Painful Intercourse: Causes, Symptoms and Treatments for Dyspareunia

Dyspareunia is a medical condition that causes pain or discomfort during sexual intercourse. It can be distressing for both the person with dyspareunia and for their intimate partners. 

In this guide, we explore what dyspareunia is, how many people experience it, its causes, symptoms, prevention strategies, available treatments and when to seek medical advice.

What is Dyspareunia?

Dyspareunia is a medical term used to describe persistent or recurrent pain experienced during sexual intercourse. This pain can occur at various points during intercourse, such as during penetration, thrusting or deep penetration. The pain can be sharp, burning or aching and it can affect both the genital and pelvic areas.

How Many People Experience Dyspareunia?

Whilst it is a condition which is often not discussed, dyspareunia affects a significant number of individuals. According to a study published in the Journal of Sexual Medicine, up to 8-21% of individuals experience dyspareunia at some point in their lives.

Causes of Dyspareunia

Dyspareunia can have various underlying causes and it's important to identify the specific cause to determine the most appropriate treatment. Some common causes include:

1. Physical Causes:
   • Infections: Certain infections, such as yeast infections or urinary tract infections, can lead to painful intercourse.
   • Vaginal Dryness: Insufficient vaginal lubrication can result in friction and discomfort during sex. This can be due to hormonal changes, medications, or inadequate arousal.
   • Vaginismus: This is a condition characterised by involuntary muscle spasms in the pelvic floor muscles, making penetration painful or impossible.
   • Pelvic Organ Prolapse: When pelvic organs like the uterus, bladder, or rectum shift from their normal position, it can cause discomfort during intercourse.
   • Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside the uterus, leading to pain during intercourse.
2. Psychological Causes:
   • Anxiety and Stress: Mental health issues, such as anxiety or stress, can result in muscle tension and discomfort during sex.
   • Relationship Problems: Dysfunctional or strained relationships can contribute to pain during intercourse.
   • History of Trauma: Past experiences of sexual or physical trauma can lead to painful sex.
3. Medical Conditions:
   • Certain medical conditions like interstitial cystitis, irritable bowel syndrome, and fibromyalgia can be associated with dyspareunia.
   • Surgical Scarring: Scar tissue from previous surgeries, such as a C-section or episiotomy, can cause pain during intercourse.

Symptoms of Dyspareunia

The primary symptom of dyspareunia is pain or discomfort during sexual activity. However, the nature and location of the pain can vary. Common symptoms include:

• Aching or burning sensation during penetration
• Sharp pain with deep thrusting
• General pelvic pain or discomfort during or after sex
• Muscle spasms in the pelvic area
• Pain that persists after intercourse

Prevention Strategies

While not all cases of dyspareunia can be prevented, there are steps you can take to reduce your risk:

1. Communication: Open and honest communication with your partner about your desires, boundaries, and any discomfort is crucial. Ensure that both partners are comfortable with the pace and intensity of sexual activity.
2. Lubrication: Adequate vaginal lubrication is essential for comfortable intercourse. If you experience vaginal dryness, consider using a water-based lubricant to reduce friction.
3. Pelvic Floor Exercises: Regular pelvic floor exercises, also known as Kegel exercises, can help maintain pelvic muscle tone and may reduce the risk of certain types of dyspareunia.
4. Seek Treatment for Infections: Promptly treat any infections, such as yeast infections or urinary tract infections, to prevent them from causing pain during sex.
5. Address Psychological Factors: If anxiety, stress, or relationship issues contribute to your dyspareunia, consider seeking therapy or counseling to address these underlying causes.

Treatments for Dyspareunia

The treatment for dyspareunia depends on its underlying cause. Here are some common approaches to managing and treating dyspareunia:

1. Medical Treatments:
   • In cases of infections, antibiotics or antifungal medications may be prescribed.
   • For hormonal imbalances, hormone therapy or topical estrogen creams can help improve vaginal lubrication.
   • Pelvic floor physical therapy may be recommended to address muscle spasms or tension.
   • In severe cases of pelvic organ prolapse or endometriosis, surgery may be necessary.
2. Psychological Therapy:
   • Cognitive behavioural therapy (CBT) can help individuals manage anxiety, stress, and negative thought patterns that contribute to pain during sex.
   • Couples therapy may be beneficial in addressing relationship issues that impact sexual intimacy.
3. Vaginal Dilators: For conditions like vaginismus, healthcare providers may recommend using vaginal dilators to gradually stretch and relax the pelvic floor muscles.
4. Pain Management: Over-the-counter pain relievers, such as ibuprofen, can provide temporary relief from discomfort during intercourse.
5. Alternative Therapies: Some individuals find relief through alternative therapies such as acupuncture or mindfulness techniques.

When to Seek Medical Advice

If you or your partner experience persistent pain or discomfort during sexual intercourse, it's essential to seek medical advice.

Here are some situations in which you should consult a healthcare professional:

• If the pain is severe or worsening over time.
• If you have a history of trauma or sexual abuse that may contribute to the pain.
• If you experience other symptoms alongside dyspareunia, such as abnormal bleeding, discharge, or urinary symptoms.
• If your symptoms are interfering with your overall quality of life and well-being.
• If you suspect a medical condition, such as endometriosis or pelvic organ prolapse, may be causing the pain.

Dyspareunia is a challenging condition that can have a significant impact on physical and emotional well-being. Remember that this condition is treatable, and there are various approaches to managing and overcoming the pain associated with sexual intercourse. Early recognition, open communication with your healthcare provider, and a willingness to explore treatment options are essential steps towards improving your sexual health and overall quality of life.

If you or your partner are experiencing dyspareunia, don't hesitate to seek help, as there are effective treatments available to address the underlying causes and provide relief. Remember, you're not alone in facing this issue, and there is support available to help you on your journey towards pain-free intimacy. 

References:

1. Reissing, E. D., Binik, Y. M., Khalifé, S., & Cohen, D. (2003). Amsel, R., Emotional Sexual Unavailability Scale, and the Sexual Complaints.
2. Graziottin, A., & Serafini, A. (2009). Dyspareunia: Painful sex in women. Women's Health, 5(3), 287-299.
3. Goldstein, A. T., Pukall, C. F., Brown, C., Bergeron, S., Stein, A., & Kellogg‐Spadt, S. (2016). Vulvodynia: Assessment and Treatment. Journal of Sexual Medicine, 13(4), 572-590.