Painful Sex (Dyspareunia)

Dyspareunia is essentially an umbrella term to describe difficult or painful sexual intercourse. Dyspareunia can be caused by several factors or conditions such as vaginismus (pelvic floor muscle spasm), vulvodynia (pain around the vulva), endometriosis (when tissue similar to the lining of the uterus grows outside of the uterus), thrush and inflammatory skin conditions. Pain may be present during intercourse as well as afterwards and could feel like burning, stabbing, sharp, or dull aching pain. 

How common is it?

It is likely that cases of dyspareunia are under-reported but currently the estimate is that 14% of vulva owners experience painful intercourse with the most common age group being 18–24 year-olds. 

What causes it?

Several factors could be responsible for someone having painful intercourse and these can be separated into two categories, superficial (entry) pain and deep pain. 

Possible causes for superficial Dyspareunia: 

• Vaginismus (pelvic floor muscle spasm)
• Vestbulodynia and Vulvodynia 
• Insufficient lubrication
• Skin conditions such as Lichens Sclerosus
• Scar tissue, e.g. perineal tears after childbirth
• Pudendal Neuralgia: irritation or compression to the pudendal nerve - which is the main nerve that supplies the vulva and anus. 
• Genitourinary syndrome of menopause (GSM): During and after menopause a decrease in oestrogen can lead to vulva irritation and vaginal dryness and thinning which can make intercourse painful for upwards of 50% of women
• Hormonal contraception: Some hormonal contraceptives can make the vaginal tissue more sensitive and reduce the amount of natural lubrication you may produce 
• Conditions such as thrush or herpes. 

Deep dyspareunia is normally (but not always) related to an identifiable condition or medical condition such as:

• Endometriosis
• Painful Bladder Syndrome
• Pelvic Inflammatory Disease
• Ovarian cysts
• Adenomyosis
• Uterine prolapse
• Uterine fibroids.

It could also be due to muscular causes like pelvic floor muscle over-activity or “trigger points”. 

How is dyspareunia treated? 

Dyspareunia is treated based on the underlying reason for the pain and discomfort. To determine why someone is experiencing pain, your doctor may do a variety of different tests such as vaginal swabs, ultrasounds, MRI/CT or even a surgical laparoscopy (telescope inside the belly) or cystoscopy (telescope inside the bladder) to look for any causes of pain. A referral to a pelvic floor physiotherapist may also be given to investigate muscular and nerve causes for your pain. 

Can Pelvic Floor Physiotherapy help?

A Pelvic floor physio has a huge role to play in treating dyspareunia, even if the reason for your pain is a medical condition like endometriosis or uterine fibroids. There is so much we can do such as: 

• Education about you pain, what will worsen it, how you can manage it and what your prognosis is.
• Dilator therapy: there is a huge role for dilators in treating dyspareunia whether that be to provide a physical stretch the pelvic floor or use graded exposure to show the nerve that penetration is not a threat. You can find more about dilators here. 
• Pelvic floor mobility and stretching: often your pelvic floor will be tight in conjunction with pain and therefore your hips, abdominals and lower back can become stiff too. We have a variety of pelvic pain mobility flows for you to complete. 

Remember pain with sex is never normal (unless you choose for it to be painful) and it is treatable. Please speak to a trusted medical professional if you are experiencing unwanted painful sex.