Having safe, consensual and fun sexual intercourse is an important part of a healthy relationship for most people. However, for some people, intercourse can, unfortunately, be an incredibly painful experience.
There are several reasons why people could experience pain during intercourse. Although you may feel embarrassed about doing so, it’s important to speak to a doctor or sexual health practitioner in order to gain a correct diagnosis.
Dyspareunia: What Does It Mean?
The medical term for painful intercourse is dyspareunia – pronounced dis-puh-ROO-nee-uh – and it refers to any type of pain that occurs before, during or after sexual intercourse. The pain may be constant, or it could be an on-and-off, temporary pain.
Where pain is felt will vary from person to person; some people will experience genitalia discomfort, others may feel pain all over the pelvis area. For some women, dyspareunia will also cause pain when using a tampon.
Stats: How Many Suffer from this Disorder?
Although men can suffer from dyspareunia, it is mainly a condition that affects women. Studies by The World Health Organization show that between 8 to 22% of women will experience dyspareunia during their lifetime. It is most common in women aged 20- 29 years old.
One study researched if menopause and decreased intercourse increased the risk of dyspareunia, found there may be a link between dyspareunia and a decrease in sexual intercourse.
Women who have recently given birth are very likely to suffer from dyspareunia, with some research suggesting that up to 45% of all postpartum women will suffer from the condition for a period.
Dyspareunia is the most common cause of all gynecological pain and it will be extremely likely that if you visit a sexual health practitioner or OBGYN, they will have treated many previous patients for the same condition.
What Causes Dyspareunia?
The causes of dyspareunia are varied and can be because of physical issues, emotional problems or a combination of both.
For those people who suffer pain during penetration, the physical causes include:
- Lack of lubrication: This could be due to hormonal changes after giving birth or after menopause. Some medications, including birth control and anti-depressants, can affect arousal levels which will limit lubrication. It can also be caused by insufficient foreplay.
- Injury or accident: Experiencing an accident, injury or an irritant in the genital area can cause a lot of pain which will be worsened by penetration.
- Skin disorder or infection: Pain can be caused by an infection or a skin problem such as eczema. For example, UTIs are a common cause of pain and discomfort.
- Vaginismis: This condition causes involuntary spasms of the muscles around the vaginal wall and can be a great source of pain during sex for those with the condition.
- Birth defects: Some people are born with a condition that can cause dyspareunia, such as having an unformed vagina.
- Illnesses and conditions: Some illnesses with cause pain during penetration, such as IBS and cystitis.
- Other treatments: The pain could be a side-effect of some other medical treatment, such as chemotherapy.
Emotional reasons why sex may be painful include:
- Stress: People who are undergoing stress can inadvertently tighten their pelvic floor muscles, leading to pain during sex.
- A history of sexual abuse: Having experienced sexual abuse in the past can lead to a negative psychological connection with sex in some cases.
- Psychological causes: Suffering from depression or anxiety can cause a low level of sexual arousal. Likewise, relationship issues or communication difficulties can also cause low arousal.
Signs and Symptoms of Dyspareunia
What are the Common Behaviors/Characteristics?
The signs and symptoms of dyspareunia all revolve around pain or severe discomfort during or after sexual penetration. Any persistent difficulty having intercourse is likely to be a sign of the condition.
A person may suffer from pain in the genital area or deep inside the pelvis whilst being penetrated or may feel a tensing or spasming of muscles in that area.
Another common symptom is suffering from anxiety or fear before or during penetration, due to the associated pain that it has caused previously.
Testing: What are the Diagnostic Criteria Per the DSM 5?
The DSM 5 criteria for dyspareunia is as follows:
- Persistent or recurrent difficulties with one (or more) of the following:
- Vaginal penetration during intercourse.
- Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
- The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.
- The symptoms in Criterion A cause clinically significant distress in the individual.
- The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of a severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
Dyspareunia and Other Conditions
Dyspareunia vs Vaginismus
A similar condition to dyspareunia is vaginismus. Vaginismus is a condition that causes pain due to muscle spasms in the vagina.
The pain difference is that the pain experienced through dyspareunia during penetration can have many root causes, whereas vaginismus pain is specifically caused by muscle spasms.
Due to the extreme similarity between these two conditions, it’s important to be examined by a medical professional in order to gain the correct diagnosis.
Related Conditions
As dyspareunia can have many different causes, both emotional and psychological, it is likely that a diagnosis of dyspareunia will be given alongside a second diagnosis.
A second diagnosis of a related condition may be physical and will usually be a gynecological condition. For example, a patient with dyspareunia may also be suffering from a Urinary Tract Infection (UTI), which is the root cause of the dyspareunia.
Example Case of Dyspareunia
Lizzie had enjoyed a normal, trouble-free sexual life from the age of eighteen until she was twenty-three. She then became pregnant with her first child with whom she experienced a long and rather traumatic vaginal birth. After birthing, her doctor advised against sexual intercourse for three to six months to allow complete healing. Lizzie’s partner was very understanding and supportive and did not insist on having relations.
After six months, however, Lizzie remained reluctant to resume their sexual activity. The first attempts were unsuccessful, and Lizzie experienced severe pain even before penetration was achieved. With the new baby taking up so much of her time, Lizzie’s partner began to feel unwanted and abandoned and Lizzie became depressed. As time went on their relationship deteriorated and their sexual and affectionate times together disappeared completely.
Eventually, Lizzie’s partner convinced her to visit the doctor to see if there was a physical reason for the problem. Lizzie was sure that it was due to the scarring occurred during giving birth, but, upon receiving a physical examination, the doctor revealed that she had healed well. Unable to find a physical reason for the pain he referred the couple to a sex therapist. She discovered that it was the anticipation of feeling again the pain that she had experienced during childbirth that was causing Lizzie to involuntarily tighten her pelvic and vaginal muscles. This was making penetration impossible. She started working with the couple in relaxation techniques and after just a few weeks of therapy, they were able to resume their sexual activities without pain.
Thanks to the therapy, and the support and understanding of her partner, Lizzie is a happy young mum who is now enjoying a full and normal sex life again.
How to Deal/Coping With Dyspareunia
Look out for These Complications/Risk Factors
The main risk of complication for those suffering from painful penetration is that it may be caused by an underlying condition that requires treatment. For example, the pain could be caused by a UTI, a simple infection that if left untreated could cause serious health problems.
Another risk of the condition is that it could cause emotional problems. Pain during sex can lead to becoming afraid or tense before penetration has even begun. Sex should be a fun experience and so it’s important to seek treatment quickly so that it doesn’t become a stressful experience instead.
Dyspareunia Treatment
The treatment of dyspareunia will depend on what the root cause or causes of the condition are. A doctor will likely treat the root cause first and foremost as that will usually result in a lessening or complete disappearance of the pain during penetration.
If the pain is being caused by an emotional or psychological reason, then it’s likely that a Doctor will recommend a form of therapy of counseling. Some of the most common therapies recommended are:
- Sex and/or relationship therapy: Seeing a therapist can help to resolve any issues that you may have around sex or within your relationship, that are causing a physical reaction and leading to painful sex.
- Desensitization therapy: This type of therapy will involve learning how to relax the vaginal muscles that may be the root cause of the pain.
Possible Medications for Dyspareunia
If required, a Doctor will prescribe medications for dyspareunia. Usually the medication is for treating the condition that is causing the dyspareunia to be present.
A medication called ospemifene (Osphena) is sometimes prescribed for this condition, if there is no underlying condition that can be found. This medication helps with improving vaginal tissue dryness and thinness and thus reducing pain during sexual intercourse.
Home Remedies to Help Dyspareunia
For those who are suffering from pain during penetration, it may be worth trying to use extra lubrication during any type of penetration. It’s worth researching and trying different types and brands until you find one that works for you. Don’t forget that lubricant can also be used during foreplay and that dedicating more time to foreplay may also help.
Trying different sex positions may also help. Do some research on easy and comfortable positions and remember to communicate with your partner on what is working for you and for them.
Living with Dyspareunia
Talking about sex can feel embarrassing so it’s important to remember that you are far from alone if you suffer from pain during penetration. Communication is a really important step to finding the right solution, both with your sexual partner and with your Doctor.
Insurance Coverage for Dyspareunia
Every insurance provider is different and will have different policies so it’s essential to contact your own provider and ask for their particular policy. Remember that the pain may be caused by a different condition that falls under a different medical policy.
How to Find a Therapist
If your Doctor thinks that the underlying cause of dyspareunia is a psychological or emotional cause, then it’s important to seek help from a therapist.
Ask your Doctor to recommend a therapist that deals with your particular cause of dyspareunia. This may be a relationship therapist, a sex therapist or a therapist who deals in sexual trauma. It may be a therapist who will help you learn to manage stress or deal with body-image disorders.
What Should I be Looking for in an LMHP?
The most important aspect in a therapist is that you are comfortable with them, and this is especially true when it comes to dealing with dyspareunia. Make sure you’re comfortable with their age, their gender and their personality, as it’s really important to speak to a therapist you trust and can be open and honest with.
Questions to Ask a Potential Therapist
Ask a therapist about their previous experiences working with a patient with this condition. You could also ask them what treatment they gave these patients and what treatment they would recommend for you, also.
Dyspareunia Resources and Support Helpline
National Suicide Prevention Lifeline: 1-800-273-8255
Crisis Text Line: Text “home” to 741741
Planned Parenthood U.S. National Sexual Health Hotline: 1-800-230-PLAN (7526)
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3026887/
https://www.aafp.org/afp/2001/0415/p1535.html
https://www.mayoclinic.org/diseases-conditions/painful-intercourse/diagnosis-treatment/drc-20375973
https://www.msdmanuals.com/en-gb/professional/SearchResults?query=Dyspareunia&icd9=302.76%3b625.0
https://www.med.unc.edu/ppru/publications/Evaluation%20and%20treatment%20of%20dyspareunia.pdf
https://www.medicalnewstoday.com/articles/192590.php
https://familydoctor.org/condition/dyspareunia/
https://www.health.harvard.edu/womens-health/painful-sexual-intercourse-dyspareunia
https://www.healthcommunities.com/female-sexual-dysfunction/dyspareunia-painful-intercourse.shtml
