Dyspareunia

Painful sex

If you're experiencing pain during or after sex, you're not alone. About 1 in 5 women, particularly those aged 18–24, experience pain with sex, but it’s often a topic that doesn’t get enough attention. This can leave you feeling frustrated, confused, or embarrassed.

The good news is that painful sex, also known as dyspareunia, is a common issue, and there are plenty of ways to manage and treat it. Whether it’s occasional discomfort or something that happens regularly, understanding the causes and exploring the right treatments can make a world of difference.

Symptoms & Treatment

What is Dyspareunia? (Painful Sex)

Dyspareunia is the medical term for painful sex, and the main symptom is exactly what it sounds like—pain during or after intercourse. But here's the thing: pain can feel different for everyone.

Some women experience a dull ache, while others might deal with sharp, burning, or even stabbing sensations. This pain can occur at the entrance of the vagina (superficial pain) or deeper inside (deep pain), depending on what's causing it. So, while it’s common, how it feels and where it happens can vary widely from one person to another.

Dyspareunia Symptoms

While painful sex can feel a little bit different for everyone, some common symptoms can include:

• Pain during penetration: This is often the first sign of dyspareunia and can occur immediately or after a few moments of intercourse.
• Persistent discomfort: Pain may linger after intercourse, making everyday activities uncomfortable.
• Pain in the lower abdomen or pelvis: Lower stomach pain after sex, or during, can occur, particularly if there’s a deeper cause like endometriosis or fibroids.
• Vaginal dryness: Often contributing to painful sex, dryness can make penetration more uncomfortable.
• Emotional distress: The pain of dyspareunia often comes with emotional distress too. It’s not uncommon to feel frustrated, anxious, or even sad about the discomfort. These feelings can add to the physical symptoms, making it all the more challenging to cope with.

If you’re experiencing any of these symptoms, it’s important to seek medical advice to help determine the cause and explore possible treatment options. Dyspareunia is treatable, and with the right support, relief is possible. Hazel offers personalised care and expert guidance to help you navigate your options and feel your best again.

Causes of Dyspareunia

Dyspareunia can have a range of causes, from physical conditions to emotional factors, and getting to the bottom of the issue is key to finding the right treatment. Whether it’s aching pain after sex or pain during sex, understanding the cause of your pain is the first step towards feeling better. Here are some of the most common culprits:

•  Infections and Irritations
  • Yeast infections: These can cause itching, burning, and discomfort during sex.
  • Urinary tract infections (UTIs): These can lead to pain during intercourse, often accompanied by a burning sensation when urinating.
  • Sexually transmitted infections (STIs): Certain STIs, such as chlamydia or gonorrhoea, can cause pelvic pain and discomfort during sex.
    
    
• Vaginal Dryness
  Reduced lubrication can turn intimacy into a less-than-pleasant experience. Vaginal dryness often pops up during menopause, thanks to hormonal shifts, but it can also strike during breastfeeding or as a side effect of medications like antihistamines or antidepressants.
  
  
• Pelvic Health Conditions
  • Endometriosis: A condition where tissue similar to the uterine lining grows outside the uterus, often causing deep pelvic pain during sex. Endometriosis is a leading cause of pelvic pain during sexual intercourse. In fact, around 50% of women with endometriosis experience deep dyspareunia, which significantly impacts their quality of life.
  • Fibroids: Noncancerous growths in the uterus that can make intercourse painful.
  • Ovarian cysts: These can create a feeling of pressure or discomfort in the pelvic area.
    

• Vaginismus
  Vaginismus is a condition where the pelvic muscles involuntarily tighten during sex, making penetration painful or impossible. One 2015 study suggests that 3 in 4 women with vaginismus experience dyspareunia, and nearly 1 in 2 women with dyspareunia experience vaginismus.
  
  
• Vulvodynia
  Around 1 in 10 women are affected by vulvodynia, a chronic condition characterised by persistent vulval pain, often described as sharp, burning, or "knife-like." This pain can significantly impact sexual intercourse and cause painful sex.
  
  
• Hormonal Changes
  Hormonal changes during menopause, pregnancy, or breastfeeding can affect vaginal health and lubrication. This can lead to discomfort or pain during sex, turning an enjoyable experience into a challenging one.
  
  
• Pregnancy/Postpartum period: During pregnancy and in the postpartum period, changes in hormone levels, vaginal tissue, and pelvic floor muscles can make sex painful for some people.
  For example, 17% to 36% of women report experiencing dyspareunia at six months postpartum, with many attributing this discomfort to vaginal dryness, reduced elasticity, or muscle tension in the pelvic region.
  
  
• Emotional and Psychological Factors
  Emotional factors, such as past trauma, stress, anxiety, or relationship issues, can play a big role in painful sex. When you're feeling emotionally overwhelmed, it can lead to physical symptoms like muscle tension or vaginal dryness, making discomfort even worse.
  
  
• Physical Trauma or Injury
  Previous surgeries, childbirth, or pelvic injuries can result in lasting pain during intercourse.

Understanding the cause of your dyspareunia is the first step in finding the right treatment. A healthcare provider can help pinpoint the underlying issue and guide you toward effective solutions.

Dyspareunia diagnosis 

Figuring out the cause of painful sex (dyspareunia) is key to finding the right treatment. Since it can be triggered by a mix of physical, emotional, or psychological factors, getting to the bottom of it may require a thorough evaluation. Here’s what you can expect during the diagnostic process: 

• Medical History: Your doctor will ask about your symptoms, sexual health, and any other issues like vaginal dryness or pelvic pressure. 
• Physical Exam: A pelvic exam may be needed to check for infections or conditions like fibroids or endometriosis. Always remember: Your body, your rules. You can decide what exams you're comfortable with and ask your healthcare provider to explain everything before proceeding.
• Laboratory Tests: If an infection is suspected, your doctor might take samples to test for STIs, UTIs, or yeast infections. Blood tests can also check hormone levels, especially if menopause or breastfeeding is a factor.
• Imaging Tests: Ultrasounds or MRIs might be used if conditions like fibroids or cysts are suspected.
• Specialist Referrals: Depending on the results, you might be referred to a gynaecologist, urologist, or sexologist for further evaluation.
• Psychological Evaluation: If emotional factors like stress or trauma are at play, seeing a mental health professional, like one of our helpful Hazel psychologists, may be helpful.

The diagnostic process can take time, but it’s essential for finding the right treatment. Once a cause has been identified, your doctor can work with you to create a tailored treatment plan.

Dyspareunia treatment

Once you've been diagnosed with dyspareunia (painful sex), the treatment will depend on the cause. The good news? There are plenty of options, from medications to lifestyle changes and therapies that support sexual health. At Hazel, we’re here to guide you to the right solution for your needs. Here’s a quick look at some of the common treatments:

Medications

• Topical treatments: Lubricants or moisturisers can help with pain during sex caused by vaginal dryness or irritation. 
• Hormonal therapy: For pain related to hormonal changes, like during menopause, estrogen creams or tablets can restore moisture and elasticity.
• Pain relief medications: Over-the-counter pain relievers or prescriptions can help with discomfort, especially for conditions like endometriosis or pelvic inflammatory disease.
• Antibiotics/antifungals: If an infection is causing pain, antibiotics or antifungals can clear it up. 
• Local anesthetics: Numbing creams or gels, like lidocaine, can temporarily take the edge off, easing pain from conditions like vulvodynia or vestibulodynia.
• Anti-inflammatory agents: NSAIDs, like ibuprofen, can help reduce inflammation and pain from conditions like endometriosis or pelvic discomfort.
• Botulinum Type A (Botox): Botox isn’t just for wrinkles—it can also help relax pelvic muscles and relieve pain from vaginismus, making things more comfortable down there.
• Systemic Medications: For chronic pain during intercourse, medications like antidepressants, or antiepileptics (for nerve pain) can help manage underlying causes and keep discomfort at bay. 

Physical Therapy

• Pelvic Floor Physical Therapy: Pelvic floor dysfunction is a common cause of painful sex.
  
• Vaginal Dilators: Vaginal dilators are sometimes recommended for individuals with vaginal tightness or muscle spasms that cause pain during sex. These devices can help gently stretch the vaginal tissues to reduce discomfort. 

Psychology

• Sexology Counseling:
  For emotional or psychological factors contributing to painful sex, a sexologist can help you work through anxiety, stress, or trauma impacting your sexual health.
  If the source is physical, a sexologist can also help identify the root cause and recommend treatments or therapies to ease discomfort. Hazel’s qualified sexologist is available to help you achieve a more comfortable and fulfilling sexual experience.
  
• Cognitive Behavioural Therapy (CBT): Sometimes, dyspareunia is linked to emotional or psychological factors such as anxiety, trauma, or past negative experiences with sex. Cognitive Behavioural Therapy (CBT) is a proven treatment that helps people change unhelpful thought patterns and behaviours. If emotional or mental health issues are contributing to your pain, Hazel offers access to trained psychologists who can help you work through these challenges.
  
• Couples Counselling: If sexual pain is a challenge but your relationship itself isn’t the issue, couples therapy can still help you both navigate the emotional impact, improve communication, and find ways to support each other through it.

Lifestyle and Home Remedies

• Relaxation Techniques: Stress can make pain worse, so try mindfulness or deep breathing to reduce tension. 
• Regular Sexual Activity: It might sound counter-intuitive, but sometimes regular, comfortable sexual activity— even non-penetrative—can help relax the pelvic area. 
• Dietary Changes: A diet rich in antioxidants, healthy fats, and vitamins can help reduce inflammation and support pelvic health, improving comfort during sex. Omega-3s, vitamins D and E, and fiber can aid in hormone balance and tissue health, complementing other treatments.
• Avoiding Irritants: Harsh soaps and fragrances can irritate the vaginal area. Try to use gentle, unscented products to keep things comfortable.

Surgical options

• In rare cases where an underlying medical condition, such as fibroids or endometriosis, is causing pain, surgery may be necessary. Surgical options may include removing fibroids, treating endometriosis, or addressing other reproductive health issues. 

Alternative Therapies

• Acupuncture: Some people find relief from painful sex with acupuncture, a traditional technique that can help manage pain and improve comfort.
• Herbal Remedies: Herbs like evening primrose oil and calendula are believed to support vaginal health and reduce inflammation. These can be safe, evidence-based alternatives to complement your treatment plan.
  
• Medicinal cannabis: Cannabis-based treatments, including vaginal suppositories, may offer relief from pain during sex.  One study even found that most women using cannabis for sex-related pelvic pain reported pain relief, with 61% to 95.5% experiencing improvement.

When to See a Doctor for Dyspareunia (Painful Sex)

Painful sex doesn’t have to be your norm. Occasional discomfort can happen (we all have our off days), but persistent pain is a red flag and should be looked into by a professional. Some signs you may need to see a doctor about dyspareunia include:

• Persistent Pain: If the pain lasts for weeks or gets worse, it’s time to speak to a doctor. Ongoing discomfort could point to an underlying issue such as vulvodynia, vaginismus, or pelvic floor dysfunction, which needs attention​.
  
• Pain Interfering with Life: When pain starts affecting your daily life, relationships, or well-being, it’s time to seek help.
  
• Other Symptoms with Pain: If your pain comes with bleeding, unusual discharge, fever, or painful urination, don’t wait. These could be signs of an infection or sexually transmitted infections (STIs) that need immediate treatment.
  
• Post-Surgery or Postpartum Pain: If you've recently had surgery, a baby, or are going through menopause, discomfort can happen. But if it’s persistent, it’s worth a doctor’s visit for personalised advice. These situations can alter pelvic health, and ongoing pain could indicate an underlying concern like pelvic inflammatory disease or hormonal imbalances​.
  
• Difficulty with Intimacy: Pain is more than just a physical feeling — it can affect your emotional connection and anxiety around sex. If that’s happening, talk to a doctor or therapist to work through both the physical and emotional symptoms. 

At Hazel, we believe in a holistic approach to treating dyspareunia—addressing both the physical and emotional factors that may be contributing to your pain. Our team works closely with you to create a personalised plan that considers all aspects of your health, from physical therapy to emotional support, ensuring that you can regain a positive and healthy relationship with your body and your sexuality.

Prevention and Self-Care Tips for Managing Painful Sex (Dyspareunia)

Dyspareunia (pain during sex) isn't always preventable, but there are plenty of simple ways to reduce the risk. Staying hydrated, using condoms, and avoiding harsh products can help keep things comfortable. If dryness is an issue, a good lubricant can be a game-changer.

Keep your pelvic floor in check with Kegel exercises or yoga, and consider pelvic therapy if the pain’s more persistent. Don't forget your mental health – stress and anxiety can make things worse, so try some relaxation techniques and, if needed, talk to a therapist. Taking these steps can make a big difference in your sexual health and comfort..

Does Dyspareunia (painful sex) go away?

The answer really depends on what's causing it. If the pain is due to something like an infection or hormonal imbalance, treating that can often clear things up. For more chronic conditions like vulvodynia or endometriosis, you may not get a complete cure. But don't despair—there are plenty of ways to manage the pain. A mix of treatments, including medication, physical therapy, and lifestyle tweaks, can make a big difference.

It may take time, but most people find relief and figure out how to manage things with the right care. With the right support, you don’t have to “just live with it”. There are options out there to help you feel more comfortable and enjoy intimacy again.

How to talk to your partner about painful sex

Talking about painful sex doesn’t need to be a taboo subject—it’s about being open and fostering understanding. Start by picking a relaxed moment to discuss it, and approach the conversation with care. Let your partner know it’s not about them but about your experience and your health.

Using “I” statements can help, like “I’ve been feeling discomfort during sex, and I need to figure out what’s going on.” This avoids sounding accusatory and makes the conversation more about your well-being.

It’s also important to invite your partner into the process. This could mean brainstorming together about potential solutions, like seeing a healthcare provider, using more lubrication, or finding alternative forms of intimacy that feel better. Acknowledge that this might take time and patience, but that you're in this together. A supportive, non-judgmental approach will help both of you feel more connected.

Dyspareunia in a nutshell: Finding Relief with Hazel

Painful sex isn’t something you should just accept—there are treatments that can help. Whether caused by physical factors like infections or conditions such as endometriosis, or emotional factors like trauma or stress, there are ways to manage and reduce discomfort. Treatment options range from medications to therapy and self-care practices, and the prognosis can be positive with the right approach.

At Hazel, we are committed to supporting your sexual health journey. Our team provides expert guidance and personalised care plans, helping you find the right solutions for your unique situation. Don’t let pain stand in the way of your sexual wellbeing—you’ve got this!

Dyspareunia FAQs

Why does it hurt when I have sex?

Pain during intercourse (dyspareunia) can happen for many reasons, like vaginal dryness, infections, or conditions like endometriosis. Emotional factors like stress or past trauma can also play a role. It’s not something you should ignore, so reach out to a healthcare provider who can help you figure it out and start feeling better.

What causes pain during intercourse?

Several factors can cause pain during intercourse, such as pelvic conditions like endometriosis, vaginal infections, hormonal changes, or pelvic floor dysfunction. Emotional causes like anxiety or past trauma can also play a significant role.

How can I stop the pain during sex?

First step, don’t suffer in silence! Treatment depends on what’s causing the pain, but options can include using lubricants, pelvic therapy, or medications. If emotional factors are involved, therapy might help. Your healthcare provider will work with you to find the right treatment for you.

Is pain during intercourse normal?

Pain during sex is common, but it’s definitely not normal, and it’s certainly not something you should just accept as part of life! It’s important to figure out what’s causing the discomfort and get the right treatment. No one should be dealing with painful sex regularly—get the care you deserve

What are the symptoms of painful intercourse (dyspareunia)?

Symptoms of dyspareunia can be a little bit different to each person, but can include pain during penetration, discomfort after sex, or pain during or after intercourse. Sometimes it’s described as sharp, burning, or aching pain that affects your ability to enjoy sexual activity.

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