Painful sex (Dyspareunia) Diagnosis and Treatment

Are there different types of dyspareunia?

The specific location of discomfort helps determine the type of dyspareunia, which can be categorised into the following:

Entry pain (introital or superficial dyspareunia)

This type refers to pain at the vaginal opening during initial penetration. It might be attributed to hormonal changes, vaginal or vulvar dryness, chronic irritation, infections, or physical injury.

Positional pain

Pain in this category is often related to problems such as pelvic floor muscle dysfunction, vaginal dryness, or infections.

Deep pain (collision dyspareunia)

This involves pain during deeper penetration, often worsened by certain positions. Conditions like pelvic congestion syndrome, endometriosis, or disorders involving the bowel, bladder, or pelvic floor may be contributing factors.

Dyspareunia is further classified based on pain occurrence:

• Primary pain: Pain experienced since becoming sexually active.
• Secondary pain: Discomfort arising after a period of pain-free intercourse.
• Complete pain: Pain occurring consistently during every sexual interaction.
• Situational pain: Discomfort that only happens in particular circumstances.

How common is dyspareunia?

Dyspareunia is significantly more prevalent among women, with approximately three out of four reporting painful sex at some point in their lives. In the UK, around 28% of the population is affected by dyspareunia at least once. However, the true prevalence might be higher, as some individuals avoid discussing this sensitive topic.

What age is it most likely to occur?

Dyspareunia can affect individuals at any age. However, it is particularly common in postmenopausal women due to reduced oestrogen levels, which are vital for maintaining vaginal lubrication and health. It is important to note that painful intercourse is not an inevitable aspect of ageing and should not be dismissed as such.

Symptoms and Causes

What are the symptoms of dyspareunia?

The symptoms associated with dyspareunia may include:

• Sharp pain at the vaginal opening or during penetration, including tampon use.
• Severe discomfort during thrusting.
• Throbbing or aching pain following intercourse.
• Pelvic cramping.
• Muscle spasms or tightness.
• Discomfort affecting the bladder.

What does dyspareunia feel like?

The pain may be felt at the vaginal entrance or deep within the pelvis. It may be localised to a particular spot or encompass the entire genital region. Common sensations include burning, stinging, or generalised discomfort.

Does dyspareunia cause bleeding?

Although dyspareunia itself does not cause bleeding, bleeding during sexual activity can indicate another medical concern that should be examined by a doctor. Potential causes range from minor issues, such as infections, to more severe conditions, including cancer.

What causes dyspareunia?

The potential causes of painful intercourse include insufficient vaginal lubrication, infections, physical injuries, or underlying medical conditions such as:

• Endometriosis: A condition where tissue resembling the uterine lining develops outside the uterus.
• Skin disorders: Conditions like dermatitis affecting genital skin.
• Pelvic floor dysfunction: Weakness or tightness in the pelvic muscles.
• Bowel conditions: Diseases like irritable bowel syndrome (IBS), Crohn's disease, or ulcerative colitis.
• Bladder disorders: Recurrent urinary tract infections (UTIs) or interstitial cystitis.
• Hormonal fluctuations: Changes related to menopause or breastfeeding.
• Neurological disorders: Nerve issues such as inflammation or pinched nerves.
• Vulvodynia: Chronic pain affecting the vulvar area.
• Genitourinary syndrome of menopause (GSM): Thinning or inflammation of the vaginal lining due to hormonal changes.
• Vaginismus: Involuntary tightening of vaginal muscles, often connected to anxiety, fear, or past trauma.

If pain persists, consulting a medical professional is recommended to effectively determine and address the cause.

Trauma or Injury

Physical trauma or injuries can also contribute to pain during intercourse. Examples include:

• Premature resumption of sexual activity post-surgery or childbirth: Engaging in intercourse too soon after these events may cause pain or injury.
• Injury to the vulva or vagina: Tearing during childbirth, episiotomies, or straddle injuries may result in discomfort.

Infections

Certain infections that might lead to dyspareunia include:

• Vaginal infections: Such as bacterial vaginosis or yeast infections.
• Sexually transmitted infections (STIs): Including genital warts and herpes.
• Uterine or vaginal infections: These may also contribute to discomfort.

Who is at risk for dyspareunia?

While dyspareunia is more commonly seen in women, particularly those who are postmenopausal, it can affect males as well as individuals of all ages and backgrounds. Causes of dyspareunia are often physical or medical but may also stem from psychological factors or mental health conditions.

What are the complications of this condition?

Dyspareunia can lead to various complications, including:

• Relationship issues: Pain during intercourse may result in reduced intimacy and strain between partners. Fear of experiencing pain can diminish the desire for intimacy, causing emotional disconnection.
• Emotional distress: Chronic pain and a lack of sexual fulfilment may lead to anxiety, sadness, or depression.
• Unaddressed medical conditions: Failure to treat underlying conditions, such as sexually transmitted infections (STIs), can lead to further complications. For instance, untreated STIs may cause infertility.

Diagnosis and Tests

How is dyspareunia diagnosed?

To determine the cause of pain during intercourse, a doctor will typically review your medical history and perform a physical examination. This may include evaluating the pelvis, abdomen, vagina, and uterus.

What tests are done to diagnose dyspareunia?

• Pelvic examination: A sample of vaginal fluid or urine may be collected to identify potential infections. In some cases, a rectal examination may also be conducted.
• Ultrasound imaging: A transvaginal ultrasound provides a detailed view of the reproductive organs and can help identify abnormalities.
• Laparoscopy: If the source of the discomfort remains unclear after other evaluations, a laparoscopy may be performed. This minimally invasive procedure enables the doctor to examine the pelvic area in detail.

How do I talk to my doctor about painful sex?

It is crucial to openly discuss dyspareunia with a healthcare professional, even if it feels uncomfortable. Medical professionals are experienced in handling sensitive topics and can help identify solutions. Be prepared to answer questions such as:

• Where do you feel the pain?
• How often does the discomfort occur?
• How long have you been experiencing this issue?
• Can you describe the type of pain (e.g., burning, aching, or stabbing)?
• Are you taking any medications?
• Have you had surgeries affecting the genital area?
• Have you been treated for any genital-related conditions?

Management and Treatment

How is dyspareunia treated?

Treatment plans depend on the specific cause of the discomfort. For instance, if pelvic floor muscle dysfunction is identified, physical therapy may be recommended.

Are there medications available for dyspareunia?

Medications may be effective, particularly for cases linked to hormonal changes or infections. Examples include:

• Topical oestrogen: This helps alleviate vaginal dryness associated with menopause.
• Ospemifene: A medication specifically approved for dyspareunia caused by menopause.
• Antibiotics or antifungals: Prescribed for treating infections.

How can dyspareunia be treated naturally?

Natural approaches for managing painful intercourse include:

• Using lubricants: Opt for water- or silicone-based lubricants to reduce vaginal dryness.
• Avoiding irritants: Refrain from using scented hygiene products, vaginal perfumes, fragranced toilet paper, or bubble baths that may cause irritation.

How do I manage symptoms of dyspareunia?

There are several ways to ease symptoms of dyspareunia during or after sexual activity, such as:

• Applying a water- or silicone-based lubricant before intercourse.
• Experimenting with alternative sexual positions or activities that minimise pain.
• Taking over-the-counter pain medications before engaging in sexual activity.
• Practising relaxation exercises to lower stress and ease muscle tension.
• Using an ice pack on the vulva post-intercourse to reduce discomfort.

Prevention

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

Although some risk factors are beyond your control, certain preventative measures might help, including:

• Practising safe sex to avoid infections.
• Maintaining good hygiene to prevent irritation or infections.

Outlook/Prognosis

How long can dyspareunia last?

The duration of dyspareunia varies depending on its cause and the treatment provided. Relief may occur quickly or require more time as suitable interventions are identified. Treatment options such as medication, pelvic floor therapy, lubricants, or surgery can significantly improve or resolve the condition in many cases.

When should I contact my medical professional?

You should seek medical attention if you experience:

• New or worsening pain during intercourse.
• Unexplained bleeding.
• Genital sores.
• Irregular menstrual cycles.
• Unusual vaginal discharge.

What questions should I ask my doctor?

Consider asking the following questions during your consultation:

• What is causing my pain during sex?
• What treatment options are available for my condition?
• Are there steps I can take to manage or reduce my pain?
• How long will it take before I notice improvement with treatment?

Takeaways

Experiencing pain during intercourse can be physically and emotionally distressing, and it may affect your intimate relationships. Addressing this issue with a medical professional is essential, as you do not have to endure this discomfort. By identifying and treating the underlying cause, you can work toward restoring a satisfying and pain-free sexual relationship.

Reach out to us today for further information regarding painful sexual intercourse.