Painful sexual intercourse (dyspareunia)

Painful Sex (Dyspareunia): Causes and Relief

Sex should never hurt — but for many women, discomfort during intimacy is a secret struggle. The prevalence of dyspareunia varies from 3% to 18% worldwide. It can affect relationships, self confidence and emotional wellbeing, leaving women feeling isolated or misunderstood.

At Happiher, we believe that addressing painful sex (medically known as dyspareunia) is just as important as treating any other aspect of gynaecological health. As a private gynaecologist in London, I offer a sensitive and expert approach to diagnosing and treating the underlying causes, so women can feel comfortable and confident again.

Painful Sex: What Is Dyspareunia?

Dyspareunia means pain in the genital area during or after sexual intercourse. It’s more common in women than men. The pain can be:

• Superficial (felt at the entrance of the vagina). Superficial pain occurs in the vulva or vaginal entrance. This type of pain is also known as superficial dyspareunia.

• Deep (felt inside the pelvis)

• Sharp, burning, aching or cramping in character

Dyspareunia can be primary, where pain starts at the beginning of sexual activity, or secondary, where pain develops after a period of pain free sex.

It can happen occasionally or be ongoing — but in either case it needs attention.

Introduction to Dyspareunia

Understanding Sexual Health

Sexual health is a big part of overall wellbeing, encompassing not just the physical but also the emotional and psychological aspects of sex. Painful sex or dyspareunia is a common issue that can affect both men and women, causing huge distress and relationship problems. Understanding the causes and risk factors of dyspareunia is key to effective treatment and management.

Several factors can cause painful sex, including pelvic floor dysfunction, vaginal dryness and underlying medical conditions such as endometriosis, pelvic inflammatory disease and skin disorders. Emotional factors like anxiety, stress and past experiences of sexual abuse can also play a big role in dyspareunia. By addressing both the physical and emotional aspects of sexual health, individuals can work towards reducing pain and overall wellbeing.

Types of Pain

There are different types of genital pain associated with dyspareunia, including superficial and deep pain. Superficial pain occurs in the vulva or vaginal entrance, deep pain occurs in the deeper parts of the vagina or lower pelvis. Deep pain is often associated with deep penetration and can be worse in certain positions. Burning pain, sharp pain and aching pain are common types of pain experienced by individuals with dyspareunia. Pain can occur before, during or after sexual intercourse and can be recurring or persistent.

Common Causes of Painful Sex

There are many possible causes of dyspareunia, often overlapping physical and emotional factors. Dyspareunia is often a symptom of other underlying medical conditions that need to be treated. Some of the most common include:

Diagnosing dyspareunia is key to identifying the underlying causes which can be both physical and emotional.

Physical Causes:

• Endometriosis (deep pelvic pain)

• Pelvic adhesions (scar tissue from surgery, infection or endometriosis)

• Adenomyosis (uterine wall thickening)

• Vaginal dryness (especially during menopause or perimenopause)

• Vaginal infections (e.g. thrush, bacterial vaginosis)

• Urinary tract infections (UTIs) or bladder issues, including painful bladder syndrome

• Fibroids or ovarian cysts

• Pelvic inflammatory disease (PID)

• Retroverted uterus

• Uterine fibroids

• Vaginismus (involuntary tightening of vaginal muscles), which can be a contributing factor in younger women experiencing dyspareunia.

Hormonal Causes:

• Reduced oestrogen levels (during menopause, breastfeeding or after certain cancer treatments)

Psychological Factors:

• Anxiety about pain

• Past traumatic experiences

• Relationship or emotional stress

Often both physical and emotional components are involved — so a holistic and empathetic approach is essential.

Symptoms of Dyspareunia

Women with painful sex may feel pain at the vaginal entrance or deeper inside. They may also experience:

• Burning, stinging or sharp sensations

• Pelvic cramping after sex

• Bleeding after sex (in some cases)

• Fear, tension or anxiety around intimacyMany women experience pain during sex which can impact their mental health. Patients with dyspareunia often don’t discuss their sexual dysfunction with healthcare providers which can delay diagnosis and treatment.

It’s important to know this is not “in your head” — pain is real, and valid and deserves compassionate investigation.

Women’s Health

Women’s health is key when it comes to dyspareunia as it’s more common in women. The female reproductive system is complex and many factors can cause painful sex. Hormonal changes, vaginal infections and pelvic surgery are some of the common causes. Women who have had painful sex in the past may be more likely to experience recurring pain and underlying conditions like uterine fibroids, ovarian cysts and abnormalities in the vaginal lining can also cause dyspareunia.

A full physical exam including a pelvic exam is essential for diagnosing dyspareunia. Healthcare providers should also consider the patient’s sexual history and mental health when developing a treatment plan. By addressing these factors women can get tailored care for their specific needs.

Emotional Factors

Emotional factors can play a big role in dyspareunia and it’s important to address these factors when treating painful sex. Fear of pain, anxiety and stress can cause involuntary spasms making penetration painful. Past experiences of sexual abuse, relationship problems and low self esteem can also affect a person’s sex life and overall wellbeing.

Desensitisation therapy, sex therapy and counseling can help individuals overcome emotional barriers and improve their sexual health. Open communication with healthcare providers and partners is key to addressing emotional factors and developing treatment options. By acknowledging the emotional aspects of dyspareunia individuals can work towards reducing pain, improving their sex life and overall quality of life.

Relationships and Sexual Health

Dyspareunia can have a big impact on relationships and sexual health leading to sexual pain and intimacy issues. It can lead to avoidance of sex, intimacy issues and relationship problems. Individuals with dyspareunia may experience emotional distress, anxiety and low self esteem which can exacerbate the condition. Dyspareunia can also affect a person’s sexual desire, arousal and overall sexual function. It’s important to address the emotional and psychological aspects of dyspareunia to get effective treatment and management.

See a GynaecologistYou should see a specialist if you experience:

• Persistent pain during sex or after sex

• New pain that wasn’t there before

• Bleeding during or after sex

• Associated symptoms like discharge, pelvic pressure or urinary problems

• Impact on your emotional wellbeing, relationships or self esteem

It’s important to discuss these symptoms with a doctor or healthcare provider to get proper diagnosis and treatment.

At Happiher, consultations are sensitive, supportive and pressure free — a safe space to talk openly. Doctors and healthcare providers play a big role in diagnosing and treating dyspareunia.

How Is Painful Sex Diagnosed?

A thorough diagnosis is key to finding solutions. According to the American College of Obstetricians and Gynecologists a thorough diagnosis is key to finding solutions for dyspareunia. A physical exam and other tests are important in the diagnostic process to get a full understanding of the underlying issues. After treatment a 24 month follow up is recommended for best results in dyspareunia management.

At Happiher your assessment may include:

• Detailed consultation about symptoms, menstrual history, sexual history and emotional health

• Pelvic examination (if you’re comfortable)

• Pelvic ultrasound to assess uterus, ovaries and surrounding structures

• Other tests may be done to rule out other conditions as part of a differential diagnosis.

• Swabs or tests if infection is suspected

• MRI scan in complex cases (e.g. suspected deep endometriosis or adhesions)

The goal is to understand not just where the pain is but why it’s happening.

Treatment Options for Painful Sex

There is no one size fits all solution — treatment is always individualised. Various methods can be used to treat dyspareunia.

Options may include:

Medical Treatment

• Hormonal therapies (e.g. vaginal oestrogen creams or tablets for dryness)

• Antibiotics or antifungal treatments for infections

• Pain management strategies

• Use of personal lubricants to enhance natural lubrication and comfort during sex

Pelvic Health Physiotherapy

• Specialised exercises and therapy for vaginismus or pelvic floor dysfunction

Minimally Invasive Surgery

• Laparoscopic or robotic assisted surgery for conditions like endometriosis or adhesions* Fertility preserving and recovery focused surgical care at Happiher

Psychological Support

• Counselling or therapy for anxiety, trauma recovery or relationship dynamics

• Cognitive behavioural therapy (CBT) for chronic pain management which has shown promising results in reducing anxiety related to dyspareunia

• Dyspareunia can be treated through a combination of physical and psychological approaches

The solution may involve a combination of physical, emotional and relational care — and that’s exactly what we do at Happiher.

Self-Care and Relief

There are many self-care measures and relief techniques that can help with dyspareunia symptoms. These include using personal lubricants, relaxation techniques and mutual masturbation as an alternative to sex. Dryness a common cause of dyspareunia can occur at any age and can be treated. People with dyspareunia can also benefit from sex therapy, desensitisation therapy and pelvic floor physical therapy. Home remedies like warm baths and sensual massage can also help. It’s important to talk openly with a doctor or healthcare provider about symptoms and concerns to get the right treatment. By addressing the underlying cause of dyspareunia and incorporating self-care measures people can reduce pain, improve their sex life and overall wellbeing.

Why Choose Happiher for Dyspareunia Treatment?

If you’re looking for expert help with painful sex in London Happiher offers:

• Private, sensitive consultations in a discreet setting

• Specialist diagnostic imaging and assessment

• Expertise in minimally invasive and robotic assisted gynaecological surgery

• Access to trusted pelvic health physiotherapists and psychologists

• Access to pelvic health physiotherapists who specialise in pelvic floor muscles

• A woman centred non-judgmental approach at every step

Our multidisciplinary approach involves collaboration with healthcare providers including gynaecologists, pain management experts and mental health professionals to get you the care you need.

We see you, hear you and work with you to find long term solutions.

Conclusion

Pain during intimacy is never something you should suffer. Whether the cause is physical, emotional or both expert help is available — and relief is possible.We see you through.