Painful sex is distressing and can result in the loss of sexual interest, relationship problems, and affect your mood. Dyspareunia is the term used to describe pain before, during or after vaginal intercourse. There are many causes of dyspareunia including physical ones like not enough lubrication, a skin infection, illness or surgery. Psychological causes like partner issues, stress and anxiety can contribute also and make it even worse. Getting a diagnosis of what is causing the pain can help you to know what treatment might be best for you.
What is dyspareunia?
Types of dyspareunia
What causes dyspareunia?
How is dyspareunia diagnosed?
Impact on libido
Management & treatment
How can you prevent dyspareunia occurring?
Expand your horizons
Seeking help
Dyspareunia is the term used to describe pain before, during or after vaginal intercourse.
Pain with intercourse affects:
If dyspareunia is not managed, it may result in a loss of sexual interest, mood changes and other psychological symptoms.
There are two main types of dyspareunia, which are classified according to where the pain is.
This is pain on attempted penetration, which may be the result of:
This is pain at the top of the vagina often experienced with thrusting. Pain can include burning, tearing or aching sensations. This pain may be the result of a pelvic disease, such as endometriosis, ovarian cysts or pelvic inflammatory disease from sexually transmissible infections such as chlamydia or gonorrhoea.
There are many physical and psychological causes of dyspareunia.
Pain felt at the vaginal entry may be caused by:
When a woman is sufficiently aroused ('turned on'), her vagina and glands around the vaginal entrance secrete fluids that reduce friction and allow penetration without pain. If you are not sufficiently aroused before attempting penetration, you may feel dry and experience a stinging, burning, tearing or throbbing sensation.
There are a number of options available including:
Talk to your doctor to find the best option for you.
The skin of the vulva (external parts of the female genitals) is extremely delicate, making it vulnerable to a wide range of conditions.
Sometimes part of the vulva, or sometimes the entire vulva, has some of the following:
Infections of the genital area or urinary tract can cause painful intercourse.
Skin problems including:
There are a number of options available to help you including:
It can also be helpful to see a psychologist or sex therapist to help you get over the fear of experiencing pain.
Talk to your doctor to find the best option for you.
Learn more about vulval irritation by downloading our booklet The vulva: irritation, diagnosis & treatment (PDF) or visiting the Vulva & vaginal irritation webpages.
Penetration may be painful for some women because the muscles in the vagina spasm. This creates a feeling of painful tightness that makes penetration painful, difficult and at times impossible.
These emotions may be caused by:
The underlying physical cause needs to be treated by a doctor or specialist.
Possible further action might include:
Deep pain can be caused by:
A number of illnesses or conditions can lead to painful sex.
The underlying physical cause needs to be treated by a doctor or specialist.
Possible further action might include:
Scars from surgery in the pelvic area can cause painful sex.
Your doctor may ask questions such as:
Your sexual history, surgical history and childbirth experiences may also be relevant.
This is a physical examination where your doctor will check for signs of infection, irritation or anatomical problems. This may involve gently touching the genital and pelvic area to locate the site of the pain and inserting a speculum (a plastic instrument that allows the doctor to see) into the vagina.
You may need further tests such as a pelvic ultrasound or laparoscopy if the cause is a condition inside the pelvis. A laparoscopy is a surgical procedure where a small incision is made in the umbilicus (navel) and a thin viewing instrument (laparoscope) is inserted to view the pelvic organs.
If you anticipate pain during sex, you will be anxious. Your potential to be become aroused will be reduced, you will have less lubrication, and this in turn can make sex even more painful. This all interferes with your desire to have sex.
In the video below, Jean Hailes physiotherapist Janetta Webb, talks about pelvic floor physiotherapy for the management and treatment of dyspareunia. Janetta explains what you can expect from an initial consultation with a pelvic floor physiotherapist, to make you more comfortable and better prepared.
The right treatment for dyspareunia depends on the cause of the pain.
Physical treatment. If dyspareunia has a physical cause, treating the underlying medical conditions may alleviate the pain.
Psychological treatment. Treatment options for dyspareunia caused by psychological factors will often include some sort of individual, couples or sexual counselling. If you are in a relationship, encourage your partner to be involved in your treatment, particularly the counselling sessions.
Change in techniques. For some women, the solution may be a change in sexual techniques. Trying different sexual positions, engaging in longer or different types of foreplay and using a personal lubricant may help reduce pain.
Pelvic floor physiotherapy can often help by using techniques such as trigger point therapy (identifying pain that is related to a discrete point) and gentle soft-tissue massage in the pelvic area and in the vagina. Physiotherapists can teach specific relaxation techniques and pelvic floor awareness exercises to help reduce over-activity of muscles and therefore decrease pain.
Vaginal dilators (these used to be called 'vaginal trainers') are sometimes recommended. They are available in graduated sizes (from small to larger) and are used to help women relax their pelvic muscles to allow pain-free sexual penetration
General fitness is important but too much training of abdominal muscles is also emerging as an issue for women, causing over-activity of pelvic floor muscles.
Enhance arousal
To prevent painful sex depends on the potential cause. There are things you can do to help prevent some causes of painful sex including:
Be aware that you may need to do things a little differently as you age. You may need more time or different techniques to become aroused or reach orgasm, so you will need to engage your partner in the process.
Treatment programs rarely deliver instant results, so it may take some time for you to notice any changes. Meanwhile, focus on fulfilling your needs (and those of your partner, if you have one) in other ways. You can show your affection and be intimate without intercourse. Kissing, cuddling, massage, mutual masturbation and oral sex are all good alternatives and can expand your views on what makes a fulfilling sex life.
If you are experiencing painful sex it is important to seek help from your doctor and receive appropriate treatment and/or management at the earliest time. Your doctor may refer you on to a psychologist or sex therapist. Seeking help early can also reduce the risk of further impact on your relationship.