Dyspareunia is a common sexual dysfunction involving pain during sexual activity. Treatment (and pleasure) is possible.
For many folks, sex can be super pleasurable. But for others, it can be physically painful — and mentally or emotionally taxing as a result.
If you’re one of many people who experience pain during sexual activity, you may be living with dyspareunia (dis-purr-OO-knee-uh). Knowing what it entails and how it typically presents among those who have it can offer you clarity, relief, and increased pleasure.
“Medically, the definition would be ‘painful intercourse’ but can be expanded to persistent or recurrent genital pain that occurs just before, during, or after [sexual] intercourse,” says Aleece Fosnight, founder of Fosnight Center for Sexual Health in Asheville, North Carolina, and medical adviser to Aeroflow Urology.
This sexual dysfunction is classified as a type of sexual disorder affecting females called “genito-pelvic pain/penetration disorder,” according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
There are different types of dyspareunia:
- superficial dyspareunia: limited to pain at the vulva or vaginal entrance
- deep dyspareunia: pain experienced during deeper vaginal penetration
- primary dyspareunia: pain at the start of sexual activity
- secondary dyspareunia: pain after extended sexual activity
Fosnight, a board certified physician assistant specializing in sexual medicine, urology, and women’s health, points out that people with vaginas who have sex with those who have penises are more likely to have painful sex.
Dr. Tamika K. Cross, a board certified OBGYN based in Houston and an adviser to retailer pH-D Feminine Health, says that the condition is common among people with different pelvic anatomies. Cross says transgender folks can experience dyspareunia, too, as a result of hormone therapy or surgeries.
Remember that penis-in-vagina penetration isn’t the only way to have penetrative sex. If you experience pain during any form of genital contact or sexual activity, you might have dyspareunia. And you’re not alone.
The most common symptoms of dyspareunia involve some form of pain or discomfort associated with sex, including:
- pain at vaginal opening
- pain along the vaginal canal
- pain with thrusting
- pain with superficial or deep penetration
- pain during orgasm
- pain with certain partners
- burning with penetration
- genital area throbbing after penetration
- sensation of tissues tearing
- lower abdominal pain
- rectal pain or discomfort
- vulvar and clitoral pain
- sexual arousal issues
But dyspareunia symptoms can also present outside of sex. Cross notes that pain can arise after sexual activity or genital contact has ended or when inserting a tampon or finger into the vagina.
There are also mental health effects of dyspareunia. A
“Not all dyspareunia presents the same, and not all dyspareunia is treated the same,” reminds Fosnight.
There are many different physical, emotional, and mental health-related causes of dyspareunia.
“Almost anything can cause dyspareunia, which is why it’s sometimes difficult to find a cause,” says Fosnight.
She notes that most causes include:
- a lack of understanding varied female sexual response cycles
- high pelvic floor muscles
- sexual trauma (including sexual assault, intimate partner violence, coercion, or trafficking)
- being in the mood but the body isn’t responding
- vaginal dryness (a side effect of lactation, menopause, anorexia, antihistamines or other medications)
- pelvic inflammatory disease
- interstitial cystitis
- ovarian cysts
- infections (sexually transmitted infections or urinary tract infections)
- birth defects
- neuropathy or paresthesias (due to spinal cord injuries, physical trauma, herniated discs, tarlov cysts, or pudendal neuralgia)
“Typically, [persistently tense] pelvic floor muscles are seen with the majority of my cisfemale patients, and past anxiety, trauma, or pain has caused a holding pattern,” says Fosnight.
The muscle memory of sexual pain may also be a critical factor in causing dyspareunia. When you have painful sex once, your body remembers and braces for pain the next time sex might happen. Fosnight explains that this tension causes the pelvic floor muscles to tighten rather than relax during penetration, which ultimately causes pain.
“Many healthcare [professionals] don’t validate a patient’s dyspareunia concern or chalk it up to being a ‘normal’ process during [a given] phase in your life,” she says. But “dyspareunia is a true diagnosis with multiple [origins] that need to be explored fully with each patient.”
If you experience genito-pelvic pain at any time, diagnostic testing can be a helpful step for determining the next steps.
Fosnight recommends seeking medical advice from a clinician who focuses on sexual medicine or pelvic health to begin the healing journey. Consider scheduling an appointment with any of the following experts:
- pelvic floor physical therapist
“Please remember that a mental health therapist or sex therapist may be able to suggest dyspareunia but not diagnose it,” she reminds. She also points out that not all healthcare professionals have specialized training to diagnose dyspareunia.
To receive a dyspareunia diagnosis, you’ll likely undergo the following testing process with a physician:
- sexual history evaluation
- consensual pelvic exam (focused on your abdomen, breathing, hip alignment, and vulva tissue)
- monomanual (one finger) exam
- genital cultures
- pelvic ultrasound, MRI, or CT scan
Rest assured that relief and pleasure are possible for folks who live with this condition. There are many ways to manage, cope with, and treat dyspareunia.
First, Cross notes that treatment depends on the cause of the pain. “For different reasons, there will be different treatment options and coping mechanisms.”
Depending on the cause and severity of your condition, you may find relief through:
- cognitive behavioral therapy (CBT)
- pelvic floor physical therapy
- using lubricant during sex
- breathing exercises
- hormone therapy
Although extra lube might help, keep in mind it isn’t always the answer. “Yes, research shows us that personal lubricants can improve sexual pleasure, but if you’re using the correct lube in the correct way and you still have pain, you don’t need more lube,” reminds Fosnight.
Whatever you do, don’t give up. Help is within reach. Fosnight reminds folks that there are professionals who can provide a diagnosis and treatment — and that treatment must be individualized to you and your needs.
Dyspareunia is a sexual dysfunction that occurs primarily among people with vaginas.
Symptoms typically include pain before, during, or after sex or genital contact. The causes can be physical, mental, or emotional (and the physical pain itself can negatively impact your mental health as well).
Understanding why you may be experiencing this pain can help you find relief and achieve a more pleasurable sex life.
“Know that you’re not alone and most reasons for this ailment are treatable, so always talk to [a] doctor about treatment options before just assuming this is how your body is and living with the pain,” says Cross.