Sexual Pain Disorders


Painful intercourse, called dyspareunia, is common. Many women experience painful intercourse at some point in their lives. For some, experiencing pain during sex is only a temporary problem, however, for others it can be a life-long condition. Similar to other sexual dysfunctions, dyspareunia may be caused by emotional and physical problems.  Dyspareunia can significantly challenge a woman's ability to have a healthy sex life and can negatively impact mental health, self-esteem, and relationships. 

Dyspareunia can be classified in two ways: vaginal entry pain and deep pain inside the vagina or lower pelvis. Entry pain occurs when initial or attempted penetration of the vagina is painful. Deep pain refers to pain that occurs during deep vaginal penetration.  

What causes entry pain?

The following are the most common problems that can contribute to entry pain:

  • Not enough lubrication
    • Lack of foreplay
    • Drop in estrogen levels during menopause
    • Breast-feeding.
  • Medications that reduce sexual desire
    • Antidepressants
    • High blood pressure medications
    • Sedatives
    • Certain birth control pills
  • Injury or trauma
    • Pelvic surgery
    • Episiotomy during childbirth
  • Vaginismus
    • Involuntary spasms (or contractions) in the muscles around the vagina

What causes deep pain?

The following are the most common problems that can contribute to deep pain:

  • Gynecological illnesses and conditions
    • Endometriosis
    • Pelvic inflammatory disease
    • Uterine fibroids
    • Irritable bowel syndrome
    • Ovarian cysts
  • Surgeries or medical treatments
    • Scarring from pelvic surgery
    • Cancer treatments (chemotherapy and radiation)

What are some emotional factors that can contribute to painful intercourse?

Studies have shown a significant connection between sexual pain and psychiatric problems such as depression and anxiety. Emotional factors may include:

  • Psychological 
  • Stress
    • During times of stress, pelvic floor muscles tend to tighten
  • History of sexual abuse
    • A history of sexual abuse can play a role in sexual dysfunction 


Vaginismus is involuntary spasms of the muscles around the opening of the vagina in women who have no genital abnormalities. Despite the desire for penetration, entry of a penis, finger, or even tampon use, tight muscle contractions makes this difficult. It is possible for vaginismus to be limited to sexual activity and not experienced during a pelvic examination. The opposite is also true: vaginismus may occur during a pelvic examination and not during sexual activity. 

Treating vaginismus is based on a combination of cognitive and behavioral therapeutic approaches in order to help a woman achieve a sense of control over a sexual encounter or pelvic examination. The goal of treatment is to lower the anxiety/panic associated with penetration and encourage an understanding that she is no longer in danger of experiencing pain. Treatment options might include:

How can Balance help?

Balance providers understand the challenges of sexual pain and the importance of determining if emotional factors are associated. Because treatments for sexual pain can vary, a thorough evaluation is conducted to review sexual history and symptoms. We know that the idea of a sexual assessment appointment may make you nervous. We are truly committed to making the process as comforting and pleasant as possible.

Please remember this information is intended for educational purposes only and should not substitute medical advice from a healthcare provider.