Dyspareunie

Dyspareunie (dyspareunie) is persistent or recurrent pain that occurs before, during, or after sexual intercourse. It can affect people of any gender but is more commonly reported by those assigned female at birth. Pain may be superficial, felt at the vaginal entrance, or deep within the pelvis.

Causes vary and are often grouped as local vulvar/vaginal conditions, vaginal dryness or infections, hormonal changes, pelvic pathology, and psychosocial factors. Superficial dyspareunia results from vulvar or vaginal disorders such as dermatitis, yeast infections, bacterial vaginosis, vulvar vestibulitis, or lichen sclerosus. Deep dyspareunia is linked to pelvic diseases (endometriosis, adenomyosis, pelvic inflammatory disease, fibroids, pelvic floor dysfunction) or bladder and urinary tract conditions. Medications, aging, anxiety, and a history of sexual trauma can contribute.

Diagnosis begins with a thorough history and physical examination, including a pelvic exam when appropriate. Tests may include vaginal swabs, urine tests, and imaging (ultrasound or MRI) to evaluate pelvic organs. Referrals to gynecology, urology, pelvic floor physical therapy, or sex therapy may be needed.

Treatment targets the underlying cause and may include lubricants or vaginal moisturizers for dryness; antibiotics or antifungals for infections; topical steroids for skin disease; hormonal therapy; pelvic floor physical therapy; and, if needed, surgery. Psychological support and sex therapy, along with open communication with partners, can help where psychosocial factors are present.

Prognosis varies; many improve with targeted treatment, though some cases become chronic and require ongoing, multidisciplinary care.