When Sex Hurts

Painful intercourse, or dyspareunia (dis-puh-ROO-ne-uh), is a common problem that affects up to 20 percent of women and a smaller percentage of men.  It has a variety of possible causes, ranging from lack of lubrication or infections, to structural or psychological problems.

Possible causes include, but are not limited to:

  • Endometriosis (when uterine tissue grows outside the uterus)
  • Ovarian cysts
  • Infections of the urinary tract, vagina or pelvic inflammatory disease
  • Uterine prolapse
  • Tumors or uterine fibroids (non-cancerous growths)
  • Scarring – from surgery or injury
  • Vaginismus (involuntary musculature contractions of the pelvic floor)
  • Peyronie’s disease or other deformities of the penis
  • Interstitial cystitis (chronic bladder pain or pressure)
  • Vaginal atrophy
  • Xerosis (vaginal dryness, especially after menopause)
  • Cancer treatment – such as radiation or chemotherapy 


Effective treatment begins with correct diagnosis, which typically starts with a physical exam and a review of the symptoms, including whether the pain feels more like aching or burning, whether it is a new symptom or an ongoing problem, and under what circumstances the pain occurs.

The physical exam may be followed by one of more of these common diagnostic tests:

  • Lab analysis – to check for bacterial, fungal or viral infections
  • Biopsies – to examine suspicious lesions or tissue changes
  • Pelvic ultrasound – to examine pelvic organs and identify painful areas
  • Magnetic resonance imaging (MRI) – to look for congenital abnormalities
  • Colposcopy – which uses a lighted, magnified scope (or tube) inserted into the vagina to examine the cervix and vaginal tissues
  • Cystoscopy – which uses a scope inserted into the urethra (the tube that carries urine out of the bladder) to examine the lining of the bladder and urinary tract
  • Laparoscopy – which uses a thin, lighted scope inserted through a small incision in the lower abdomen to check for cysts, adhesions or fibroids 

Treatment Options

Treatment varies depending on diagnosis, but may include one or more of the following options:

  • Lubrications and creams – including over-the-counter options as well as those containing estrogen, for postmenopausal women
  • Medications – including hormones to treat dryness or endometriosis, antibiotics for infections, analgesics for pain, muscle relaxants and medications to treat underlying illnesses
  • Physical therapy – including vaginal relaxation and pelvic floor (Kegel) exercises
  • Biofeedback or electrical stimulation – to assist with Kegel exercises or with relaxation and stretching of the pelvic floor
  • Surgery – to correct physical abnormalities or to remove fibroids or other tumors
  • Counseling or sex therapy – to treat anxiety, to seek out less painful behaviors or positions, and to reduce negative emotional responses that may linger even after treatment of physical disorders

The MyMichigan Difference

  • MyMichigan offers DaVinci Robotic Surgery to enable advanced minimally invasive procedures for many complex surgeries.
  • MyMichigan facilities are conveniently located in safe and friendly communities, with easy access and parking.

Your Next Steps

For more information about painful sex, talk to your physician. For a physician referral, visit our Find a Doctor section, or call the MyMichigan Health Line at (989) 839-9090 or toll-free at (800) 999-3199.