Women

The cause is believed to be related to physical factors at least 75%-80% of the time.

Some pain occurs during vaginal entry but decreases over time. This is often caused by not having enough lubrication due to a lack of sexual arousal and stimulation. It can also be due to some medicines. Antihistamines can cause dryness. Frequent douching can also cause problems.

Other causes in women include:

• Postpartum period after childbirth
• Vaginal infections, such as yeast vaginitis
• Postmenopausal atrophic vaginitis—irritation of the vaginal mucosa due to lack of estrogen
• Endometriosis
• Herpes or genital warts
• Pelvic inflammatory disease —serious infection of the female reproductive organs
• Urinary tract infection
• Problems affecting the pelvic bones
• Abnormal orientation of the uterus called retroversion
• Chronic constipation

The cause of dyspareunia may also be related to psychological factors, although this is less common. Some examples include:

• Previous sexual trauma, such as rape or abuse
• Feelings of guilt
• Negative attitudes toward sex

These factors may lead to a condition called vaginismus. This is painful and involuntary contractions of vaginal muscles. It is usually a response to past sexual trauma or other painful circumstances, but it can also be the result of chronic irritation from a physical cause.

Men

The most common causes of pain in men are:

• Prostatitis —inflammation of the prostate
• Urethritis —inflammation of the urethra

Pain occurs at the time of ejaculation.

Pain that occurs while obtaining an erection may be associated with:

• Inflammation of the foreskin
• Loss of elasticity of the foreskin
• Trauma to the penis
• Herpes or genital warts
• Local allergies or irritations
• Curvature of the penis caused by Peyronie's disease

Women

• Your doctor may recommend that you use water-soluble lubricants or creams that contain estrogen. Other medicines may be prescribed, as well.
• Infections may be treated with antibiotics or antifungal medicine.
• Inflammation and dermatitis may be treated with topical or injectable corticosteroids.
• Viral infections like herpes and genital warts will need to be treated.
• Endometriosis may be treated with medicines. In some cases, surgery may be necessary.

Men

To treat prostatitis and urethritis, the doctor may recommend:

• Antibiotic treatment
• Sitz baths—soaking the hip and buttocks area in warm water
• Avoiding alcohol and caffeine, which may be helpful for prostatitis

Sometimes, surgery may be done to treat foreskin and other erectile problems.

Men and Women

When no physical cause of the pain can be found, sex therapy may be helpful. Some concerns need to be worked through in counseling. These may include:

• Guilt
• Inner conflict
• Unresolved feelings about past abuse
• Need for self-punishment