Physical causes of dyspareunia are attributed to entry pain or deep pelvic thrusting. Emotional factors can be and are usually associated with many types of painful intercourse.

Pain associated with entry can be associated with factors such as:

Insufficient lubrication Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding. Certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.

Injury, trauma or irritation This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).

Inflammation, infection or skin disorder An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.

Vaginismus Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.

Congenital abnormality A problem present at birth, such as the absence of a fully-formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could be the underlying cause of dyspareunia.

Pain associated with deep penetration can be caused by:

Certain illnesses and conditions The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.

Surgeries or medical treatments Scarring from pelvic surgery, including hysterectomy, can sometimes cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

Emotional factors:

Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain. Emotional factors include:

Psychological problems Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.

Stress Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.

History of sexual abuse Most women with dyspareunia don't have a history of sexual abuse, but if you have been abused, it may play a role.

Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. As with any pain in your body, you might start avoiding the activities that you associate with the pain.