Painful sexual intercourse (dyspareunia)

Painful Sexual Intercourse (Dyspareunia): Understanding the Causes and Finding Relief

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

At Happiher, we believe that addressing painful intercourse (known medically as dyspareunia) is just as important as treating any other aspect of gynaecological health. As a private gynaecologist in London, I provide a sensitive, expert approach to diagnosing and treating the underlying causes, helping women reclaim comfort and confidence.

Painful Sexual Intercourse: What Is Dyspareunia?

Dyspareunia refers to persistent or recurrent pain in the genital area during or after sexual intercourse. It is more common in women than men. The pain may 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 classified as primary, where pain starts at the beginning of sexual activity, or secondary, where pain develops after a period of pain-free intercourse.

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

Introduction to Dyspareunia

Understanding Sexual Health

Sexual health is a vital aspect of overall well-being, encompassing not only the physical but also the emotional and psychological dimensions of sexual activity. Painful intercourse, or dyspareunia, is a common issue that can affect both men and women, leading to significant distress and relationship problems. Understanding the causes and risk factors of dyspareunia is essential for effective treatment and management.

Several factors can contribute to 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 significant role in dyspareunia. By addressing both the physical and emotional aspects of sexual health, individuals can work towards reducing pain and improving their overall well-being.

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, while 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 it can be recurring or persistent.

Common Causes of Painful Intercourse

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 addressed. Some of the most common include:

Diagnosing dyspareunia is crucial to identify the underlying causes, which can be both physical and emotional.

Physical Causes:

• Endometriosis (causing 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 — making a holistic, empathetic approach essential.

Symptoms Associated with Dyspareunia

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

• Burning, stinging, or sharp sensations

• Pelvic cramping after intercourse

• Bleeding after sex (in some cases)

• Fear, tension, or anxiety around intimacy

Many women experience pain during intercourse, which can significantly impact their mental health. Patients with dyspareunia often hesitate to discuss their sexual dysfunctions with healthcare providers, which can delay diagnosis and treatment.

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

Women’s Health Considerations

Women’s health considerations are crucial when it comes to dyspareunia, as it is more common in women. The female reproductive system is complex, and various factors can contribute to painful intercourse. Hormonal changes, vaginal infections, and pelvic surgery are some of the common causes. Women with a history of painful sex 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 thorough physical exam, including a pelvic examination, 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 receive comprehensive care tailored to their specific needs.

Emotional Factors

Emotional factors can play a significant role in dyspareunia, and it is essential to address these factors when treating painful intercourse. Fear of pain, anxiety, and stress can contribute to 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 well-being.

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 vital for addressing emotional factors and developing effective treatment options. By acknowledging the emotional aspects of dyspareunia, individuals can work towards reducing pain, improving their sex life, and enhancing their overall quality of life.

Impact on Relationships and Sexual Health

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

When to See a Gynaecologist

You should seek expert advice if you experience:

• Persistent pain during sex or after intercourse

• New onset of 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 is important to discuss these symptoms with a doctor or healthcare provider to ensure proper diagnosis and treatment.

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

How Is Painful Intercourse Diagnosed?

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

At Happiher, your assessment may include:

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

• Pelvic examination (only if you’re comfortable)

• Pelvic ultrasound to assess uterus, ovaries, and surrounding structures

• Other tests may be conducted to rule out various 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 Intercourse

There is no one-size-fits-all solution — treatment is always personalised. 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

• The use of personal lubricants to enhance natural lubrication and comfort during intercourse

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

• Expertise at Happiher ensures fertility-preserving and recovery-focused surgical care

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 effectively treated through a combination of physical and psychological approaches

The right solution may involve a combination of physical, emotional, and relational care — and that’s exactly the holistic model we use at Happiher.

Self-Care and Relief

There are several self-care measures and relief techniques that can help alleviate dyspareunia symptoms. These include using personal lubricants, practicing relaxation techniques, and engaging in mutual masturbation as an alternative to intercourse. Dryness, a common cause of dyspareunia, can occur at any age and may be alleviated with appropriate treatments. Individuals with dyspareunia can also benefit from sex therapy, desensitisation therapy, and pelvic floor physical therapy. Home remedies, such as warm baths and sensual massage, can also provide relief. It is essential to talk openly with a healthcare provider about symptoms and concerns to determine the best course of treatment. By addressing the underlying cause of dyspareunia and incorporating self-care measures, individuals can reduce pain, improve their sex life, and enhance their overall well-being.

Why Choose Happiher for Dyspareunia Treatment?

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

• Private, compassionate 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 trusted pelvic health physiotherapists who specialise in pelvic floor muscles

• A woman-centred, non-judgmental approach at every step

Our multidisciplinary approach involves collaborative efforts of healthcare providers, including gynecologists, pain management experts, and mental health professionals, ensuring comprehensive care tailored to your needs.

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

Final Thoughts

Pain during intimacy is never something you should simply endure. Whether the cause is physical, emotional, or both, expert support is available — and relief is possible.

At Happiher, we help women move from pain to confidence, from confusion to clarity, and from isolation to empowerment — with expert care delivered with heart.