Painful Sex (Dyspareunia)

Written By georgia allen

‘Dyspareunia’ is essentially an umbrella term to describe difficult or painful sexual intercourse. Dyspareunia can be caused by several factors or conditions such as vaginismus (pelvic floor muscle spasm), vestibulodynia (pain at the entrance of the vagina) and/or vulvodynia (pain around the vulva). Pain may be present during intercourse as well as afterwards and could feel like burning, stabbing, sharp, or dull aching pain. 


How common it is?

It is likely that cases of Dyspareunia are under-reported but currently the estimate is that 14% of women experience painful intercourse with the most common age group being 18–24 year-olds. 


What causes it?

Several factors could be responsible for someone having painful intercourse and these can be separated into two categories, superficial (entry) pain and deep pain. 


Possible causes for superficial Dyspareunia: 

  • Vaginismus (pelvic floor muscle spasm)

  • Vestbulodynia and Vulvodynia 

  • Insufficient lubrication

  • Skin conditions such as lichen sclerosis

  • Scar tissue, e.g. perineal tears after childbirth

  • Pudendal Neuralgia: irritation or compression to the pudendal nerve - which is the main nerve that supplies the vulva and anus. 

  • Genitourinary syndrome of menopause (GSM): A decrease in estrogen that can lead to irritation, vaginal dryness and thinning which can make intercourse painful for upwards of 50% of women

  • Hormonal contraception: Some hormonal contraceptives can make the vaginal tissue more sensitive and reduce the amount of natural lubrication you may produce 

  • Conditions such as thrush or herpes. 


Deep Dyspareunia is normally (but not always) related to an identifiable condition or medical condition such as:

  • Endometriosis

  • Painful Bladder Syndrome

  • Pelvic Inflammatory Disease

  • Ovarian cysts

  • Adenomyosis

  • Uterine prolapse

  • Uterine fibroids.

It could also be due to muscular causes like pelvic floor muscle over-activity or “trigger points”. 

How is it treated?


Dyspareunia is treated based on the underlying reason for the pain and discomfort. To determine why someone is experiencing pain, your doctor may do a variety of different tests such as vaginal swabs, ultrasounds, MRI/CT or even a surgical laparoscopy (belly) or cystoscopy (bladder) to look for any causes of pain. A referral to a pelvic floor physiotherapist may also be given to investigate muscular and nerve causes for your pain. 


Can Pelvic Floor Physiotherapy help?

Pelvic floor physio has a huge role to play in treating Dyspareunia - even if the reason for your pain is a medical condition like endometriosis or painful bladder syndrome. There is so much we can do such as: 

  • Education: about you pain, what will worsen it, how you can manage it and what your prognosis is

  • Dilator therapy: there is a huge role for Dilators in treating dyspareunia weather that be to physically stretch the pelvic floor or use graded exposure to show the nerve that penetration is not a threat.

  • Pelvic floor mobility and stretching: often your pelvic floor will be tight in conjunction with pain and therefore your hips, abdominals and lower back can become tight too.

If you want to book an appointment with one of our physiotherapists to discuss painful intercourse and treatment options you can do so here.

georgia allen
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What is Vaginismus?