Dyspareunia – painful intercourse

Dyspareunia is pain during intercourse. Up to 75% of women may experience painful intercourse at some point during their life. It can be due to many reasons, including underlying medical conditions as well as psychological reasons. It can be due to factors related to the external genitals, intra-vaginal or deeper, cancers, infections, hormonal imbalances, skin disorders and many other reasons.

It can also be due to physical or mental stress, the mental inability to relax or enjoy sex which can lead to vaginismus (vaginal muscular spasms).

Many factors can play a role in the development of painful intercourse. Taking a proper history and medical examination may often be sufficient to diagnose the underlying cause of painful intercourse. Painful intercouse can be categorized into three main forms of pain: entry pain, deep pain and pain related to emotional factors.  Pain during penetration might be associated with a range of factors

Painful intercourse: Entry pain

Entry pain during intercourse can be caused many conditions and factors of which we’ll present some below.

Not enough lubrication

When sexually aroused, vaginal secretions will increase and cause the woman to get “wet”. This serves as an important lubricant that eases the entry of the penis and the thrusting. While friction is reduced it’s also important to have some friction between the vagina and penis for sexual stimulation. Some women may not get sufficiently wet to ease the entry and penetration by the penis which can cause entry pain. There are multiple reasons why women may not produce enough lubrication

Lack of stimulation and not enough foreplay can reduce lubrication

if vaginal entry is attempted before getting sufficiently sexually aroused, the vaginal secretions may not be enough for lubrication. Foreplay can help increase the lubrication. Foreplay can be physical or mental and does not necessarily have to start during the sexual act alone. It can start hours before. A touch, words, hints, attention, expression of affection, a romantic dinner and other gestures can indicate that something is going to happen later. Of course, physical and non-physical foreplay before penetration is also important.

Low estrogen levels and lack of lubrication

Estrogen is vital for vaginal health and it can impact on the thickness of the vaginal mucosa, vaginal lining and it helps in vaginal elasticity. Estrogen also helps in keep the vagina moist and increases wetness during sexual arousal. Lubrication may decrease in cases of low estrogen levels. Low estrogen and vaginal dryness can be seen after giving birth, during breast-feeding and after menopause.

Medications can cause reduced vaginal lubrication and vaginal dryness

Unfortunately, many medicines may cause sexual side-effects in men and women. In women, medicines may affect sex-drive and reduce lubrication. Some medicines that can potentially cause lubrication issues include hormonal contraception, sedatives, decongestants, calcium channel blockers, beta-blocker, benzodiazepins, anti-depressants, medicines used to control epilepsy and seizures and anti-histamines.

Injury or trauma

Trauma or injury to the external or internal female genitals can cause entry pain. This may be due to accidents and may also be due to surgery in the female genitals. For instance, during vaginal delivery a cut may be required to ease the childbirth. In some cases the healing of the cut and the scar-tissue may cause entry pain.

medical disorders of the female genitals

A rash, skin disorder, infection or inflammation of the external or internal female genitals and the urinary tract can cause painful entry. Fungal infection such as candida, viral infections such as herpes and bacterial vaginosis such as chlamydia and gonorrhea along with a urinary tract infection can play a role in the development of entry pain.


Vaginismus is the involuntary contraction of the muscles in the vaginal wall. Vaginismus may be the result of past painful sexual experiences, fear of penetration or pain, childhood trauma, vaginal infections, recurrent UTI or other factors.

Painful Intercourse: Deep pain

Painful intercourse can be due to more deep pain. Entry pain and deep pain may occur simultaneously or they may occur separately. Depending on what structures and causes are at play, deep pain may get worse in some positions and better in other positions.

As expected, there are multiple causes of deep pain. It may be due to conditions or factors related to the external or internal female reproductive organs or it may be due to factors beyond the genitals:

Vaginal or anogenital factors
  • Endometriosis, Pelvic Inflammatory Disease (PID), uterine disorders such fibroids, uterine prolaps or a retroverted uterus can cause deep pain. Ovarian cysts and dysfunction of the pelvic floor can play a role in the development of deep pain.
  • Hemorrhoids and anal disorders can lead to deep pain during intercourse
Gastrointestinal factors

In some cases bowel disorders, such as Irritable Bowel Syndrome, Inflammatory Bowel Disease and chronic constipation can cause deep pain

Previous surgery or medical treatments

Scarring from previous pelvic surgery such as hysterectomy, cut during vaginal delivery, adhesions and other complications to previous surgery can lead to deep pain during intercourse. This may also include previous surgery of the abdomen if structures are moved during thrusting.

Medical treatment, for instance radiation therapy and chemotherapy for cancer treatment can cause significant changes in the genitals that can generate painful intercourse and reduce pleasure from sexual activity.


painful intercourse: Emotional factors

Needless to say that the emotional state of the woman or the partner may greatly affect whether a sexual interaction is perceived as being pleasant or unpleasant. Some emotional factors that can cause painful intercourse include

Psychological disorders
  • Depression has a wide range of effects on our physical, mental and sexual wellbeing. It’s not surprise that it can also greatly reduce sexual pleasure and even be the reason for pain during intercourse.
  • Anxiety, guilt, unhappiness about your physical appearance, fear of penetration or fear of pain of penetration, lack of sexual stimulation, financial concerns etc can all play a role in the development of dyspareunia.
  • With a modern lifestyle often comes a some degree of stress. Stress can elevate the stress hormone, cortisol, and epinephrine/adrenaline. Stress can lead to tightening of the pelvic floor muscles, both during sexual activity or otherwise. This can lead to painful intercourse.
  • Sexual abuse or childhood trauma can cause the development of an unhealthy relation to sex, intercourse and sexual pleasure.


Platelet Rich Plasma for Sexual Rejuvenation

Platelet Rich Plasma has found it’s way into various fields of medicine. It can also be used for sexual rejuvenation in men and women. Keep in mind, that you may need maintenance treatment 8-12 months after the initial course. For some, the effect may last much longer.

PRP may be used in the following conditions for men:

  • Impotence or Erectile Dysfunction (ED)
  • Small or abnormal sized penises
  • To increase sex drive, get a harder erection, even in the absence of any medical condition
  • Increase the sensitivity of the penis

PRP treatment in men, may improve libido (sex drive), increase sexual pleasure, increase penile girth and length and improve penile blood circulation.

PRP may be used for the following conditions in women:

  • Anorgasmia
  • Decreased libido
  • Vaginal dryness
  • Dyspareunia (pain during intercourse)
  • Urinary incontinence

PRP can improve libido, increase sexual pleasure and improve the ability to achieve climax, reduce vaginal dryness and reduce or remove dyspareunia/pain during intercourse. Keep in mind, that the above conditions may be interlinked. Thus, vaginal dryness may cause pain during intercourse. The anticipation of pain, may in turn reduce libido and the pain during intercourse, may lead to anorgasmia/lack of climax, which in turn may further reduce libido. Thus, a vicious cycle is established, which can be very hard to break out of.

In our experience, the taboo surrounding sexual problems greatly impacts married life and may, in some cases, lead to divorce or separation. It’s a problem that can impact a great number of people, including the couple, the children and maybe an extended family. It’s a pity, that we rather keep silent about these issues, than deal with them.

It’s vital to mention here, that MY SKIN CLINIC strongly believes in confidentiality. A concept not fully developed or understood in Pakistan, but it plays a central role for the CEO of Dr Mohammad Mazhar Hussain, that lived in Denmark for 31 years and has received his medical training from there.

Sexual Rejuvenation for men and women in Islamabad and Lahore

No need to despair, if you suffer from sexual problems. In many cases we’ll be able to help you identify the underlying cause or causes and help you recover. Apart from Dr Hussain, we also have female doctors that can guide and treat you for sexual problems and conditions.

Call on WhatsApp 03175555920 (Islamabad) or 03175555950 (Lahore) to take the first step for a more satisfactory sexlife.