Dyspareunia – what is it and how is it treated?

Symptoms of dyspareunia

The main symptom of dyspareunia, regardless of gender, is pain during sexual intercourse of varying intensity , causing great discomfort. In women and people with a vagina, it can:

• be located in the vaginal vestibule ( shallow dyspareunia ),
• be located in the vault inside the vagina ( deep dyspareunia ),
• involve the entire vagina ( generalized dyspareunia ).

The fear of pain during intercourse, difficulties with vaginal penetration or increased tension in the pelvic floor muscles may also contribute to the diagnosis .

Depending on the cause, the pain manifests itself during the first sexual intercourse ( primary dyspareunia ) or at any time during intercourse ( secondary dyspareunia ).

Dyspareunia can also be divided by frequency . When pain occurs during every sexual encounter, it is called continuous dyspareunia , while when pain is experienced only in specific sexual positions, it is called sporadic dyspareunia .

Causes of pain

Wondering where that pain during intercourse comes from? There are many causes of dyspareunia, and they involve both physical and psychological problems. The most common physical causes include:

• abnormal structure of the organs (e.g. underdevelopment of the vaginal vestibule, fibrous hymen),
• endometriosis , ovarian cysts and other pelvic diseases,
• side effects of procedures such as radiotherapy or caesarean section ,
• inflammation of the genital organs,
• vulvar and vaginal infections and urinary tract infections,
• hormonal disorders (e.g. postmenopausal atrophy),
• vascular and neurological diseases,
• sexually transmitted diseases,
• allergies,
• vaginal dryness .

In the case of psychological causes, pain during intercourse may be caused by anxiety disorders , depression , excessive stress , low self-esteem and past events, such as unsuccessful sexual intercourse or abuse .

It can also be caused by issues related to the partner relationship, such as a lack of emotional closeness or a misunderstanding of sexual needs .

We recommend our article: " How to talk about sex with your partner? ".

However, if organic causes of dyspareunia are excluded, we are dealing with so-called provoked vulvodynia .

How to diagnose?

The most important thing is to diagnose the cause of dyspareunia. To do this, you will need to visit various specialists: a gynecologist/urologist, psychiatrist, psychologist, sexologist, and physiotherapist.

It is best to start diagnosing pain with a gynecological/urological consultation. The doctor will conduct an interview and a physical examination. During the interview, the doctor will ask about the exact location of the pain , the time of occurrence and the frequency . He may order ultrasound examinations and laboratory tests to determine the concentration of hormones and the carrier of sexually transmitted diseases (or he will perform a culture of the organs).

Regardless of the diagnosis, it is recommended to visit the other specialists listed above. Pain complaints are often of mixed origin , meaning that several sources occur at the same time.

How to treat?

The most commonly used treatment methods include pharmacological methods (e.g. hormonal therapy), surgical methods (surgical procedures in the case of anatomical defects) and therapeutic procedures, including individual or couple psychotherapy .

Regardless of the type of dyspareunia, urogynecological physiotherapy is also recommended . Its goal is to restore the proper functioning of the pelvic floor muscles - disrupted by pain or excessive tenderness of the genitals. During physiotherapy, the specialist will select the appropriate technique depending on the source of the condition. This may be manual therapy , breathing exercises coordinated with the work of the pelvic floor muscles, or even learning to maintain proper body posture .

There is no reason to be ashamed

People who experience pain during intercourse often downplay the problem, are afraid of examination or are ashamed to go to the doctor due to the intimate nature of the condition. This is a big mistake! Pain during intercourse is NOT something to be ashamed of , and every year in doctors', physiotherapists' or psychotherapists' offices dyspareunia is diagnosed in many patients. According to research conducted by Ingela Danielsson in 2003, as many as 13% of women between the ages of 20 and 29 suffer from it.

It is worth overcoming your fear as soon as possible and finding the cause of the dysfunction as soon as possible, because if left untreated, it can intensify current symptoms and even contribute to the development of new ones. However, if cured... it allows you to enjoy sex. So if you haven't been diagnosed with dyspareunia yet, it is high time to visit a specialist.

E. Baszak-Radomańska, M. Jantos, Vulwodynia - state of knowledge for 2017 , "Sexuologia Polska" 2017, vol. 15, no. 1, pp. 27-33.
I. Danielsson, I. Sjöberg, H. Stenlund, M. Wikman, Prevalence and incidence of prolonged and severe dyspareunia in women: results from a population study , "Scandinavian Journal of Public Health" 2003, vol. 31, i. 2, p. 113-118.
A. Drosdzol-Cop, R. Stojko, K. Skowronek, D. Sowa, Female sexual disorders associated with pain , "Forum Położnictwa i Gynecologii" 2020, no. 55, https://www.forumginekologii.pl/artykul/zaburzenia-seksualne-kobiet-zwiazane-z-bolem [online access from 22/03/2022].
G. Jarząbek-Bielecka, D. Radomski, M. Mizgier et al., Dyspareunia and painful menstruation in women with endometriosis – clinical observations on the use of dienogest , "Current Gynecologic Oncology" 2014, vol. 12, no. 4, pp. 272-273.
Pain-related sexual disorders , [in:] Sexology , ed. M. Lew-Starowicz, Z. Lew-Starowicz, V. Skrzypulec-Plinta, Warsaw 2017, pp. 978-983.