Dyspareunia: We need to talk about painful sex and what you can do about it

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  • Dyspareunia, when you experience pain during or after sex, is a common problem, especially for women going through menopause. It can also affect men.

    Almost one in 10 British women experience dyspareunia, according to an international study, by Royal College of Obstetricians and Gynaecologists. It can be caused by both physical and psychological factors, and affect all ages, but is most common in women in their 50s and 60s.

    What is ‘dyspareunia’?

    “Dyspareunia is the technical term for painful or uncomfortable sexual intercourse,” says Dr Anne Henderson, gynaecologist and menopause specialist at the Kent Menopause Clinic. Pain or discomfort can be felt in a woman’s labial, vaginal or pelvic areas during, or immediately following intercourse.

    There are two different types of pain you may be experiencing:

    Superficial dyspareunia: “This is the term given to pain which is experienced in the vulva or vaginal region. The pain is not felt deep in the pelvis,” says Dr Henderson.

    Deep dyspareunia: “This is the term given to pain which is experienced within the pelvis. For example, around the bladder, ovaries or sometimes towards the lower back,” says Dr Henderson.

    Whichever kind of pain you experience, dyspareunia can have a huge impact on your emotional health and shouldn’t be ignored. Just because you are over 40 years old, it doesn’t mean you can’t have a fulfilling sex life. The most important thing to do is talk to a medical professional to get to the root of the pain and problem. Despite this, 60% of women surveyed said they had never discussed living with painful sex with their health care provider.

    How does painful sex manifest?

    • The most common symptom of dyspareunia is pain on entry and is often described as sharp or burning.
    • The second most common symptom of dyspareunia is deep pain.
    • Other symptoms include feelings of muscle spasms, pelvic cramping or muscle tightness.

    “The severity of pain caused by dyspareunia can vary significantly, but most women describe a burning or tearing, throbbing, cramping pains similar to menstruation and occasionally stabbing pain, which can extend from the pelvis to the vagina,” says Dr Henderson.

    “Many women will experience dyspareunia as a “one off”. If this is the case, it’s very unlikely to be caused by anything serious and does not require medical attention,” says Dr Henderson. Although it may be worth making a note of the circumstances incase this happens again at a later date.

    “Some conditions, however, are linked to persistent and repetitive dyspareunia,” says Dr Henderson. “Women in this category should seek medical attention from their GP initially. Feeling worried by pain? If pain is persistent for 6-12 weeks without improvement, you need to see your GP,” says Dr Henderson. Don’t worry – you’re never wasting your GP’s time.

     

     

    What causes painful sex?

    There are many reasons why sex becomes painful sex, depending on the cause.

    1. Dryness is the most common cause in menopausal and post-menopausal women but younger women can also experience it. During sexual arousal, glands at the entrance of the vagina produce fluids to assist intercourse. If you don’t produce enough fluid, this can lead to painful sex.
    2. It can also be caused by a lack of foreplay.
    3. Medications, including certain antihistamines.
    4. “Reduced lubrications leads to increased friction during intercourse. This causes microtears and fissures, leading to pain and bleeding,” says Dr Henderson.
    5. Involuntary spasms of the vaginal muscles can also cause painful sex. This is often due to psychological reasons.
    6. Inflammation is another big cause of painful sex. This is often the case when a woman or man has an sexually transmitted infection or something has caused irritation.
    7. Sometimes painful sex is caused by damage to the vagina after having a baby.
    8. It can also be due to ovulation.

    Issues that cause pain during sex and how to fix them

    1. Vaginal dryness

    “A wide range of problems can lead to vaginal dryness. This includes low mood or anxiety, vaginal infections and STIs, plus hormonal contraceptives such as the combined pill,” says Dr Henderson. “Women who are experiencing dryness will notice these symptoms. They may also be aware of generalised discomfort even when they are not sexually active.”

    How to fix it:
    “A diagnosis needs to be made before treatment to determine the most effective way,” says Dr Henderson. “If a women is using the combined pill and does not wish to stop, a high quality lubricant is recommended. “Lubricants should always be organic, paraben and fragrance-free. The best quality options are buys which include coconut oil and shea butter,” says Dr Henderson. “However, oil-based lubricants should not be used with condoms. And women should stick to water-based options, but also avoid any potential irritants.”

    2. Vaginismus

    This is the involuntary spasm in the vaginal muscles and is a very common cause of painful sex. “It involves an involuntary contraction of the strong pelvic floor muscles, usually upon attempted penetration. It makes intercourse impossible,” says Dr Henderson. “This happens at a subconscious level. It’s not something that a woman can necessarily control herself merely by trying to relax. True vaginismus makes any kind of vaginal examination or penetrative sex impossible and also very painful.”

    How to fix it: “Treatment usually includes extensive psychosexual therapy and and cognitive behavioural therapy (CBT),” says Dr Henderson. “Both of which need to be addressed by a skilled and experienced practitioner. Treatment includes finding out the initial case, which is usually a traumatic emotional or physical event,” says Dr Henderson. “It can include sexual abuse, sexual assault and other underlying psychological issues, including some religious issues.”

     

    3. Vulvodynia

    “Vulvodynia covers a wide range of unpleasant symptoms, including pain, burning and stabbing,” says Dr Henderson. “The most common point of pain is six o’clock at the entrance to the vagina. It used to be known as “Burning Vulva Syndrome” which accurately describes the type of symptoms women may experience. The condition is not fully understood but it is thought to be a neuropathic type pain. In simple terms, it can best be described as “faulty wiring” between the vulva and the brain.”

    “Causes generally include some form of acute or severe stress, which can be emotional, psychological or physical. You may not initially link the event to the subsequent development of vulvodynia. There may be a gap between the event and symptoms developing. Even a severe viral illness an result in vulvodynia. The exact link between the two events may not be obvious.”

    How to fix it: “Treatment options include counselling where necessary, topical steroids and pain-reducing drugs, such as Amitriptyline,” says Dr Henderson.

    “Women should also avoid any potential irritants, such as soaps, bubble baths, bath oils and intimate deodorants. I would recommend washing with bland products, such as colloidal oatmeal or emulsifying lotion.  Plus, women should also use organic pads and tampons. Chemicals used in processing synthetic sanitary towels can contribute to the irritation.”

    4. Vaginal infections

    “Vaginal infections are caused by a wide range of organisms including bacteria, viruses and yeasts,” says Dr Henderson. Some infections occur spontaneously due to hormonal and pH change, such as thrush. While some infections are sexually transmitted, such as chlamydia and gonorrhoea.  Painful sex can arise because of  inflammation in the pelvis and genital region. There may also be infected discharge, pus or even abscesses in severe cases.”

    How to fix it: “Some infections, such as thrush, can initially be treated with over- the-counter medications,” says Dr Henderson. “But always seek medical advice if symptoms do not resolve within seven days or if the problem recurs.” Think you have an STI? “Go to your local STD clinic, sometimes known as GUM (Genito-Urinary Medicine) clinics,” says Dr Henderson. “These clinics have access to quick onsite testing and results. Plus, they can prescribe suitable medication.”

     

    Two pairs of feet in bed, belonging to a man and woman. Painful sex is a common problem

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    5. Ovarian cysts

    These fluid-filled sacs on the ovaries often have no symptoms but when they rupture, they can cause pain and bleeding. “There are numerous different types of ovarian cyst,” says Dr Henderson. Most women form small cysts every month during ovulation. When these cysts bursts or disperse at the time of ovulation this can cause pain,” says Dr Henderson. “Pain generally only lasts for 24-36 hours at the most. Other ovarian cysts can occur due to accumulation of blood and fluid within part of the ovary. There are a high number of pain receptors and causes pain,” says Dr Henderson. “This pain will primarily be felt during sex but may also be present at other times as well.”

    How to fix them: “The vast majority of these cysts are benign and, if they are below 5cm in diameter, they tend to disappear spontaneously,” says Dr Henderson. “Some ovarian cysts are more sinister and in some cases can be either borderline or malignant, and will require surgical removal. Certain conditions, such as endometriosis, can also lead to recurrent ovarian cyst formation, typically known as chocolate cysts. This is due to the formation of thick dark brown material within the cyst, which is essentially congealed and oxidised blood. This condition will usually require a combination of hormonal treatment and surgery.”

    6. Fibroids

    These are growths on the uterus, which can cause heavy menstrual bleeding, pelvic pressure, pain and painful intercourse. “If the blood supply is good, they will continue to grow over months to years, and can reach a considerable size,” says Dr Henderson. “Why they occur is not fully understood, but they are generally benign and only a very small number turn cancerous,” says Dr Henderson. “These are known as sarcomas. Certain ethnic groups are more likely to suffer from fibroids than others. Fibroids often run in families and affect all female members,’ says Dr Henderson. “It’s thought to affect up to 20-25% of the population.”

    How to fix them: “Fibroids can be shrunk using certain types of hormonal treatment but in many cases will require surgery,” says Dr Henderson. “Nowadays. this is generally carried out by laparoscopic.”

    7. Pelvic floor dysfunction

    The pelvis floor muscles, the ones you tighten when you want to stop passing urine quickly, can become uncomfortably tight. This can lead to pelvic aches and pain on entry during sex.

    “The commonest cause of pelvic floor dysfunction (PFD) is childbirth,” says Dr Henderson. “This damages the pelvic floor muscles and can lead to a combination of laxity and scar tissue. Painful sex is rarely associated with this condition, although sex can become uncomfortable.”

    How to fix it: “Common therapeutic techniques include physiotherapy,” says Dr Henderson. “You may need surgery in more severe cases.”

     

    Psychological problems that may cause dyspareunia

    Stress, anxiety, depression, guilt, relationship problems and a history of sexual abuse can also cause pain during sex.

    “Emotions are deeply intertwined with sexual activity and may play a role in pain,” says Dr Henderson. “This can include a fear of intimacy, which can cause reduced lubrication. Even mild to moderate depression and anxiety can reduce lubrication.”

    “In some cases women have experienced a particular event which has led to vaginismus. This is where the pelvic floor muscles contract spontaneously when she attempts to have sex, making this impossible,” says Dr Henderson. “This could be something as serious as a sexual assault or rape. It could even be due to an unhappy relationship where sex became a difficult issue.”

    How to fix them: “A skilled counsellor will offer both individual and couples therapy,” says Dr Henderson. “Psychosexual therapy can be very effective. Unfortunately, in the UK, there is a definite lack of specialist practitioners in this field. There may be long waiting lists for women to obtain help. Going private? It is extremely important that anyone you see has the requisite qualifications. They need to be  a member of the Institute of Psychosexual Medicine (IPM).”

    Dyspareunia: We need to talk about painful sex and what you can do about it. Men have issues too

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    Why men feel pain during sex

     1. STIs

    “STIs can cause inflammation and skin irritation from a possible discharge from the penis,” says Dr Lucy Glancey founder of Dr Glancey Cinics. “A man may experience pain when peeing or notice lumps or skin growths around the genitals. They may also experience itchiness and possible blisters and sores depending on what kind of STI.” As some STIs have no symptoms, it’s always recommended to use protection, especially if you are having casual sex.

    How to fix it:  “Most symptoms can be extremely uncomfortable and need to be treated immediately to avoid any further infection,” says Dr Glancey. “In the first instance, visit your GP who will likely refer you to a sexual health clinic.”

     2. Foreskin problems

    “This is when the foreskin is too tight. It’s called phimosis,” says Dr Glancey. “When the penis is retracted it can cause small cracks that hurt but also they can cause soreness, swelling, become infected. A man may also have problems urinating.”

    How to fix it:  “Most cases of phimosis resolve before adolescence, but it’s possible for the condition to last into adulthood,” says Dr Glancey. “If it becomes a problem then seek advice from your GP.

    3. Deformities of the penis

    “Peyronie disease is a non-cancerous type of deformity which makes the penis bent to a certain degree. It can make intercourse difficult and painful,” says Dr Glancey. “This is due to fibrous scar tissue that develops on the penis and causes curved, painful erections.”

    How to fix it:  “Penises, of course, vary in shape and size, and having a curved erection isn’t necessarily a cause for concern. But if you’re worried seek advice from your GP,” says Dr Glancey.

    4. Allergy or Hypersensitivity

    “This can lead to itchiness and skin breakage, which can makes penetration painful, particularly when it may lead to an infection,” says Dr Glancey.

    How to fix it:If it doesn’t clear up after a couple of days you need to see your GP who can recommend a treatment.”

    5. Prostate glands

    “The prostate is a small gland, located in the pelvis, between the penis and bladder,” says Dr Glancy. “Very enlarged or inflamed prostate gland can make intercourse painful. You may also find it difficult to pee or have a frequent urge to pee and difficulty emptying the bladder.”

    How to fix it: ““You may experience a frequent urge to urinate, blood in the urine or semen, pain or burning, pain or stiffness in the lower back, hips, pelvic or rectal area,” says Dr Glancey. “You need to see your GP immediately.”

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