What are the causes of dyspareunia?

Following are the most common gynecologic conditions that cause pain during sex.

• Vaginismus: This is a very common cause of dyspareunia. Vaginismus is a physical or psychological condition in which there are involuntary spasms and tightening of vaginal muscles. It is mainly caused due to feeling of getting hurt. During sexual intercourse, vaginal tightness may cause sexual discomfort, sensations of burning, tightness, pain or inability to penetrate. Identifying the cause of vaginismus is important to decide the mode of treatment.
• Insufficient vaginal lubrication or vaginal dryness: This is often reported by breast‑feeding mothers. Insufficient vaginal lubrication or vaginal dryness leads to difficulty in penetration and pain during intercourse.
• Vulvodynia: Vulvodynia is a chronic burning pain near vulvar area without any identifiable cause. The exact location and severity of the pain vary highly among patients. Some women experience pain only near area of the vulva (only in the left labia or near the clitoris), while others experience pain in multiple areas (such as labia, vestibule, clitoris, perineum and inner thighs).
• Vaginal infections: These include yeast, fungal or bacterial infections in vagina or lower urinary tract infections. In most of the cases they cause superficial pain. Whilst, infections of cervix or pelvic inflammatory diseases cause deeper pain at the time of penetration, as the tissues deep inside become badly inflamed.
• Allergic reactions or skin disorders: Certain skin disorders or allergies like contact dermatitis can result in ulcers, rash or cracks in the skin of valve and vagina. Skin allergies near genital area may be due to perfumed soaps, douche product, synthetic undergarments, condoms or lubricants.
• Sexually transmitted diseases: These can include genital warts, genital herpes, syphilis or gonorrhea. As a result, the patient experiences striking burning pain during sexual intercourse.
• Obstructions: Some of the obstructive disorders such as hemorrhoids, fibroids, endometriosis, ovarian cysts, uterine retroversion (uterus is tilted backward instead of forward) and genital or pelvic tumors can also cause pain during sexual penetration.
• Interstitial cystitis: This is a chronic inflammatory bladder condition that causes recurrent pelvic pain, bladder pressure, or mild discomfort in the bladder and pelvic region. In turn leading to dyspareunia.
• Injuries: Tissue injuries after trauma to pelvis from injury, surgery or tear from childbirth may cause extreme pain during sexual intercourse.
• Hormonal changes: Age related changes associated with menopause are one of the causes of dyspareunia. With menopause, the estrogen levels drop down and vaginal lining loses its normal moisture. As, estrogen deficiency is associated with lubrication inadequacy, it can lead to painful friction during intercourse.
• Congenital abnormality: Problems present right from birth such as absence of fully formed vagina or immature hymen can lead to dyspareunia in future.

Other than these gynecologic causes, there are some psychological factors that can adversely affect sexuality and lead to dyspareunia. These factors may include trauma due to sexual assault, emotions such as fear, guilt and awkwardness about having sex, anxiety and depression. Additionally, there are some sexual response problems which can cause sexual pain. These may include relationship problems with partner that lead to stress and fatigue and in turn affect desire to have sex. Many medications like birth control methods, painkillers also reduce sexual desire.