Fast Five Quiz: Painful Sexual Intercourse

Bradley Schwartz, DO; Michel E. Rivlin, MD


May 21, 2021

Patients with deep, internal, or thrust dyspareunia often express a feeling that some sort of internal collision is occurring during sexual activity. Any pelvic pathology may be responsible for this discomfort, but abnormalities such as endometriosis, pelvic adhesions, retroverted uterus, adnexal pathology or prolapse, and uterine fibroids are the most likely causes. Dyspareunia associated with interstitial cystitis is commonly deep before it proceeds to chronic unremitting pain.

Causes of entry dyspareunia include dermatologic diseases (eg, lichen planus, lichen sclerosus, psoriasis), vaginismus, and vulvodynia. Inadequate lubrication, perivaginal infections (eg, urethritis, vaginitis), and vaginal atrophy are associated with both entry and deep dyspareunia.

Read more about interstitial cystitis.