The short answer: pain during sex is common, and most causes are treatable and are not cancer. Pain at the entrance is often from dryness (after childbirth, while breastfeeding or after menopause), an infection, skin irritation or tight pelvic-floor muscles. Deeper pain is more often from endometriosis, adenomyosis, an ovarian cyst or scarring after an old pelvic infection. See a gynaecologist if it keeps happening, and get checked promptly if it comes with bleeding after sex, a lump, or new pain after menopause.
In Hindi this is often searched as sambandh banate samay dard (संबंध बनाते समय दर्द). For a shorter overview of this symptom, see pain during intercourse: symptom overview.
On this page
- Pain During Intercourse: A Symptom That Deserves Medical Attention
- Types of Dyspareunia
- Causes of Deep Dyspareunia
- When Is Dyspareunia Urgent?
Pain During Intercourse: A Symptom That Deserves Medical Attention
Dyspareunia — pain during or after sexual intercourse — is experienced by an estimated 10–20% of women at some point in their lives. Despite its prevalence, it is under-reported and under-treated. Many women feel embarrassed to raise it with their doctor, or assume it is a normal part of ageing, menopause, or having children. It is not. Painful intercourse is a symptom with identifiable causes, and most of those causes are treatable. If you also have pain at other times, read about pelvic pain and associated symptoms. If the pain started after surgery, radiotherapy or chemotherapy for a cancer, see pain during sex after cancer treatment.
Types of Dyspareunia
Superficial dyspareunia — pain at the vaginal entrance on initial penetration. Common causes: vaginal atrophy (thin, dry vaginal skin from low oestrogen, common after menopause and while breastfeeding), vestibulodynia (long-lasting soreness at the vaginal entrance), vaginismus (the vaginal muscles tighten on their own), active infection, or scarring, for example from a tear or stitches after childbirth.
For dryness, a water-based lubricant or a vaginal moisturiser often helps. If it does not, your doctor may suggest a low-dose vaginal oestrogen cream, which is not right for everyone.
Deep dyspareunia — pain felt deeper in the pelvis during penetration or thrusting. This variety is more likely to reflect a significant gynaecological condition and warrants thorough investigation, although even then cancer is an uncommon cause.
Causes of Deep Dyspareunia
- Endometriosis (tissue like the womb lining growing outside the womb) — particularly deep endometriosis affecting the supporting ligaments and the space behind the womb (uterosacral ligaments and Pouch of Douglas), or the bowel
- Adenomyosis — uterine muscle disease; worst pain typically in the days before menstruation
- Ovarian cysts — particularly endometriomas
- Uterine fibroids — especially posterior fibroids
- Pelvic inflammatory disease (PID) and adhesions following infection or prior surgery
- Cervical or vaginal cancer (uncommon) — post-coital bleeding alongside deep dyspareunia needs urgent evaluation
When Is Dyspareunia Urgent?
Deep dyspareunia accompanied by any of the following needs urgent specialist review:
- Post-coital bleeding (any bleeding after intercourse)
- A lump you can feel in your lower tummy, or a mass seen on a scan
- New onset in a postmenopausal woman
- Rapid onset or worsening over weeks
- Associated weight loss, fatigue, or change in bowel habit
A thorough pelvic examination, transvaginal ultrasound (an internal scan), and — if needed — laparoscopy (a keyhole camera test under anaesthetic) can identify the cause of dyspareunia in most women. Treatment ranges from topical oestrogen for atrophic changes to laparoscopic excision of endometriosis, all the way to specialist cancer management if needed.
Which doctor should I see? Start with a gynaecologist; most causes are diagnosed and treated in a routine clinic. A gynaecological oncologist becomes involved only if an examination or scan raises a concern about cancer.
Contact Dr. Nishtha Tripathi Patel at +91 76988 00333 for a confidential assessment of dyspareunia in Ahmedabad.