Hypertonic pelvic floor, excessive and often involuntary tension in the pelvic floor muscles, can lead to pain at penetration, burning sensations, and muscle spasms, and is a common contributor to all types of dyspareunia.
Hormonal fluctuations at different life stages or due to medications may decrease estrogen levels, leading to vaginal dryness, thinning vaginal tissue, and sometimes vaginal atrophy. These changes, in turn, often cause burning sensations, irritation, and painful intercourse.
Common life stages at which estrogen levels drop include postpartum, breastfeeding, and menopause (natural or surgically induced). Low-estrogen contraceptives can also have these effects and, in some women, lead to vestibulodynia as well. During pregnancy, increased blood flow to the pelvic region may increase sensitivity in some women, although this is not typically painful unless other factors are present.
Vaginal dryness: In addition to hormonal changes, certain medications (e.g., antidepressants, antihistamines, contraceptive pills, and some medications for acne or high blood pressure), or even just a lack of foreplay, can lead to vaginal dryness and resulting discomfort.
Injury, trauma (e.g., from surgery or perineal trauma from childbirth), inflammation or infection (e.g., yeast infection, bacterial vaginosis or herpes), anatomical abnormalities (e.g., imperforate hymen), or neuroproliferation (an unusually high density of nerve endings, which can heighten sensitivity) may also lead to vaginal pain.
Underlying pelvic conditions—such as endometriosis, pelvic inflammatory disease, uterine abnormalities, fibroids, hemorrhoids, bladder prolapse, uterine prolapse, or ovarian cyst—can cause pain felt deep inside the vagina, known as deep dyspareunia.
Common irritants that may contribute to pain include latex, spermicides, toiletries with fragrance, and some lubricants.
Skin conditions of the vulva, including atrophy, eczema, lichen sclerosus, or lichen planus, can cause sexual pain.
