Dyspareunia: Causes, Symptoms and Treatment of Painful Sex

If sex has become painful, you probably have questions: Is it normal? What's causing it? Should I see a doctor? Pain during intercourse, known as dyspareunia, is one of the most common sexual health concerns many women experience. While it might feel isolating or embarrassing to talk about, it's a medical issue with real causes – and most of them are treatable once identified.

What is dyspareunia?

Dyspareunia is the medical term for pain that occurs during or after sexual intercourse. While this condition can affect both men and women, it's more commonly experienced by women. The pain can range from mild discomfort to severe pain and may occur in the genital area or deep within the pelvis.

Are there different types of dyspareunia?

Understanding where and when you feel pain can help your doctor identify the underlying cause.

Dyspareunia is typically divided into two main types:

• Superficial Dyspareunia: 

  • Pain felt at the outer genital area, including the vulva, labia, or vaginal opening. 

  • Often caused by vaginal dryness, irritation, or infection.

• Deep Dyspareunia: 

  • Pain that occurs deeper inside the pelvis during penetration. 

  • May be related to conditions affecting internal reproductive organs, such as endometriosis, pelvic inflammatory disease (PID), or uterine fibroids.

What are the symptoms of dyspareunia?

The hallmark symptom is pain during or after intercourse, but the way this pain presents can vary significantly from person to person.

The pain may feel like:

• Burning

• Stabbing

• Aching

• Throbbing

• Stinging

Other symptoms you might experience include:

• Vaginal dryness, especially common in postmenopausal women

• Difficulty achieving or maintaining sexual arousal due to discomfort

• Pain during specific positions or activities

• Anxiety or fear around sexual intimacy

What causes dyspareunia?

There are many potential causes for painful sex, ranging from medical conditions to physical trauma and emotional factors.

Medical Conditions

Several health conditions can contribute to pain during intercourse:

• Vulvodynia: 

  • Chronic pain or discomfort in the vulva without a clear identifiable cause

• Endometriosis: 

  • A condition where tissue similar to the uterine lining grows outside the uterus, causing significant pain during sexual intercourse

• Pelvic Inflammatory Disease (PID): 

  • An infection affecting the reproductive organs that can lead to chronic discomfort

• Vaginal Infections: 

  • Common infections such as yeast infections or bacterial vaginosis can cause irritation and pain

• Uterine Fibroids: 

  • Non-cancerous growths in the uterus that may cause deep pelvic pain

• Vaginismus: 

  • Involuntary muscle contractions in the pelvic floor that make penetration painful or impossible

• Hormonal Imbalances: 

  • Particularly during menopause or breastfeeding, hormonal changes can lead to vaginal dryness and irritation

Trauma or Injury

Past physical trauma can have lasting effects on sexual comfort:

• Previous surgeries involving the pelvic organs or perineum

• Childbirth complications, especially involving tearing or episiotomy

• Physical trauma or abuse

Infections

Sexually transmitted infections (STIs) such as chlamydia or gonorrhoea can cause inflammation and pain during intercourse. If you suspect an infection, prompt testing and treatment are essential.

Who is at risk for dyspareunia?

While painful sex can affect women at any age, certain groups face higher risk. You may be more susceptible if you:

• Recently gave birth, especially following a traumatic delivery

• Are postmenopausal due to decreased oestrogen levels leading to a lack of vaginal lubrication.

• Have chronic medical conditions like:

  • Endometriosis

  • Fibroids

  • Pelvic inflammatory disease

• Have experienced sexual trauma or abuse

What are the complications of this condition?

Left untreated, dyspareunia can affect more than just your physical health. The condition may lead to:

• Emotional distress: 

  • Ongoing pain can contribute to anxiety and depression

  • Decreased interest in sexual intimacy

• Relationship problems: 

  • Pain during sex may strain intimate relationships, particularly when it's difficult to discuss openly

• Decreased quality of life: 

  • Persistent discomfort can impact your overall well-being, work performance, and social interactions

If you're experiencing persistent pain during sex that's affecting your quality of life, schedule an appointment with Thomson Medical for a thorough evaluation in a supportive, confidential environment.

How is dyspareunia diagnosed?

Your doctor will take a comprehensive approach to identify the cause of your pain.

The diagnostic process usually includes:

• Medical history: 

  • Your doctor will ask detailed questions about the nature of your pain, sexual history, and any other related symptoms

• Physical examination: 

  • A pelvic exam helps identify signs of infection, injury, or structural abnormalities

• Laboratory tests: 

  • These can rule out infections, STIs, or other underlying conditions

• Imaging tests: 

  • Ultrasound, MRI, or laparoscopy may be used to assess conditions like endometriosis or fibroids

What tests are done to diagnose dyspareunia?

Depending on your symptoms and initial examination, your doctor may recommend several tests.

Common diagnostic tests include:

• Pelvic ultrasound is done to check for fibroids, cysts, or other abnormalities in the reproductive organs

• Pap smear is done to detect abnormalities in cervical cells that could cause discomfort

• STI tests is done to rule out sexually transmitted infections

• Blood tests is done to assess for hormonal imbalances

• Laparoscopy is a minimally invasive surgical procedure that can diagnose conditions like endometriosis

How is dyspareunia treated?

Treatment varies based on the underlying cause of your pain, but most conditions respond well to appropriate intervention, helping restore the quality of your sex life.

Medical treatments

Your doctor may recommend:

• Antibiotics or antifungals for bacterial or fungal infections

• Hormonal therapies such as oestrogen creams or birth control pills for vaginal dryness or hormonal imbalances

• Pain relievers or anti-inflammatory medications for conditions like endometriosis

• Physical therapy for pelvic floor dysfunction or vaginismus

Psychological and emotional support

Mental health plays a significant role in sexual wellness:

• Therapy or counseling, particularly if pain is related to trauma, anxiety, or relationship issues

• Sex therapy to address sexual concerns and improve intimacy with your partner

Surgical Interventions

In cases of endometriosis, fibroids, or pelvic abnormalities, surgery may be necessary to provide long-term relief.

If you're struggling with painful sex and unsure where to start, book a consultation with Thomson Medical. Our specialists will work with you to identify the cause and create a personalised treatment plan tailored to your needs.

How can I manage vulvodynia symptoms?

If you've been diagnosed with vulvodynia, several management strategies can help reduce discomfort.

Consider these approaches:

• Topical treatments: 

  • Lidocaine or other numbing creams can provide temporary relief

• Pelvic floor physical therapy: 

  • Specialised therapy can address muscle tension or spasms

• Dietary changes: 

  • Avoiding irritants like acidic foods, caffeine, or spicy foods may reduce symptoms in some women

• Stress management: 

  • Relaxation techniques, yoga, or mindfulness can help reduce tension that exacerbates pain

When should I see a doctor?

Don't hesitate to seek medical attention if you're experiencing painful sex. You should schedule an appointment if you:

• Experience persistent pain during intercourse

• Notice that the pain is severe or worsening over time

• Find that pain is affecting your emotional well-being or relationship

• Notice any unusual discharge, bleeding, or other changes in your body

If any of these symptoms sound familiar, book an appointment with Thomson Medical for compassionate care in a comfortable setting.

FAQ

How can you treat dyspareunia naturally?

How long can dyspareunia last?

Is there anything I can do to reduce my risk of dyspareunia?

What does dyspareunia feel like?

Women describe the sensation differently, but it commonly feels like sharp, burning, aching, or throbbing pain. The discomfort may occur at the entrance of the vagina or deeper in the pelvic area.

Does dyspareunia cause bleeding?

Dyspareunia usually doesn't cause bleeding on its own. However, in some cases – such as vaginal or cervical irritation, injury, or infection – light bleeding or spotting may occur during or after intercourse. 

What age is it most likely to occur?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique situation, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.