What is Dyspareunia or Painful Sex?

Sexual health means a lot more than STDs or STIs, and while common, most people ignore the fact there are many other disorders and/or dysfunctions. One of the most common sexual health-related concerns is Dysparenuia or ‘Painful Sex.’ People who experience Dysparenuia have recurrent pain when engaging in sexual intercourse - both men and women experience Dysparenuia but females are more commonly affected. There are various causes behind painful sex or intercourse in both males and females - this handbook will cover the most common ones.

Medical Conditions & Sexual Dysfunctions

Contributing To Painful Sex - in Males

Infections 
Yeast Infections | ‘Thrush’

In men, the symptoms of yeast infection or thrush include uncomfortable symptoms such as itching, redness, and soreness on the glans (head) of the penis, and under the foreskin,  discharge (commonly described as ‘cottage cheese discharge’), and pain or discomfort when pulling the foreskin back and forth  - these combined can cause stinging during urination and also during sexual intercourse.

STDs | STIs

Certain STIs and STDs can cause pain, and burning sensations in the penis, testicles, and other organs. This is because the symptoms of some of the conditions can be sores, bumps, inflammation, redness, and swelling.

Sexual dysfunction 
Phimosis and Paraphimosis | ‘Tight foreskin’

In Phimosis, the foreskin of an uncircumcised individual can not completely be pulled back or retracted from the head of the penis. In Paraphimosis, the foreskin is retracted but can't move back up to its original position, preventing healthy blood flow to the penis. Phimosis can lead to paraphimosis. Symptoms of the condition include inflammation, discolouration, pain or soreness around the penis head, during sexual activity, while getting an erection, or otherwise, pain during urination, and penis discharge due to irritation or infection.

Glans Penis Hypersensitivity

Most men who have an intact foreskin have a sensitive glans penis. When they have sexual intercourse the first few times, they can experience pain or discomfort when the foreskin gets pulled due to friction. While it may be common to have a sensitive penis, an oversensitive one can be painful and cause discomfort. Glans is the head of the penis, and hypersensitivity means that it can be too sensitive. In some cases, glans hypersensitivity can cause premature ejaculation and erectile dysfunction as well. The main symptom is pain or discomfort during sex or otherwise

Peyronie’s Disease

This condition results from the formation of penis scar tissue that can cause abnormal curvature or bending and painful erections. This can make it hard to have sex, as at times it can be difficult to maintain an erection leading to erectile dysfunction. Some of the symptoms of Peyronie’s Disease include scar tissue buildup that can be felt under the skin of the penis upon physical examination, and penis bend because due to the condition, the penis has an upward or downward curvature or bend, penis shortening and penile pain.

Medical conditions 
Prostatitis

This is the inflammation of the prostate gland - a gland only males have. The symptoms of the condition include pain around the penis, anus, testes, lower stomach, and lower back. It can hurt during urination and defecation - these symptoms alone can affect arousal and desire and can make it rather painful to engage in sexual intercourse.

Testicle pain/swelling

There are infections such as Chlamydia that can cause testicle pain and swelling, while other causes can include injury, an allergic reaction, or medication side effects. Various conditions can cause growths or lumps on the testicles such as hydrocele, varicocele, cysts, testicular torsion, epididymitis, and cancer.

Tears in foreskin

Tears in the foreskin can be caused by injury, or ‘rough sex’ and sometimes can’t be seen. However, it can causes ‘stinging’ pain and soreness which can make it painful during sex.

Contributing To Painful Sex - in Females

Infections 
Yeast Infections | ‘Thrush’

In women, the symptoms of vaginal yeast infection or thrush include uncomfortable symptoms such as vaginal discharge (commonly described as ‘cottage cheese discharge, vaginal itching, redness, and soreness - these combined can cause stinging during urination and also during sexual intercourse.

STDs | STIs

Certain STIs and STDs can cause pain, and burning sensations in the vagina, vulva, urethra, clitoris, Labia Minora and Majora, and other organs. This is because the symptoms of some of the conditions can be sores, bumps, inflammation, redness, and swelling.

Sexual Dysfunction
Vaginismus

Vaginismus is a condition in which the muscles in the vagina tighten up during penetration. It is a phobia or fear and avoidance of penetration during sex. There is no physical cause associated with this female sexual dysfunction it is said to be caused by psychological factors. The vaginal tightening is the body's response/reaction to the fear or discomfort with vaginal penetration. Women don't have control over the tightening, and it can be painful. The condition can also affect an individual's arousal or desire to have sex. 

The physical symptoms caused by Vaginismus include discomfort/pain when inserting/removing feminine products (tampons) into the vagina and when engaging in vaginal penetration during and after sexual intercourse. The mental implications of Vaginismus include fear and anxiety associated with sex and/or vaginal penetration and depression, low libido due to unsatisfactory sexual experiences, and/or fear/anxiety.

Low Sexual Desire

The symptoms of low sexual desire can be the lack of arousal, which for women could mean a lack of lubrication. The friction that results from penetration can cause pain due to the lack of natural lubrication that occurs when a woman is aroused.

Medical Conditions
Endometriosis 

This is a disorder in which uterine tissue grows outside of the uterus such as in the ovaries, intestine, and/or the fallopian tubes. Endometriosis causes symptoms such as menstrual pain and irregularities, pain during defecating and sexual intercourse, and in some cases, infertility.

Increased tone of the Pelvic Floor

In this condition, the pelvic floor muscles are unable to relax causing symptoms such as pain during sex, constipation, and pelvic pain.

Inflammation of the Urinary bladder

This condition refers to chronic and painful inflammation of the bladder. The symptoms experienced by the patient include bladder and pelvic pain and pressure which can cause individuals to deter away from sexual intercourse.

Vulvodynia

These conditions result in chronic vaginal opening pain-causing intense discomfort and pain when sitting, or during sexual intercourse.

Atrophic Vaginitis

In this condition, there is thinning and drying of the vaginal walls along with possible inflammation. One of the most common causes of Atrophic Vaginitis is the drop in the production of estrogen, such as during menopause. Due to the lack of lubrication, vaginal penetration can cause discomfort and pain.

Vulvar Dermatological Conditions

Skin conditions such as folliculitis, contact dermatitis, lichen sclerosus, and Bartholin gland cysts fall under this category. Due to the discomfort, inflammation, and possible pain caused by these conditions, sex is commonly avoided.

Fibroids

These are benign uterine growths that can result in Menorrhagia (heavy period bleeding), pressure in the pelvis, and pain during sexual intercourse.

Biological Conditions
Menopause | Lack of Lubrication

Women experience menopause commonly between the age of 40-50. This is a natural biological process that is caused by the fact that as a woman ages, her body produces less estrogen. The hormone is responsible for helping in vaginal lubrication, its thickness, and its elasticity. Essentially, the symptoms of menopause are the symptoms of low estrogen in the body which include the thinning, inflammation, and drying of the walls of the vagina which can result in vaginal atrophy. The physical symptoms resulting from this process are hot flashes, mood changes, sleep disruption, mental health conditions, and in terms of sexual health lack of vaginal lubrication which can cause pain during sex.