DYSPAREUNIA (PAINFUL COITUS): Recurrent or persistent genital pain associated with sexual intercourse in either male or a female.

In females, the pain may be superficial during penetration or deep during penile thrusting. The intensity of pain may range from mild discomfort to sharp pain. On examination, no genital abnormalities are seen. Repeated genital pain during coitus may result in the avoidance of sexual activity, disrupting existing sexual relationships.
In Females, Dyspareunia can be of psychogenic or organic in origin-
  • Pain in vaginal outlet and clitoris: If the hymen is intact, this is a source of irritation. Episiotomy scar can cause pain. Smegma accumulated under the foreskin of clitoris irritates the area and causes intense burning.
  • Pain in the vagina: One of the common causes is failure to lubricate. This happens when the women has no affection, respect or understanding for her husband. Because of various fears like fear of pregnancy or of coitus, her natural responses will be inhibited. Many woman do not lubricate because of aging. Thin walls of vagina crack and bleed easily during the intercourse, causing discomfort that lasts for hours to days. Homosexual women will not lubricate in heterosexual activity. Infections of vaginal or urinary tract will give rise to burning, itching or pain in the vagina. When there is itching and burning but no infection, sensitivity to the rubber of condom is a possibility.
  • Pain deep in pelvis: Laceration or tears in the ligaments which support the uterus, caused by gang rape or criminal abortion may result into pain deep in pelvis. It is associated with backache, throbbing in pelvis, tired feeling and painful menstruation . 
  • Endometriosis, infection in cervix, uterus, and tubes cause pain during thrusting . Infection can be due to gonorrhea or of E.coil.Hysterectomy, tumors and ovarian cysts can cause pain deep in the pelvis.
  • Some men do not retract the prepuce during masturbation. Their glans of penis remains hypersensitive to touch. They find pain during coitus. 
  • In men with poor hygiene, the smegma accumulates on the glans, causing pain during coitus.
  • Phimosis can cause pain during coitus. 
  • Allergy to condom rubber, jellies, foams and douching materials can give hypersensitivity reaction to the males. 
  • Infection of vaginal canal causes burning and itching. 
  • Fibrosis of penile tissue following a trauma causes pain during masturbation and intercourse.

Reassurance, countering myths and misconceptions and supportive psychotherapy will be helpful in dyspareunia of psychogenic origin. 

  • Insufficient foreplay may lead to failure of lubrication in females. Thick hymen will need excision.
  • Accumulation of smegma needs cleaning daily. 
  • Senile vaginitis requires hormonal replacement. 
  • Homosexual women are not amenable to any treatment.