It is common to experience pain during penetrative sex. However, it doesn't always have to be painful. With disorders like dyspareunia, there is hope to recover and enjoy penetrative sex again fully. 

How prevalent is it?  A recent study showed that as much as 20% of females suffer from dyspareunia.

Dyspareunia and vaginismus are similar but not the same. While they both cause you pain during penetration, dyspareunia is caused by an underlying medical issue. 

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What is dyspareunia?

Dyspareunia is a general term for recurring pain within your pelvis or genitals during penetrative sex. The pain varies from sharp and intense to mildly bothersome. For some, it only happens during intercourse. For others, it can come on before sex has started or even occur after the fact.

The term is used to cover all forms of penetrative pain in the vagina. The pain isn't limited to intercourse. It could be around the use of tampons or even vaginal suppositories. 

In both the sexological and medical world, four different types of dyspareunia are recognized:

• Primary dyspareunia: 

  • You have never been able to experience penetration by an object or person and have always suffered from pain and discomfort.

• Secondary dyspareunia: 

  • You have been penetrated in the past, but objects can no longer penetrate you due to developments in life.

• Situational dyspareunia: 

  • The person may be able to experience certain types of penetration without pain or discomfort. But they experience pain during other circumstances.

• Complete dyspareunia: 

  • The person has a total inability to be penetrated without pain 

Symptoms of dyspareunia

The symptoms of vaginismus and dyspareunia are very similar. If you're worried that you suffer from one of these, make a note of your symptoms:

• Pain at the sexual entry of the vagina

• Pain in the vagina, urethra, or bladder

• Pain with penetration by a penis, fingers, toys, or tampons

• Burning or aching pain in the vagina

• Deep pain during thrusting

• Throbbing pain during or after penetration of any kind

• Difficulty or inability to insert a tampon

• Stabbing pain in the body similar to cramps

• Deep pain in the pelvis before, during, or after penetration.

The symptoms of dyspareunia will vary from person to person, but pain during penetration is the baseline symptom.

Potential causes of dyspareunia

Medicine has only recently started to study vaginismus and dyspareunia. Therefore, there is minimal understanding of what causes either. In the case of dyspareunia, there are primarily organic causes.

Organic causes imply that there is something diagnosable happening. Dyspareunia is a symptom of that organic cause. Therefore, to be correctly diagnosed with this sexual disorder, you may undergo some medical examinations. 

Physical causes of dyspareunia 

• Vaginal dryness can be caused by childbirth, menopause, or too little arousal before intercourse

• Skin disorders such as ulcers or anything that leads to itching, burning, or skin cracking

• Infections like a Urinary Tract Infection (UTI) or yeast infection

• Vaginitis or inflammation of the vagina

• Endometriosis

• Pelvic Inflammatory Disease  (PID)

• Genital warts

• Scarring

• Low estrogen levels

• Abnormal masses

• Radiation or chemotherapy

• Childbirth recovery

• A reaction to medications such as birth control pills or antidepressants

• Medical conditions such as cancer, arthritis, or thyroid disease

Emotional and psychological causes of dyspareunia

• Stress or anxiety in life or around sex leads the person's pelvic floor to "brace itself." 

• Self-image or body issues

• A history of sexual abuse or rape

• Interpersonal problems with a partner

• Shame, guilt, fear, or anxiety around sex or sexuality

• Fear of becoming pregnant or getting a sexually transmitted disease

Diagnosis of dysparuenia

You find yourself experiencing pain from intercourse. That pain before penetration, during, or after. Regardless, they could all be symptoms of dyspareunia. 

To learn which one you are suffering from, you'll need to speak to a gynecologist or medical doctor. 

You may be required to make multiple trips to specialists. This is because there is limited information and training available on these disorders. 

Before undergoing a pelvic inspection, your medical care provider may ask you questions such as:

• Where do you feel the pain?

• What activities cause you pain?

• Do any other activities cause you pain?

• Do you have any conditions that may be contributing to your pain?

• Have you ever been able to experience penetration?

During a pelvic check, remind whoever is performing it to go slow. You may need to move around and adjust yourself to get comfortable with the speculum. Try moving on your side or simply removing your feet from the stirrups. Whatever makes you comfortable.

If it is too painful to have the speculum inserted, you may ask your doctor for other tests you can have done. You can get similar lab results to start eliminating potential underlying causes. 

They may try to do some other tests such as:

• Allergy tests

• Urine tests

• Blood tests

• A pelvic ultrasound

• A culture test to check for bacterial infection or a yeast infection

Suggest coaching or counseling to identify any emotional causes

Treatments for dyspareunia

There are medical treatments for dyspareunia. These depend on what the underlying cause is. 

If you're suffering from an underlying infection, your doctor may provide you with antibiotics or corticosteroids.

If you're suffering from long-term vaginal dryness, then there are prescriptions or specialty lubricants available.

Your doctor may also suggest the following home treatments:

• Using water-based lubricants

• Waiting until you're relaxed to have sex with a partner

• Urinating before sex

• Communicating openly with your partner about your pain

• Taking an over-the-counter pain reliever

• Taking a warm bath before sex

However, these treatments rarely get to the heart of the cause of dyspareunia. 

Living with dyspareunia

It may take a while to learn the underlying cause of your vaginal pain from intercourse. That doesn't mean you should put a stop to your sex life completely! 

Keep things alive and fresh by trying some of these options:

• Make sure you're relaxed before any sexual contact. Try taking a bath, meditating, or going for a long walk.

• Insist on extensive foreplay. A vagina to be ready for sexual intercourse. It typically takes 15-20 minutes of full body massage and kissing. Then, a further 10-15 minutes of clitoral and vulva massage to experience vaginal tenting. So slow things down and take your time.

• Make sure to empty your bladder directly before and after sex. Doing this can also help prevent contracting a UTI.

• Apply an ice pack to your vulva after sex if you experience burning.

• Do Kegel exercises three times daily to make sure your pelvic floor is in shape.

• Don't forget about non-penetrative sexual options! Clitoral stimulation with fingers, a toy, or a tongue often brings more pleasure than penetrative sex does.

Many sources suggest trying to grit your teeth through the pain. 

Don't try and take over-the-counter pain relievers or using numbing creams to enjoy sex. When you feel pain, that is your body trying to communicate with you. If you silence it with numbing creams or pain relievers, you may experience harmful lasting results. 

Please don't ignore the pain and hope it goes away on its own. You may have something easily treatable! 

Can sex coaching help with dyspareunia?

In many cases, yes! 

Adding sex coaching to your recovery plan can be very helpful.

Through a combination of talk therapy and home assignments you may be able to achieve a full recovery. 

If you want to learn more about how sex coaching can help your dyspareunia, contact me today!

“If love can fade, then so can pain.”

— Fawaway

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