Condition: Dyspareunia

Dyspareunia is the medical term used to describe pain during or after vaginal intercourse, on the vulva, inside the vagina or in the uterus or pelvis. It’s a common problem that affects women.

You may feel embarrassed to talk to a health specialist about this condition, but your symptoms can be a sign that something is wrong, so it’s important to speak to a specialist and seek treatment.

Dyspareunia can be caused by physical and/or psychological problems.

Physical causes depend on whether the pain occurs upon initial penetration (entry) or with deep thrusting.

Entry pain may happen as a result of:

• Poor lubrication due to lack of foreplay or reduced oestrogen levels after menopause or childbirth or during breastfeeding

• Taking certain medications such as antidepressants, high blood pressure drugs, sedatives, antihistamines and certain birth control pills

• Injury, trauma or irritation from an accident, pelvic surgery, female circumcision or an episiotomy

• Inflammation, infection or a skin disorder such as a urinary tract infection (UTI), thrush, a sexually transmitted infection (STI) or eczema

• Irritation due to an allergy to latex condoms or certain hygiene products

• A condition called vaginismus where the muscles of the vaginal wall spasm

• A congenital problem such as vaginal agenesis or an imperforate hymen

Deep pain can be worse in certain positions and may be caused by:

• Certain illnesses and conditions such as endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, pelvic floor dysfunction, adenomyosis, haemorrhoids and ovarian cysts

• Surgeries or medical treatments such as hysterectomy, radiation and chemotherapy

Feelings and emotions play a large role in intercourse, so they can also contribute to sexual pain.

Emotional factors that may cause dyspareunia include:

• Psychological problems such as stress, anxiety, depression, poor self-esteem or fear of intimacy

• Relationship issues

• History of sexual abuse or trauma

It can sometimes be difficult to identify the cause of dyspareunia as the physical and emotional factors that can cause it can be so intertwined. For example, the initial pain may be caused by a physical problem, which then leads to fear of pain during intercourse, which can cause more pain.

Your specialist will be able to make a diagnosis of dyspareunia based on your medical history, symptoms and a physical examination.

To identify the cause of the condition and make the best possible recommendation for treatment, your specialist may also need to perform some tests including:

• A pelvic exam, rectal exam and smear test

• Swabs of vaginal fluid and urine collection to test for infection

• Transvaginal ultrasound

• Laparoscopy

The most common symptom of dyspareunia is pain at the opening of the vagina or pain deep in the pelvis. One small area can be affected, or you may feel pain in your entire genital region.

If you have dyspareunia you may experience:

• Sharp pain upon or during penetration

• Deep pain during thrusting

• A throbbing or aching feeling after intercourse

• Burning

• Cramping in your pelvic area

• Spasms or muscle tightness

The best treatment for dyspareunia depends on the cause. If an underlying condition such as endometriosis is contributing to your dyspareunia, appropriate treatment can help reduce your symptoms. Medications can be used in some cases to treat conditions such as thrush or an STI.

Where poor lubrication is an issue, it can help to spend more time on foreplay, use a water-based lubricant or have treatment for low oestrogen levels in the form of oestrogen creams, tablets, rings or other medications.

If you have an allergy or irritation around your genitals, it’s important to stop using the products that could be causing it and wait until your skin has healed before having intercourse again.

If the cause of your dyspareunia is psychological, counselling, sex therapy or cognitive behavioural therapy (CBT) may be helpful.

Vaginal Dilator Therapy

Vaginal Dilator Therapy can help women diagnosed with complex issues resulting in sexual dysfunction, and is offered at our Women's Health centre. Vaginal dilators (a plastic or silicone tube) are provided to those who experience conditions such as dyspareunia, as it helps to stretch the vagina or vulval area overtime. Our Clinical Nurse Specialist will advise you on how to use the dilator, as well as what size you should be using, which is in accordance with your needs.

This treatment can help those who are experiencing pain during or after intercourse, to enjoy penetration without any pain.