexual trauma, can also contribute or amplify pain.

Evaluation typically begins with history and physical examination, including external vulvar assessment and possibly a pelvic exam. Tests may check for infections, hormonal status, and other conditions. Imaging such as ultrasound or MRI is used if deep pathology is suspected. In many cases, multidisciplinary care from gynecology, physical therapy, and sexual health specialists improves assessment and management.

Management targets the underlying cause and symptom relief. Treatments may include lubricants and vaginal moisturizers, topical estrogen for atrophy, treatment of infections, and management of endometriosis or other pelvic disease. Pelvic floor physical therapy, graded dilator therapy, and sex therapy can help with pain and anxiety. Lifestyle measures and partner involvement are also important. Many patients improve with appropriate care, though some require ongoing management.