Painful Intercourse (Dyspareunia): not normal, but treatable
Pain during sex is common, but it is not something you should accept as “normal.” With the right diagnosis and treatment, it can improve significantly or resolve completely. MyDocsy provides discreet evaluation and structured plans targeting the true cause.
What Type of Pain Are You Having?
Pain at the entrance
- Burning, stinging, tearing sensation
- Pain when penetration begins
- Common causes: dryness, infection, vulvar skin conditions, vaginismus, pelvic floor spasm
Deep pain
- Pain felt inside pelvis or deep abdomen
- Worse with certain positions
- Common causes: endometriosis, adenomyosis, fibroids, ovarian cysts, pelvic adhesions
Pain after sex
- Cramping, spotting, pelvic soreness
- Common causes: cervical issues, infection, deep pelvic inflammation, endometriosis
Common Causes of Painful Intercourse
A) Vaginal dryness
- Perimenopause / menopause
- Postpartum and breastfeeding
- Hormonal contraception use in some women
- After ovarian surgery or low estrogen states
- Leads to friction, micro-tears, burning, and fear of penetration
B) Infection or inflammation
- Recurrent yeast or bacterial vaginosis
- STIs in some cases
- Cervicitis: burning, discharge, odor, itching, or pelvic discomfort
C) Endometriosis
- Pain during sex + painful periods
- Pain with bowel movements during periods
- Chronic pelvic pain
- Infertility
D) Adenomyosis
- Deep pain
- Painful periods
- Heavy bleeding
- Bulky uterus on scan
E) Fibroids or ovarian cysts
Can cause deep pain, pressure, and discomfort in certain positions.
F) Pelvic floor muscle spasm / vaginismus
- Tightening of pelvic muscles, making penetration painful or impossible
- Often linked to fear, anxiety, trauma, postpartum changes, chronic pelvic pain
G) Vulvar skin conditions
- Lichen sclerosus or dermatitis
- Symptoms: burning, itching, white patches, cracks, pain at the entrance
H) Pelvic adhesions
Post-surgery or post-infection scarring can pull tissues and cause deep pain.
When Painful Sex Needs Urgent Care
Seek prompt evaluation if you have fever, foul-smelling discharge, new pain after high-risk exposure, severe pain with vomiting, heavy bleeding after sex, or pain with missed period.
What MyDocsy Evaluates First
1) Pain mapping
- Entrance vs deep
- Duration
- Relation to periods
- Position-related or constant
2) Associated symptoms
- Discharge, odor, itching
- Irregular bleeding
- Painful periods
- Bowel or urinary pain
- Fertility concerns
3) Exam and imaging
- Gentle pelvic exam if appropriate
- Ultrasound for uterus/ovaries
- Targeted swabs when infection is suspected
Tests That Usually Matter
Targeted tests only: pelvic ultrasound, vaginal swabs if infection, urine test if urinary symptoms, STI testing if indicated, MRI pelvis if deep endometriosis suspected, evaluation of pelvic floor tone.
Treatment Options (Cause-Based)
Dryness
- Local estrogen therapy
- Moisturizers and lubricants
- Pelvic floor therapy if laxity/post-delivery changes
Infection
- Accurate organism-specific treatment
- Partner treatment when needed
- Recurrence prevention plan
Endometriosis
- Medical suppression protocols
- Pain management
- Laparoscopic excision if needed
- Fertility-aligned planning
Pelvic floor spasm / vaginismus
- Pelvic floor physiotherapy
- Relaxation training and graded dilation
- Pain cycle reversal plan
- Counselling support
Fibroids/cysts/adenomyosis
Targeted uterine/ovarian treatment, uterus-sparing prioritized, surgery only if clearly beneficial.
Vulvar skin disorder
Diagnosis and dermatology-guided therapy, long-term symptom control.
Speak to a Gynecologist
Pain during sex can improve dramatically with correct diagnosis and treatment. Message us to speak to your personal doctor on MyDocsy.
Experiencing these symptoms?
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