Pain with sexual intercourse

Pain that occurs in the vagina during intercourse will occur in one of three places:
  1. The opening of the vagina (introitus, vulva);
  2. Part of the way along the vaginal walls; or
  3. Deep inside of the vagina

Different things cause pain in each of these three areas.  At the opening of the vagina, the most common cause for pain is vaginal infection, either with yeast or bacteria.  These problems are not usually hard to diagnose and treat. 

In some women, the problems become chronic and recurring.  Successful treatment comes about by finding the right combination of measures that will minimize symptoms with the least amount of treatment.  Complete, lasting cure is much more difficult to achieve.  Most often, control of symptoms can be accomplished with a regimen of intermittent medications that prevent overgrowth of the offending germs.  When infection has been well treated and pain persists at the opening of the vagina, an examination should be performed to look for the typical findings of vulvar vestibulitis.

When pain is felt halfway in the vagina, usually this means that the pelvic floor muscles have become unusually tense therefore hurt when they are touched.  In this situation, some women also experience unusual discomfort when passing a bowel movement as well.

Another cause for pain in the mid-vagina can be urethral and bladder problems, either chronic infection, or inflammatory conditions like interstitial cystitis.  When bladder problems are responsible for the pain, one usually also has symptoms of voiding frequently, getting up at night to void, and intermittent pain with voiding.  Conditions that can cause pain deep inside the vagina include inflammation of the cervix, past trauma to the cervix, abnormalities of the uterus (fibroids, adenomyosis), and diseases of the tubes and ovaries (endometriosis, old infection, obstruction of the tubes with swelling, etc.)

In each of these problems, however, not everyone has pain, so the assessment of whether or not a known disease is the cause of the pain must be carefully evaluated on an individual basis.