What Is Dyspareunia?

Overview

Dyspareunia is a medical term that refers to persistent or recurrent pain experienced during sexual intercourse. It can affect both AMABs (assigned male at birth) and AFABs (assigned female at birth) and is often associated with physical, psychological, or relational factors. The pain can occur before, during, or after sexual activity, ranging from mild discomfort to severe pain.

Physical causes of dyspareunia may include vaginal dryness, infections, pelvic floor muscle dysfunction, endometriosis, or certain gynaecological conditions. Psychological factors, such as anxiety, stress, or a history of sexual trauma, can also contribute to the condition. Additionally, relationship problems, communication issues, or lack of sexual arousal and lubrication can exacerbate the pain.¹

Types of dyspareunia

Pain during sexual intercourse can be classified into different types based on its underlying causes. Here are some common types of dyspareunia:

1. Superficial dyspareunia: also called entry pain or intraorbital dyspareunia, is characterised by pain near the entrance of the vagina or the perineal area. It is often caused by conditions such as vaginal dryness, infections, skin disorders, or injuries.²
2. Deep dyspareunia, also called collision dyspareunia, refers to pain felt deep within the pelvis during intercourse. It can be caused by certain gynaecological conditions, such as endometritis and pelvic congestion

Furthermore, dyspareunia can be categorised according to when the pain is experienced.

• Primary pain refers to pain that has developed since becoming sexually active, meaning pain was experienced from the first intercourse
• Secondary pain describes pain that arises after previously having painless sexual intercourse 
• Complete sexual pain is pain that is endured after every sexual intercourse
• Situational pain only occurs on some occasions

Causes of dyspareunia

The causes of dyspareunia depend on whether it is superficial or deep. Psychological factors can also contribute to the pain.

Superficial dyspareunia

When it is superficial, it can be caused by many factors like:

• Vaginal dryness: this state results in a lack of lubrication and sexual arousal. The condition can be a cause of hormonal imbalances
• Injury and post-surgery trauma: these include childbirth tears, circumcision in AFABs or any other post-operative injury
• Infection and skin disorders: any infection in the genital area, such as one caused by a sexually transmitted disease (STD) like chlamydia, can cause painful sexual intercourse
• Vaginismus: this is when the vaginal muscles contract involuntarily due to stress or previous trauma

Deep dyspareunia

In cases of deep pain, causes of dyspareunia can be related to the following:

• Gynecological disorders: such as endometriosis, uterine fibroids, ovarian cysts or, pelvic inflammatory disease can cause pain in the deeper parts of the reproductive system
• Medical treatments: agents used for chemotherapy or radiotherapy can cause side effects that result in painful intercourse

In AMABs, painful sexual intercourse can be caused by foreskin tears, STDs, or any painful penile conditions.

Psychological factors 

Anxiety, depression, post-traumatic stress disorder (following sexual abuse), body image concerns and relationship problems are just some of the psychological factors that can contribute to the development of dyspareunia. Additionally, relational factors, like lack of emotional intimacy, poor communication, sexual incompatibility, and relationship conflicts, can also impact sexual comfort. Dyspareunia can result from a combination of these factors and identifying them is important for effective treatment. 

Signs and symptoms of dyspareunia

Dyspareunia symptoms can often be mistaken for a condition called vulvodynia. Therefore, it is important to distinguish between the two to understand your symptoms. The main difference between dyspareunia and vulvodynia lies in the location and timing of the pain. Dyspareunia specifically refers to pain during sexual intercourse, while vulvodynia involves chronic pain in the vulva, which may or may not be related to sexual activity.³

Symptoms of dyspareunia are as follows:

• Pain or discomfort during or after sexual intercourse
• Sexual pain at the vaginal entrance or deeper within the pelvis
• Sexual pain that is described as burning, sharp or aching
• Pain that may occur with penetration, thrusting or both
• Pain that can persist even after sexual activity ends
• Sexual pain that may be accompanied by vaginal dryness, itching and irritation

Diagnosis of dyspareunia

Diagnosing dyspareunia typically involves a comprehensive evaluation that includes a patient’s medical history, physical examination and possibly additional diagnostic tests.

• Medical history: The healthcare provider will ask you about your symptoms, their onset, and duration and also ask about any other associated factors. They may request information about your sexual history, previous medical conditions, surgeries, and if you are currently taking any medications
• Physical examination: a pelvic examination will be performed to assess for external and internal signs of genital infection, inflammation or structural abnormalities. This examination may include a visual inspection, palpation and an assessment of the pelvic floor muscles
• Pain assessment: the healthcare provider will evaluate the pain's location, severity and characteristics. They may use pain scales or questionnaires to assess the impact of pain on sexual functioning and quality of life.⁴
• Laboratory tests: a swab test of vaginal discharge can be made to check for any yeast infections that could be related to the experienced sexual pain. A blood test can check the levels of the hormone oestradiol, which is linked to certain sexual pain disorders¹
• Imaging or specialised tests: in some cases, additional tests may be required to diagnose dyspareunia. This can include a colposcopy, a technique used to observe the cervix and the vagina, an ultrasound, magnetic resonance imaging (MRI) 
• Psychological assessment: since psychological factors can contribute to dyspareunia, the healthcare provider may explore any emotional or psychological factors that may be influencing the pain experience. This may involve a psychological assessment or a referral to a mental health professional

It's important to communicate openly and honestly with your healthcare provider about your symptoms, concerns and any relevant information that can aid in the diagnosis. This will help them determine the underlying cause of dyspareunia and develop an appropriate treatment plan.

Management and treatment for dyspareunia

Treatment of dyspareunia depends on individual needs and on the presence of underlying. Hence, it is important to consult a healthcare professional before initiating treatment. Here are some examples of how this condition can be managed:

Medical interventions

This includes treating underlying conditions that cause vaginal dryness or hormonal imbalances with medication, prescribing topical agents to relieve pain and inflammation, undergoing pelvic floor therapy with a physiotherapist to relieve muscle contractions and administering hormonal therapy to alleviate any hormonal fluctuations.²

Psychological support

As psychological factors can contribute to the development of dyspareunia, counselling and therapy to address any anxiety and trauma around the condition can act as an effective treatment. Therapy can also highlight and help address relationship issues. 

Cognitive Behavioural Therapy (CBT) is another management technique that can assist in changing certain behaviours and avoiding negative thought patterns regarding sexual pain. It is the most recommended form of therapy for patients suffering from dyspareunia. 

Couples therapy is also helpful for improving communication, addressing relationship issues and finding solutions that work for both partners.

Lifestyle change

Finally, there are lifestyle changes that can be made to help with the condition, such as deep breathing exercises to help relax vaginal muscles, using lubricants and altering positions during sexual intercourse to avoid pain.

FAQs

Can dyspareunia be prevented?

Dyspareunia is characterised by superficial pain (caused by conditions like vaginal dryness) and is typically preventable with lifestyle changes. Yet, deep dyspareunia cannot always be prevented as it can be associated with gynaecological disorders.

How common is dyspareunia?

Between 3 and 18% of people are affected by dyspareunia worldwide.²

Who is at risk of dyspareunia?

Dyspareunia can affect individuals of any sex, but certain factors, such as vaginal dryness, hormonal changes, pelvic floor disorders, history of sexual trauma, psychological conditions, certain medications and certain medical conditions can increase the risk of developing the condition.

Can dyspareunia cause bleeding?

Any bleeding that might occur during sexual intercourse could be due to an underlying medical issue and not necessarily because of dyspareunia.

When should I see a doctor?

You should see a doctor if you experience persistent or worsening pain during sexual intercourse, as this could be a sign of an underlying medical condition that requires evaluation and treatment.

Summary

Dyspareunia refers to persistent or recurrent pain experienced during sexual intercourse. It can affect both AMABs and AFABs and has various causes. Physical factors, such as vaginal dryness, infections, hormonal imbalances and structural abnormalities, can contribute to the pain. Psychological factors, including anxiety, depression, past trauma and relationship issues, can also play a role. Your healthcare provider will diagnose dyspareunia with a thorough medical history, a physical examination and, sometimes, imaging and blood tests. Once diagnosed with dyspareunia, treatment is started. Treatment depends on the underlying causes and may involve addressing physical issues, such as infections or hormonal imbalances, through the use of medications or hormone therapy. Psychological support, such as counselling or therapy, can help address any emotional factors that may be contributing to the pain. Lifestyle changes, such as using lubricants or practising relaxation techniques, may also be beneficial. Open communication with healthcare professionals and partners is crucial for effective management of dyspareunia. With proper diagnosis and appropriate treatment, many individuals with dyspareunia can find relief and improve their sexual well-being.