Skip to main content

Advertisement

SpringerLink
Log in

When Love Hurts: Evaluation and Management of Painful Intercourse in Women

  • Female Sexual Dysfunction and Disorders (A Stanton, Section Editor)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to provide general considerations for the work up and management of dyspareunia, describe the various causes, provide first line treatment options, and note when surgical management is indicated. We also aim to provide additional resources for management.

Recent Findings

Recent studies have demonstrated the complex nature of female sexual dysfunction and the multimodal treatment options that are often needed including surgical intervention.

Summary

Recurrent or persistent discomfort before, during, or after intercourse may occur in approximately 15% of women. The differential diagnosis of dyspareunia is vast. A thorough history and physical exam are imperative for diagnosis and treatment of dyspareunia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wheeler LJ, Guntupalli SR. Female sexual dysfunction: pharmacologic and therapeutic interventions. Obstet Gynecol. 2020;136(1):174–86.

    Article  Google Scholar 

  2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.

    Article  CAS  Google Scholar 

  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Ameri-can Psychiatric Association; 2014.

    Google Scholar 

  4. Wright JJ, O’Connor KM. Female sexual dysfunction. MedClin North Am. 2015;99:607–28.

    Article  Google Scholar 

  5. Younes G, Goldschmidt E, Zilberlicht A, Auslender R, Haya N, Abramov Y. Vaginal adhesions after transvaginal pelvic reconstructive surgeries: prevalence and clinical implications. Int Urogynecol J. 2016;27(1):141–5. https://doi.org/10.1007/s00192-015-2807-5 Epub 2015 Aug 5.

    Article  PubMed  Google Scholar 

  6. Kim HM, Bae JY, Cho YJ, Kim MJ, Cha HH, Seong WJ. Vaginal adhesions in a woman with the history of dystocia. Obstet Gynecol Sci. 2014;57(1):70–2. https://doi.org/10.5468/ogs.2014.57.1.70 Epub 2014 Jan 16. Erratum in: Obstet Gynecol Sci. 2014 Mar;57(2):180. Cha, Hyun Wha [corrected to Cha, Hyun-Hwa]. PMID: 24596821; PMCID: PMC3924740.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Morris L, Do V, Chard J, Brand AH. Radiation-induced vaginal stenosis: current perspectives. Int J Womens Health. 2017;9:273–9. https://doi.org/10.2147/IJWH.S106796 PMID: 28496367; PMCID: PMC5422455.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dietrich JE, Millar DM, Quint EH. Non-obstructive müllerian anomalies. J Pediatr Adolesc Gynecol. 2014;27(6):386–95. https://doi.org/10.1016/j.jpag.2014.07.001 Epub 2014 Jul 17.

    Article  PubMed  Google Scholar 

  9. Skinner B, Quint EH. Nonobstructive reproductive tract anomalies: a review of surgical management. J Minim Invasive Gynecol. 2017;24(6):909–14. https://doi.org/10.1016/j.jmig.2017.05.002 Epub 2017 May 9.

    Article  PubMed  Google Scholar 

  10. Kroese JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren P, et al. Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial. BJOG. 2017;124(2):243–9. https://doi.org/10.1111/1471-0528.14281 Epub 2016 Sep 19.

    Article  CAS  PubMed  Google Scholar 

  11. World Health Organization: Female Genital Mutilation. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation (2020). Accessed 10 Oct 2020.

  12. Lurie JM, Weidman A, Huynh S, Delgado D, Easthausen I, Kaur G. Painful gynecologic and obstetric complications of female genital mutilation/cutting: a systematic review and meta-analysis. PLoS Med. 2020;17(3):e1003088.

    Article  Google Scholar 

  13. Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S. Reasons for and experiences with surgical interventions for female genital mutilation/cutting (FGM/C): a systematic review. J Sex Med. 2017;14(8):977–90. https://doi.org/10.1016/j.jsxm.2017.05.016 Epub 2017 Jun 27.

    Article  PubMed  Google Scholar 

  14. Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S. The effectiveness of surgical interventions for women with FGM/C: a systematic review. BJOG. 2018;125(3):278–87. https://doi.org/10.1111/1471-0528.14839 Epub 2017 Aug 28.

    Article  CAS  PubMed  Google Scholar 

  15. Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital region. Dermatol Ther. 2004;17:8–19.

    Article  Google Scholar 

  16. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Diagnosis and management of vulvar skin disorders: ACOG Practice Bulletin, Number 224. Obstet Gynecol. 2020;136(1):e1–e14. https://doi.org/10.1097/AOG.0000000000003944.

    Article  Google Scholar 

  17. Flynn AN, King M, Rieff M, Krapf J, Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med. 2015;3(4):251–5. https://doi.org/10.1002/sm2.90.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kennedy C, Dewdney S, Galask RP. MS vulvar granuloma fissuratum: a description of fissuring of the posterior Fourchette and the repair. Obstet Gynecol. 2005;105(5):1018–23. https://doi.org/10.1097/01.AOG.0000158863.70819.53.

    Article  PubMed  Google Scholar 

  19. Wesselmann U, Bonham A, Foster D. Vulvodynia: Current state of the biological science. Pain. 2014;155(9):1696–701.

    Article  Google Scholar 

  20. Edwards L. New concepts in vulvodynia. Am J Obstet Gynecol. 2003;189:S24–30.

    Article  Google Scholar 

  21. Crandall C, Hovey K, Andrews C, et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause. 2018.

  22. Lyytinen H, Pukkala E, Ylikorkala O. Breast cancer risk in postmenopausal women using estrogen-only therapy. Obstet Gynecol. 2006.

  23. Barbieri RL. Differential diagnosis of sexual pain in women. In: UpToDate, Sharp HT and Eckler K (Ed), UpToDate, Waltham, MA. (Accessed on October 27, 2020.)

  24. Binik YM. The DSM diagnostic criteria for vaginismus. Arch Sex Behav. 2010;39(2):278.

    Article  Google Scholar 

  25. Reissing ED, Binik YM, KhaliféS CD, Amsel R. Etiological correlates of vaginismus: sexual and physical abuse, sexual knowledge, sexual self-schema, and relationship adjustment. J Sex Marital Ther. 2003;29(1):47–59.

    Article  Google Scholar 

  26. Melnik T, Hawton K, McGuire H. Interventions for vaginismus. The Cochrane database of systematic reviews. 2012;12(12):CD001760. https://doi.org/10.1002/14651858.CD001760.pub2.

    Article  PubMed  Google Scholar 

  27. Ghazizadeh S, Nikzad M. Botulinum Toxin in the treatment of refractory vaginismus. Obstet Gynecol. 2004;104(5):922–5.

    Article  CAS  Google Scholar 

  28. Hanno P, Burks D, Clemens JQ, Dmochowki R, Erickson D, MP FG, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185:2162–70.

    Article  Google Scholar 

  29. Wiesenfeld HC, Sweet RL, Ness RB, et al. Comparison of acute and subclinical pelvic inflammatory disease. Sex Transm Dis. 2005;32:400–5.

    Article  Google Scholar 

  30. Ness RB, Kip KE, Hillier SL, et al. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. 2005;162:585–90.

    Article  Google Scholar 

  31. Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med. 2012;30:1114–7.

    Article  Google Scholar 

  32. Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. “Pelvic Inflammatory Disease (PID).” CDC. Late reviewed: June 4, 2015. https://www.cdc.gov/std/tg2015/pid.htm

  33. Fauconnier A, Dubuisson JB, Foulot H, Deyrolles C, Sarrot F, Laveyssière MN, et al. Mobile uterine retroversion is associated with dyspareunia and dysmenorrhea in an unselected population of women. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):252–6. https://doi.org/10.1016/j.ejogrb.2005.11.026 Epub 2006 Feb 21.

    Article  PubMed  Google Scholar 

  34. Ferrero S, Ragni N, Remorgida V. Deep dyspareunia: causes, treatments, and results. Curr Opin Obstet Gynecol. 2008;20(4):394–9. https://doi.org/10.1097/GCO.0b013e328305b9ca.

    Article  PubMed  Google Scholar 

  35. Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2007;22(4):1142–8. https://doi.org/10.1093/humrep/del465 Epub 2006 Dec 20.

    Article  CAS  PubMed  Google Scholar 

  36. Lukic A, Di Properzio M, De Carlo S, Nobili F, Schimberni M, Bianchi P, et al. Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment. Arch Gynecol Obstet. 2016;293(3):583–90. https://doi.org/10.1007/s00404-015-3832-9 Epub 2015 Aug 6.

    Article  CAS  PubMed  Google Scholar 

  37. Fritzer N, Tammaa A, Salzer H, Hudelist G. Dyspareunia and quality of sex life after surgical excision of endometriosis: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2014;173:1–6. https://doi.org/10.1016/j.ejogrb.2013.10.032 Epub 2013 Nov 8.

    Article  CAS  PubMed  Google Scholar 

  38. Fritzer N, Hudelist G. Love is a pain? Quality of sex life after surgical resection of endometriosis: a review. Eur J Obstet Gynecol Reprod Biol. 2017;209:72–6. https://doi.org/10.1016/j.ejogrb.2016.04.036 Epub 2016 Apr 30.

    Article  CAS  PubMed  Google Scholar 

  39. Struble J, Reid S, Bedaiwy MA. Adenomyosis: A clinical review of a challenging gynecologic condition. J Minim Invasive Gynecol. 2016;23(2):164–85. https://doi.org/10.1016/j.jmig.2015.09.018 Epub 2015 Sep 30.

    Article  PubMed  Google Scholar 

  40. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014;89(5):341–6.

    PubMed  Google Scholar 

  41. Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85(6):552–9. https://doi.org/10.4065/mcp.2009.0586 PMID: 20511485; PMCID: PMC2878259.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Khan TA, Rudolph KP, Huber TS, Fatima J. May-Thurner syndrome presenting as pelvic congestion syndrome and vulvar varicosities in a nonpregnant adolescent. J Vasc Surg Cases Innov Tech. 2019;5(3):252–4. https://doi.org/10.1016/j.jvscit.2019.02.008.

    Article  PubMed  PubMed Central  Google Scholar 

  43. O’Brien MT, Gillespie DL. Diagnosis and treatment of the pelvic congestion syndrome. J Vasc Surg Venous Lymphat Disord. 2015;3(1):96–106. https://doi.org/10.1016/j.jvsv.2014.05.007 Epub 2014 Jun 25.

    Article  PubMed  Google Scholar 

  44. van den Beukel BA, de Ree R, van Leuven S, Bakkum EA, Strik C, van Goor H, et al. Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: a systematic review and meta-analysis. Hum Reprod Update. 2017;23(3):276–88. https://doi.org/10.1093/humupd/dmx004.

    Article  PubMed  Google Scholar 

  45. Steege JF, Stout AL. Resolution of chronic pelvic pain after laparoscopic lysis of adhesions. Am J Obstet Gynecol. 1991;165(2):278–81; discussion 281–3. https://doi.org/10.1016/0002-9378(91)90079-7.

    Article  CAS  PubMed  Google Scholar 

  46. Miles T, Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev. 2014;2014(9):CD007291.

    PubMed Central  Google Scholar 

  47. Fraunholz IB, Schopohl B, Böttcher HD. Management of radiation injuries of vulva and vagina. Strahlenther Onkol. 1998;174(Suppl 3):90–2.

    PubMed  Google Scholar 

  48. Hofsjö A, Bohm-Starke N, Bergmark K, Masironi B, Sahlin L. Sex steroid hormone receptor expression in the vaginal wall in cervical cancer survivors after radiotherapy. Acta Oncol. 2019;58(8):1107–15.

    Article  Google Scholar 

  49. Hammett J, Peters A, Trowbridge E, Hullfish K. Short-term surgical outcomes and characteristics of patients with mesh complications from pelvic organ prolapse and stress urinary incontinence surgery. Int Urogynecol J. 2014;25(4):465–70. https://doi.org/10.1007/s00192-013-2227-3 Epub 2013 Oct 2.

    Article  PubMed  Google Scholar 

  50. Lindberg LD, Maddow-Zimet I, Boonstra H. Changes in adolescents’ receipt of sex education, 2006–2013. J Adolescent Health. 2016;58(6):621–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Emory University, Atlanta, GA, USA

    Jessica Hammett

  2. Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA

    Brooke Hyman & Mark Lachiewicz

Authors
  1. Jessica Hammett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brooke Hyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark Lachiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica Hammett.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Disclaimer

This article does mention use of off-label medications and commercially available products to treat dyspareunia in women. The authors have no relationships with these companies, financial or otherwise.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the topical collection on Female Sexual Dysfunction and Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hammett, J., Hyman, B. & Lachiewicz, M. When Love Hurts: Evaluation and Management of Painful Intercourse in Women. Curr Sex Health Rep 13, 14–22 (2021). https://doi.org/10.1007/s11930-020-00300-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-020-00300-5

Keywords

Search

Navigation