Is Painful Sex Affecting Your Relationship?

The journey from ‘ahh’ to ‘ouch’ while having sex is unwelcome but not uncommon. Studies show that millions of people worldwide (3%-18%) experience discomfort during intimacy. What starts as physical pain can quietly reshape your relationship with your body — and your partner. But here's the thing: painful sex doesn't have to be your normal. Opening up about dyspareunia (the medical term for painful intercourse) might feel vulnerable, but it's often the first step toward reclaiming your intimate life. 

What is dyspareunia?

Let’s define dyspareunia in the simplest way. Pronounced as 'dis-Pah-ROO-nee-uh', it is the recurrent or persistent pain that one experiences before, during, or after having sex. The pain may linger or subside right after. 

Usually seen in women, painful intercourse can be an issue in men too. The biggest aftermath of this rarely-discussed aspect of sexual health is likely to be the mental anguish and poor self-image related to it. 

Dyspareunia can be superficial/primary or deep/secondary. Superficial dyspareunia is limited to the vaginal entrance (vulva), but the deeper variation affects the innermost areas of the vagina and the lower pelvis region. It happens only after deep penetration. 

While experiencing discomfort right from the beginning of sexual intercourse is called primary dyspareunia, if the pain starts after some time, that is termed secondary dyspareunia.

If you have been having pain in and around your vulva for three months or more, with or without sexual intercourse, then this is medically known as vulvodynia. Though used interchangeably by many, dyspareunia is different from it. Vulvodynia often has no clear cause, while dyspareunia usually has identifiable triggers we can address.

Understanding the causes of dyspareunia 

Figuring out the root cause of dyspareunia is key to treating it. From pelvic floor dysfunction and shifting hormones to emotional factors, painful sex has many reasons. Some of the causes of dyspareunia include:

• Structural issues in the genitalia: Dyspareunia can stem from various anatomical and physiological issues, including pelvic floor muscle dysfunction, uterine retroversion, hymenal remnants, and pelvic organ prolapse.

• Vaginal dryness (lack of lubrication): This is common in reproductive years and can result from hormonal surges or sexual arousal disorders. The use of medications to prevent pregnancy in reproductive-aged females or poor oestrogen levels in post-menopausal women can contribute to this issue.

• Endometriosis: A condition where the internal tissue of the uterus is seen outside the uterus. Endometriosis-related deep dyspareunia may result from indirect contributors like bladder or pelvic floor dysfunction too.

• Skin problems and infections: Inflammation from regular skin issues like lichen planus, psoriasis, etc. can affect the genital region. Infections in the region, such as urethritis, vaginitis, and pelvic inflammatory disease, can also make sex painful.

• Postpartum trauma: Dyspareunia after childbirth is often linked to the trauma of the vaginal entrance during delivery or apprehension due to a healed incision. 

• Vaginismus: This condition, more common in younger women, involves involuntary pelvic floor muscle contractions during attempted vaginal penetration, hindering penetrative sex and causing pain. It can stem from pelvic floor dysfunction or deep-seated psychosocial issues like sexual abuse history.

• Overlap with other pain syndromes: Dyspareunia and vulvodynia (pain in the vulva with or without penetrative sex) may overlap with other conditions such as irritable bowel syndrome (IBS), fibromyalgia, etc.

Underreporting is the most significant pain point with pain during intercourse. Despite its prevalence, dyspareunia is considered a physical drawback, with many women not discussing it with healthcare providers. Here are some red flags to look out for if you've been experiencing painful intercourse for a while.

Symptoms and types of dyspareunia

Dyspareunia, or painful intercourse, comes in more than one form, and understanding the signs is the first step to finding relief. Here’s what you need to know.

Common symptoms include:

• Pain during penetration 

• Burning or aching sensations during or after sex

• Throbbing pain that can last for hours post-intercourse

• Emotional distress or anxiety related to sexual activity

• Tightening of vaginal muscles due to anticipated pain

Types of dyspareunia:

• Superficial dyspareunia: Pain at the vaginal opening, often caused by dryness, infection, or skin conditions

• Deep dyspareunia: Pain felt deeper inside during thrusting, possibly linked to conditions like endometriosis or pelvic inflammatory disease

• Primary dyspareunia: Pain present from the first sexual experience

• Secondary dyspareunia: Pain that develops after a period of pain-free intercourse

• Situational dyspareunia: Pain that only occurs in specific situations or with certain partners

• Generalised dyspareunia: Pain that occurs regardless of circumstances

What does painful sex feel like?

For instance, you might feel like the penis, tampon, finger, or toy is ‘hitting a wall,’ a barrier inside the vagina that stops anything from going further in. If pushed further, it initiates a stinging ache. This barrier is a contracted pelvic floor muscle inside the vaginal canal, causing vaginismus, a cause of painful sex.

When does it hurt?

The main symptom of dyspareunia is pain related to intercourse. However, the timing may vary. Some people may feel pain upon penetration (entry pain), while others may feel discomfort during deeper penetration or thrusting (deep pain). Knowing when the pain occurs is vital in diagnosing the condition.

What is the intensity of the pain?

The intensity of dyspareunia pain can range from mild discomfort to severe agony. None should be ignored. 

The pain can interfere with sexual enjoyment and intimacy, impacting the overall quality of life. Understanding how severe your pain is helps your doctor determine which tests to run and create the right treatment plan for you.

Are there any associated health issues?

If you have been suffering from transient or persistent pain during intercourse, it is best to consider whether you have other health conditions. Here we are pointing to issues that you may already have, like endometriosis, vaginal infections (such as vaginitis), hormonal imbalances (leading to vaginal dryness or atrophy), psychological factors (such as anxiety or history of sexual trauma), or the need to see a gynaecologist right away. 

Diagnosis of dyspareunia

A medical assessment for dyspareunia typically includes:

• Comprehensive medical history: Your healthcare provider may inquire about the onset of your discomfort, its location, sensation, and its occurrence with different sexual partners and positions. They may also explore your sexual history, surgical background, and childbirth experiences. It's essential to answer truthfully without letting embarrassment hinder you, as these inquiries offer insights into the underlying cause of your pain.

• Pelvic examination: During this procedure, your healthcare provider examines for signs of skin irritation, infection, or anatomical abnormalities. They may gently apply pressure to your genital and pelvic muscles to pinpoint the source of your pain. Additionally, a visual assessment of your vagina may be conducted using a speculum to separate its walls. It's worth noting that some individuals experiencing painful intercourse may also find pelvic examinations uncomfortable. You have the right to request the cessation of the exam if it becomes too painful.

Who’s at risk of dyspareunia?

Pain during sex isn’t just uncomfortable, it can point to deeper issues, both physical and emotional. While dyspareunia can affect anyone, some people are more likely to experience it.

Those at higher risk of dyspareunia include:

• Women going through menopause or hormonal changes

• Individuals with vaginal dryness or infections

• People with conditions such as endometriosis or fibroids

• Those who’ve experienced trauma or have a history of sexual abuse

• Individuals with anxiety, depression, or relationship stress

• Women recovering from surgery or childbirth

Treatment options will vary depending on the underlying cause of the pain. If an infection or medical condition is contributing to the discomfort, addressing that root cause may help relieve the symptoms. Additionally, reviewing and adjusting any medications that might be affecting vaginal lubrication could also improve the situation.

Lifestyle and home remedies to manage dyspareunia

• Change positions: If you experience sharp pain during thrusting, experimenting with different positions, such as being on top, may help. This position allows you to control penetration depth, potentially reducing discomfort.

• Communicate: Openly discussing what feels good and what doesn't with your partner is important. If you require a slower pace, communicate this need.

• Take your time: Extended foreplay isn't just about pleasure — it's about preparing your body for comfort, potentially reducing pain. Consider delaying penetration until you feel fully aroused.

• Use lubricants: Utilising a personal lubricant can enhance comfort during sex. It may be helpful to try various brands until you find one that suits you.

• Explore alternative intimacy: While vaginal penetration remains painful, exploring varied forms of intimacy with your partner can be beneficial. Activities such as sensual massages, kissing, and mutual masturbation offer enjoyable alternatives to intercourse that may be more comfortable and fulfilling.

Can men have dyspareunia?

Though the focus of painful sex is on women, men too can suffer from similar conditions. Research from urologists Wayne JG Hellstrom and Kenneth DeLay reveals that 1%-5% of men experience pain during sex. But the real numbers are likely higher — many men don't report these issues due to the stigma around male sexual health problems. 

Pain during sex in men primarily happens due to issues in the foreskin, penile yeast infections, STDs (sexually transmitted diseases), an episode of UTI (urinary tract infection), or more.

The final takeaway

Painful sex might not make for easy conversation, but it absolutely deserves your attention. Dyspareunia isn't something you should simply endure — think of it as your body's way of asking for help. Whether the root cause is hormonal, physical, or emotional, getting answers can be life-changing. Your comfort, pleasure, and overall wellbeing matter. And the best part? You don't have to figure it out alone.

Frequently Asked Questions

1. What is dyspareunia?

Dyspareunia refers to persistent or recurring pain during or after sexual intercourse. It can be felt at the vaginal opening, deep inside, or throughout the pelvic area.

2. Is dyspareunia only caused by physical issues?

No, it can be caused by both physical and psychological factors. Emotional stress, anxiety, or past trauma can contribute just as much as medical conditions.

3. Can vaginal dryness cause dyspareunia?

Yes, vaginal dryness, especially common during menopause, can lead to friction and discomfort during sex, making it a frequent cause of dyspareunia.