Dyspareunia — the medical term for painful intercourse — affects up to 75% of women at some point in their lives, yet remains one of the most underreported symptoms in gynaecological practice. Women endure it silently, assuming it is normal, inevitable, or too embarrassing to discuss. It is none of these things.
Pain during intercourse is a symptom — and every symptom has a cause. Identifying WHICH of the 7 causes below is responsible for your dyspareunia is the difference between years of suffering and targeted treatment that actually works.
Superficial vs Deep Dyspareunia
Pain location guides diagnosis. Superficial dyspareunia — pain at or near the vaginal opening — points toward causes at or near the surface: infections, skin conditions, dryness, vaginismus, or vulvodynia. Deep dyspareunia — pain felt deep inside the pelvis during intercourse — points toward internal causes: endometriosis, fibroids, ovarian cysts, or pelvic nerve involvement.
Many women have both. Understanding which type you have helps your gynecologist target the investigation appropriately.
7 Causes of Dyspareunia
Cause 1: Endometriosis
Deep dyspareunia is the hallmark symptom of endometriosis — particularly when endometriotic tissue is located behind the uterus (pouch of Douglas) or on the uterosacral ligaments. Pressure during intercourse directly compresses these inflamed implants, causing severe deep pain. The pain is often worse during or just before menstruation.
If your dyspareunia is deep, worsens during periods, and is accompanied by severe cramps, an endometriosis specialist should evaluate you. Standard ultrasound may miss endometriosis — a thorough clinical examination and potentially diagnostic laparoscopy is needed.
Cause 2: Vaginismus
Involuntary pelvic floor muscle spasm that makes penetration painful or impossible. The muscles tighten reflexively before or during penetration — causing superficial pain at the vaginal entrance. Often described as “hitting a wall.” Vaginismus treatment involves pelvic floor physiotherapy, graduated desensitisation, and addressing any underlying nerve contributors.
Cause 3: Vaginal Dryness (Atrophy)
Declining estrogen — from menopause, breastfeeding, birth control pills, or chemotherapy — thins the vaginal walls and dramatically reduces lubrication. The friction of intercourse on thin, dry tissue causes burning, rawness, and tearing. Topical estrogen therapy prescribed by a gynecologist is highly effective. Also consider lubricants and vaginal moisturizers as immediate relief.
Cause 4: Pudendal Neuralgia
Compression or irritation of the pudendal nerve creates burning, stinging superficial pain that is often worst with penetration and persists for hours afterward. Unlike other causes of dyspareunia, pudendal neuralgia-related pain often worsens with sitting and may include numbness or electric sensations in the genital area.
This is the cause most frequently missed. A neuropelveology specialist can diagnose pudendal neuralgia through specific clinical examination that standard gynaecological assessment does not include. Dr. Juhi Dhanawat’s Masters in Neuropelveology from Switzerland makes her uniquely equipped to identify and treat this cause.
Cause 5: Vaginal Infections
Yeast infections, bacterial vaginosis, and sexually transmitted infections cause inflammation, swelling, and pain that makes intercourse extremely uncomfortable. Burning, itching, unusual discharge alongside pain point toward infection. A simple swab test identifies the organism and guides antibiotic or antifungal treatment. Recurrent infections may signal an underlying issue — hormonal, immune, or hygiene-related — that needs investigation.
Cause 6: Ovarian Cysts or Fibroids
Large ovarian cysts can cause deep pain during intercourse when the cyst is compressed during certain positions. Similarly, large fibroids — particularly subserosal fibroids near the outer surface of the uterus — can cause pressure and pain with deep penetration. Laparoscopic surgery to remove cysts or fibroids resolves the dyspareunia.
Cause 7: Post-Surgical Scarring
Episiotomy scars, laparoscopy port site adhesions, or scarring from previous pelvic surgery can create areas of restricted, tender tissue. The scar tissue lacks the elasticity of normal tissue — pulling and tearing with movement causes pain. Minor surgical scar revision or physiotherapy can address this. In complex cases involving nerve entrapment within scar tissue, neuropelveological assessment identifies whether the nerve itself is involved.
The Diagnostic Approach
At Dr. Juhi Dhanawat’s practice, dyspareunia evaluation begins with a detailed history — the character of pain (superficial vs deep, burning vs aching vs sharp), timing (during, after, or both), relationship to menstrual cycle, and associated symptoms. This history alone often points strongly toward one or two causes.
Physical examination includes assessment of the vulva and vaginal entrance, evaluation of the pelvic floor muscle tone and any trigger points, a speculum examination, and a bimanual examination assessing the uterus, ovaries, and pelvic ligaments. When endometriosis or nerve involvement is suspected, specific examination protocols are applied.
Investigations follow as needed — transvaginal ultrasound, hormonal blood tests, swab tests, and in selected cases, MRI or diagnostic laparoscopy.
What makes Dr. Juhi’s approach different is the addition of a neuropelveological examination when nerve involvement is suspected — systematically testing sensation across pelvic dermatomes and nerve pathways that standard gynaecological examination does not assess. This catches pudendal neuralgia and other nerve-related causes that would otherwise be missed entirely.
Consultations are completely confidential at Neotia Bhagirathi, Rawdon Street and New Town, and Motherhood Hospital, Kasba, Kolkata. Both individual and couple consultations are available — because dyspareunia affects both partners.
Frequently Asked Questions
Q: Is painful intercourse a sign of something serious?
A: It depends on the cause. Most causes of dyspareunia are treatable and not dangerous. However, some causes — particularly endometriosis — can worsen over time if untreated and eventually affect fertility. Pain during intercourse should always be investigated rather than endured.
Q: Can dyspareunia resolve on its own?
A: Occasionally, if the cause is a temporary infection or mild dryness, it may resolve spontaneously. However, most causes — endometriosis, vaginismus, pudendal neuralgia, scar tissue — do not resolve on their own and require targeted treatment.
Q: Should I tell my partner about the pain?
A: Yes — open communication with your partner is important. Concealing the pain leads to anticipatory anxiety that makes the condition worse. Your partner’s understanding and cooperation is an important part of treatment.
Q: Can dyspareunia cause relationship problems?
A: Yes, and significantly. Sexual pain affects intimacy, emotional connection, and relationship satisfaction. Treating the physical cause removes the barrier — and often restores the relationship naturally. In some cases, couple consultation addressing the relationship dimension is helpful alongside medical treatment.
Q: Which doctor should I see for painful intercourse in Kolkata?
A: A gynecologist with expertise in pelvic floor conditions, endometriosis, and ideally neuropelveology — covering all possible physical causes. Dr. Juhi Dhanawat at Neotia Bhagirathi and Motherhood Hospital, Kolkata provides this comprehensive evaluation.
Dr. Juhi Dhanawat — Gynaecologist, Endometriosis Specialist & Neuropelveology Expert. Consults at Neotia Bhagirathi, Rawdon Street and New Town, and Motherhood Hospital, Kasba, Kolkata.
Book: Call +91 8240886334 or visit drjuhidhanawat.in/book-anappointment/