Dyspareunia: Symptoms and Signs To Look For, and What To Do About It
Dyspareunia, also known as painful sex, is pain in the vulva, vagina or pelvis that’s experienced during sexual intercourse. While dyspareunia can be experienced by all people, it’s more common in people with vulvas and it’s a common condition with a prevalence of approximately 10% to 20%.
Dyspareunia is a persistent physical pain experienced in the pelvic region but it also negatively affects people in a number of ways. People suffering from dyspareunia may experience reduced pleasure during intimate activities, reduced libido and strain on their relationships or a loss of intimacy with partners. As a result, dyspareunia or pain with sex can contribute to diminished quality of life, depression, and anxiety for those who experience it.
Fortunately, dyspareunia can be treated. In this guide, we’ll cover what dyspareunia is, its symptoms, causes, and treatment.
What is Dyspareunia?
Dyspareunia is pain that occurs during sexual intercourse, typically upon penetration. It can be experienced at initial penetration, with each thrust, or even for hours after the act of sexual intercourse or other sexual activities. Dyspareunia isn’t related to any one specific organ, rather it’s a pain that is experienced in the vulvar region — the opening of the vagina or labia. Many people also experience pain internally in the cervix, uterus, or lower abdomen.
The pain experienced from dyspareunia can be mild to severe and is generally localized. Dyspareunia can be an acquired pain, lifelong, or even a secondary pain that comes about from another medical condition.
Two Types of Dyspareunia
There are types of dyspareunia, each distinguishable by the type of pain experienced.
Intraorbital or superficial dyspareunia or entry pain: This type of dyspareunia is experienced at the entrance of the vagina and occurs during the initial penetration. This can often be affected by a lack of lubrication, hormonal changes, a previous injury, or an infection in the area.
Collision dyspareunia or deep pain: This type of dyspareunia is experienced during deep penetration while having sex and can feel more or less intense depending on the sexual position. Typically collision dyspareunia comes with more internal pain found in the cervix or lower abdomen.
Symptoms of Dyspareunia
The most common symptom of dyspareunia is pain that’s experienced during sexual intercourse, either at the vaginal opening or in the pelvic region. People suffering from dyspareunia may also experience a variety of symptoms such as:
Sharp pain during penetration or with each thrust
Pain at the entry of the vagina
A throbbing or aching sensation after intercourse or other sexual acts
Burning sensation
Cramping in the pelvic region
Muscle spasms or tightness or spasms
Pain while using a tampon
Pain during pelvic exam
Symptoms can vary from person to person but the vast majority are experienced during the act of sexual intercourse.
What Causes Dyspareunia?
People may experience pain during sex if there isn’t enough vaginal lubrication, which may improve with foreplay and proper lubrication. However, if dyspareunia is persistent, it’s more likely the result of other conditions. Some common causes of dyspareunia include:
Menopause: Menopause affects estrogen levels, which are responsible for natural lubrication, the elasticity of the vaginal mucosa, and the overall health of the vaginal tissue. Up to 50% of postmenopausal people experience dyspareunia as a result of these lower estrogen levels.
Vaginal atrophy: This occurs when the vaginal lining loses proper moisture,viscosity and becomes dry and inflamed. Vaginal atrophy can be a result of menopause, hormonal changes, or brought on by certain medications.
Vaginismus: Vaginismus is a symptom, not a condition. Vaginismus occurs when the pelvic floor muscles reflexively spasm at attempted penetration. This can occur the very first time penetration of any sort is attempted, including with tampon insertion or a gynecologic exam, or can develop overtime.
Sexual intercourse too soon after childbirth: Not waiting the recommended time of 6-8 weeks can lead to significant pain.
Injury to the vulva or vagina from childbirth: Injuries from tears or from an episiotomy during childbirth affect can cause long-lasting but treatable pain.
Ectopic pregnancy: A pregnancy in which a fertilized egg develops outside of the uterus.
Problems with the cervix: If there is a problem with the cervix, such as an infection, deep penetration during sex can lead to further pain and dyspareunia.
Uterine problems: Problems with the uterus like fibroids are known to be a source of dyspareunia.
Endometriosis: A condition in which the issue lining grows outside of the uterus.
Ovarian cysts: Problems with the ovaries like cysts can be a significant source of pain.
Pelvic inflammatory disease: Also known as PID, the internal tissues within the pelvic region become badly inflamed and are worsened by intercourse.
Yeast infections: A vaginal infection that causes irritation, discharge, and intense itchiness in the vaginal area.
Sexually transmitted infections (STIs): A wide variety of STIs like genital warts or herpes sores can cause significant pain.
Who is Most Likely to Experience Dyspareunia?
Both people with vulvas and penises can experience dyspareunia. However, it’s far more common among people with vulvas, affecting an estimated 10% to 20% of women of all age groups. While dyspareunia is largely caused by physical pain and underlying physical conditions
Postpartum people are also more likely to experience dyspareunia. Although not widely discussed, postpartum dyspareunia is a common result of overactive pelvic floor muscles (PFM) that occur after a vaginal delivery. During the pushing phase of vaginal delivery, the pelvic floor must stretch and contract. However, after giving birth, the pelvic floor may fatigued and as a result, can go into spasm. In many cases, postpartum people won’t realize they even experience a spasm or a tight pelvic floor until having sexual intercourse after 6-8 weeks, at which point the muscle spasm or tight pelvic floor can cause significant pain. A tight pelvic floor can be treated but can take time and physical therapy to return to normal.
How is The Cause Of Dyspareunia Diagnosed?
Healthcare providers can diagnose dyspareunia and the underlying causes of pain during sex through a thorough physical examination that looks at a patient’s pelvis, vagina, uterus, and abdomen. A medical provider will typically conduct the following exams to properly diagnose dyspareunia.
Physical exam: A full physical exam for a person with a vulva will look at the vagina, cervix, uterus, pelvis, and abdomen. This may also include a rectal exam. If performed by an MD, DO or midwife, this may also include a pap test as well as a taking a collection of vaginal fluid and urine to test for any infections.
Patient report: How you describe the pain you experience provides useful information to the provider attempting to diagnose the cause of your pain.
Ultrasound: Transvaginal ultrasound can get a better view of the reproductive system, helping to discern whether there are structural or anatomical factors contributing to the pain.
Biopsy or Wet Mount: These options can help determine if there is an infection or dermatologic cause contributing to pain.
Laparoscopy: Certain conditions like endometriosis can only be diagnosed with a laparoscopic procedure.
How to Treat Dyspareunia
How dyspareunia gets treated will ultimately depend on the underlying causes, which can be determined by a medical provider. In many cases, dyspareunia pain from vaginal dryness or a lack of lubrication can be solved by using water-based lubricants, more foreplay, modifications to sexual activity, and healthy sex practices. If the pain caused by vaginal dryness is due to menopause, healthcare providers can provide medications or estrogen creams.
If the source of dyspareunia is a tight pelvic floor, your medical provider may refer you to a physical therapist to help relax and lengthen the pelvic floor through mobilization, manual therapy techniques, mobility, and relaxation training. Physical therapists may also use dilators or an EMG to get a better understanding of your pelvic floor muscles, muscle tone, and how to go about the right course of treatment.
While pain with sex is common, dyspareunia can be treated, and not all sexual pain requires medical intervention. If you feel you might be suffering from dyspareunia, talk to your healthcare provider to determine the right treatment and course of action.
If you’re wondering what’s causing your pain, our pelvic floor physical therapists can help determine the underlying cause and help outline an appropriate treatment plan. Contact us here to get your appointment scheduled with our team or give us a call at 512-766-2649.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.