Why Does Dyspareunia Happen? Causes, Symptoms, and Treatment Options to Treat Painful Sex

KEY TAKEAWAYS

Pain during sex is common but not normal. Dyspareunia affects up to 20% of people with a vulva, yet it is often dismissed. If you experience pain, seek medical advice, it is not something you have to endure.

Dyspareunia has multiple causes. It can be due to physical conditions like endometriosis, vaginismus, vulvodynia, or infections, as well as psychological factors like stress or trauma. Identifying the root cause is key to effective treatment.

Treatment options exist. Whether through pelvic floor therapy, hormonal treatment, pain management, or surgery, dyspareunia is treatable. A multidisciplinary approach often provides the best results.

Sex should never be painful. Painful sex is not a “rite of passage” or something to “get used to.” There are alternative ways to experience pleasure, and modifying positions, using lubricants, or exploring non-penetrative intimacy can help.

Advocating for your sexual health is essential. If a doctor dismisses your pain, seek a second opinion. Your discomfort is valid, and solutions exist. Speaking up about sexual health leads to better diagnosis, treatment, and quality of life.

What Dyspareunia Means

Dyspareunia (pronounced dis-pə-ˈrü-nē-ə, -nyə.) is the medical term for pain during or after sexual intercourse. It is a common but abnormal condition that affects 7% to 46% of women and individuals with a vulva, according to research (Tayyed & Gupta, 2021). A 2014 U.S. study found that 10% to 20% of women and individuals with a vulva experience persistent pain during sex.

Why Does Dyspareunia Happen

Dyspareunia can occur due to physical, emotional, and psychological factors. It may stem from medical conditions like endometriosis, vaginismus, vulvodynia, hormonal changes, or vaginal infections. Emotional aspects such as stress, anxiety, or past trauma can also contribute to painful intercourse.

Debunking Myths About Dyspareunia

Many misconceptions surround dyspareunia, making it a taboo topic. Here are some myths we need to break:

“Pain during sex is just in your mind.”
FALSE! Dyspareunia has real physical and medical causes. Patients need to be heard, and their pain should never be minimized.

“Only women experience dyspareunia.”
FALSE! Dyspareunia can affect anyone, including men and individuals with a penis.

“Pain is normal during first-time sex.”
FALSE! While some discomfort might occur, severe pain is not normal and may indicate an underlying issue.

“Penetrative sex is necessary for a healthy sex life.”
 FALSE! Non-penetrative sexual activities can also provide pleasure and intimacy.

“Dyspareunia is only caused by vaginal penetration.”
 FALSE! Pain can also occur from clitoral stimulation, deep penetration, or external vulvar conditions.

Symptoms of Dyspareunia

Dyspareunia can manifest in different ways depending on the underlying cause. Common symptoms include:

  • Pain during penetration – whether initial entry or deep thrusting
  • Burning or stinging sensation in the vaginal area
  • Sharp or aching pain that lingers after intercourse
  • Throbbing discomfort that lasts hours or days post-sex
  • Tightness or muscle spasms in the pelvic floor (common with vaginismus)
  • Pain localized to the vaginal entrance (vestibule) or deep in the pelvis
  • Worsening pain in certain positions or during specific activities (e.g., tampon use)
  • Discomfort during gynecological exams – inserting a speculum or ultrasound probe may feel painful, and some healthcare providers allow patients to insert the device themselves to reduce anxiety, discomfort or pain.

The nature and intensity of pain can vary, making it essential to track symptoms and seek a professional diagnosis.

Causes of Dyspareunia

Superficial vs. Deep Dyspareunia

  • Superficial Dyspareunia: Pain at the vaginal entrance (caused by conditions like vulvodynia, vaginismus, or vestibulodynia).
  • Deep Dyspareunia: Pain felt deep inside during penetration, often linked to conditions like endometriosis, adenomyosis, or a retroverted uterus.

Medical Conditions That Contribute to Dyspareunia

Why Dyspareunia in Endometriosis?

Endometriosis causes deep vaginal pain during penetration because the uterine-like tissue grows outside the uterus, leading to inflammation, scarring, and nerve irritation. Why is there dyspareunia in endometriosis? This pain occurs due to adhesions, pelvic muscle tightness, and inflammation in the rectovaginal septum, ovaries, and uterosacral ligaments.

Clitoral Phimosis and Dyspareunia

Clitoral phimosis happens when the clitoral hood is too tight, preventing full retraction. This condition is rarely screened but affects sexual function. Treatment can be surgical (hoodectomy) or non-surgical (topical treatments, manual stretching known as Specific Myofascial Release (SMR). This technique involves gentle massage of the clitoral region to alleviate muscle tension and improve the mobility of the clitoral hood. Typically performed by a pelvic floor therapist, SMR can help manage discomfort and restore natural movement without the need for surgery.

Vulvar Conditions Causing Dyspareunia

  • Vulvodynia: Chronic pain in the vulva lasting more than three months.
  • Vestibulodynia: Intense pain when applying pressure to the vestibule (vaginal entrance).
  • Vulvar Lichen Sclerosus: A dermatological condition that causes thinning, irritation, and scarring of the vulvar skin.

Vaginismus: When Penetration is Impossible or Painful

Vaginismus is an involuntary contraction of pelvic muscles, making penetration painful or impossible.

  • Primary vaginismus: Present since first tampon use or attempted intercourse, often linked to fear, cultural beliefs, or trauma.
  • Secondary vaginismus: Develops after trauma, childbirth, surgery, or painful physical or emotional experiences.

Other Causes of Dyspareunia

  • Postpartum dyspareunia: Pain after childbirth due to tears, episiotomies, or pelvic trauma.
  • Retroverted uterus: Certain positions (like rear-entry position “doggy style”, missionary with legs elevated “anvil position”) may cause pain due to the uterus tilting backward.
  • IUD complications: Some individuals experience deep vaginal pain during sex due to an intrauterine device.

Diagnosing Dyspareunia

Who Treats Dyspareunia?

Several specialists can help diagnose and treat dyspareunia:

  • Gynecologists: Identify medical conditions like endometriosis or infections.
  • Pelvic Floor Therapists: Help with vaginismus, hypertonic pelvic floor, and postpartum recovery.
  • Sex Therapists: Address psychological and relationship factors.
  • Dermatologists: Diagnose vulvar skin conditions.
  • Psychologists: Help process trauma and anxiety related to pain.

Diagnostic Tests

  • Q-tip test: To diagnose vestibulodynia. The Q-tip test involves gently pressing a cotton swab on the vestibule to check for localized pain.
  • Pelvic exam with patient control: The doctor may let the patient insert the speculum themselves to ensure comfort.
  • Ultrasound or MRI: To detect endometriosis, adenomyosis, or fibroids.

Treatment and Management of Dyspareunia

Can Dyspareunia Be Treated? Can Dyspareunia Be Cured?

Yes, dyspareunia can be treated! In some cases, full recovery is possible, but for chronic conditions, management is key.

Medical and Physical Interventions

  • Hormonal therapy (for endometriosis, vaginal atrophy).
  • Pelvic physiotherapy (for vaginismus, hypertonic pelvic floor).
  • Antifungal or antibiotic treatment (for infections like yeast infections or bacterial vaginosis).
  • Surgical correction (for hymenal bridge or clitoral phimosis).

Pain Management and Lifestyle Adjustments

  • Lubricants: Reduce friction and discomfort.
  • Sexual position modifications: Spoon position, using a buffer ring to control penetration depth.
  • Non-penetrative sex: Sensual massages, mutual stimulation, and oral sex.

How Long Does Dyspareunia Last?

When Does Dyspareunia Go Away?

The duration of dyspareunia depends on the cause:

  • Temporary cases (e.g., infections, postpartum recovery) resolve within weeks or months.
  • Chronic conditions (e.g., endometriosis, vaginismus) require long-term management.

Preventive Measures and Solutions

  • Maintain vaginal health: Avoid harsh soaps, douching, and excessive use of feminine products.
  • Choose contraception wisely: Some birth control methods can impact lubrication.
  • Good hygiene: Wash hands, partners, and sex toys to prevent infections.
  • Seek early diagnosis: Don’t wait to consult a professional!

Dyspareunia is common but not normal—it deserves medical attention and compassionate care. Whether it’s due to endometriosis, vaginismus, or vaginal infections, solutions exist. If you or someone you know is struggling, speak up, seek help, and prioritize your sexual health.

SARGENIUM Women’s Health • The French Way

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