It is estimated that up to 60% of women experience sexually-related pain at some point in their life. The terms most frequently used to describe sexual pain disorders include dyspareunia, vaginismus, and vulvodynia. Sexual pain may be superficial (pain around the vaginal opening) and/or deep inside the vagina causing pelvic pain. Women with sexual pain often see multiple healthcare providers or clinicians before they receive the correct diagnosis or treatment. A delay in the treatment can lead to feelings of self-doubt, anxiety, depression, or suicide. We can help.

Common Presenting Complaints

  • Pain upon penetration
  • Pain with tampon insertion
  • Pain with gynecological exam (ex., speculum insertion or Pap smear)
  • Burning or “knife-like” pain
  • Paper cut tears around the vaginal opening
  • Dryness or itching around the vaginal opening
  • New onset of pain (previous pain-free intercourse or tampon insertion)
  • Deep pain which may feel like “something is being bumped into”
  • Abdominal, pelvic, bladder or back pain
  • Pain that is worse following sexual activity
  • Pain after sitting for prolonged periods or wearing tight clothing

Causes of Vulvar Pain Due to a Specific Disorder

  • Infectious: Recurrent yeast/bacterial vaginal infections, recurrent UTIs, or genital herpes can trigger an inflammatory response and cause pain around the vaginal opening. The pain may persist even after the infection has been treated due to persistent inflammation.
  • Hormone Deficiency: A lack of estrogen and/or testosterone can cause thinning and atrophy of the vaginal tissues, also known as genitourinary syndrome of menopause (GSM). This commonly occurs with natural menopause, surgical removal of the ovaries (surgical menopause), chemotherapy (chemical menopause), and breastfeeding. Oral contraceptive pills (OCPs) can also increase the risk for a type of vulvodynia known as provoked vestibulodynia, especially when started at a younger age. OCPs that contain ethinyl estradiol (especially low dose pills) suppress estradiol and testosterone levels, which alters the vaginal and vulvar mucosa and decreases the mechanical threshold for pain around the vaginal opening. This has been thought to be a trigger for a type of vulvodynia known as anterior provoked vestibulodynia. In fact, any history of using low dose contraceptives in some women has been shown to result in vulvar pain, even after the pill has been discontinued.
  • Inflammatory: ex., lichen sclerosus, lichen planus, or immunobullous disorders. A vaginal skin condition such as lichen sclerosus can cause the vaginal tissues to become thin and feel like “paper cut tears.” Some products can irritate the vaginal tissues and trigger an inflammatory response. Once the irritant is discontinued, the pain and discomfort may persist. Examples include: scented soaps, “warming” lubricants, and over the counter treatments for a vaginal infection.
  • Neurologic:  ex., postherpetic neuralgia, nerve compression, neuroma, or nerve injury
  • Injury or Trauma: pelvic/gynecologic surgery or obstetrical related, scar tissue (ex., episiotomy), female genital cutting
  • Iatrogenic: ex., post surgical, radiation, or chemotherapy
  • Neoplastic: ex., vulvar cancer (squamous cell carcinoma), Paget’s disease

Causes of Deep Pain

  • Endometriosis
  • Interstitial cystitis/Painful bladder syndrome
  • Ovarian cysts
  • Radiation/Chemotherapy
  • Scar tissue after surgery
  • Uterine fibroids
  • Retroverted uterus
  • Constipation

Psychological Conditions, Abuse, or Stress

  • Anxiety, depression, concerns about physical appearance, fear of intimacy, past negative gynecological or sexual experience, relationship problems, and a history of sexual abuse or rape can contribute to painful intercourse. Also, pelvic floor muscles are sensitive to stress and this can contribute or lead to painful intercourse.