What’s dyspareunia? Causes of pain during sex

TL;DR: Dyspareunia is defined as pain with sex that has lasted at least three months. It can leave people feeling confused and isolated, especially if it isn’t talked about openly. Today, let’s dive into dyspareunia: what causes it, how it can be fixed, and considerations for folx with endo.

Do you remember the first time you saw a sex scene on TV? The red roses, the candles, the lights, the perfect people who had a perfectly perfect experience…

It’s hard to imagine that awkward, painful sex could ever happen in such an idealistically romantic moment. However, while pop culture would have us believe differently, pain with sex is more common than you may think.  

In the U.S., up to 20% of people with vulvas experience dyspareunia: The medical term for painful sex.¹

The expanded definition of dyspareunia includes pelvic or vaginal pain that happens before, during, or after sexual intercourse.  

This is distinct from another condition called vulvodynia, which is a general pain in the genital area that comes and goes. Vulvodynia can be, but isn’t always, associated with sex.

Before we go any further in this conversation, let’s take a beat to address the elephant in the room. How do you pronounce dyspareunia?

Like with many things, it depends where you are and is somewhat of a caramel-caramel situation. But, the most common way to pronounce this word is:

[DIIS-puh-roon-yah]

The word has its origins in Ancient Greek: dys=bad, pareunia = sexual intercourse. Now that we know how to pronounce it, let’s discuss it.

Why does it hurt when I have sex? What causes dyspareunia

If you’re sitting and wondering “why does sex hurts all of a sudden?”, we’re here to tell you dyspareunia can happen for a number of reasons:

Psych 101

Your psychological state truly has an impact on how you experience sex, which makes sense. So much of sexual experience is based on context, whether it’s your underlying mindset or your relationship with your partner. Oftentimes, there can also be a psychological thread that is affecting one’s perception of a sexual experience.

Conditions like sexual aversion disorder or hypoactive sexual desire disorder have been linked with involuntary vaginal spasms during sex (Vaginismus).² Taken together, this can produce discomfort that leads to pain during sex (dyspareunia).

Your psychological mindset affects physical arousal by triggering pleasure centers in the brain. Signals travel down the spinal cord when aroused,³ stimulating the Bartholin’s glands to produce lubrication.That’s right, your body self-produces lube (and at less than the retail price).

If you are unable to be adequately aroused — then you won’t produce natural lubrication endogenously. This can result in more friction and irritation with sex.

Of course, while psychological reasons can influence dyspareunia, they are by no means the only cause of your pain. There are also several structural reasons why women experience painful intercourse.⁴

The most common causes of painful intercourse

What other factors can cause dyspareunia? Here’s what the research tells us:

• Vaginitis, which is a general term for irritation in the vagina
• Dermatosis, or inflammation in the skin of the vagina
• Vaginal dryness or low vaginal lubrication
• Vaginal changes post-childbirth
• Vaginal atrophy, which is when the vaginal walls thin over time
• Ovarian cysts
• Yeast infections, other vaginal infections, or STDs

Some more serious causes include:

• Endometriosis (more on this later)
• Uterine fibroids
• Pelvic inflammatory disease (PID)
• Pelvic adhesions

Research shows that women on birth control pills may experience decreased sex drive, arousal, and an increased risk of dyspareunia due to vestibulitis and vaginal dryness.⁵

Before immediately jumping to conclusions, these are just some of the many potential causes of dyspareunia. Experiencing pain during sex doesn’t necessarily mean you have one of these things.  

Dyspareunia is a complex pain syndrome that can have more than one cause. It’s helpful to understand some of the physical mechanisms involved, to know that dyspareunia is a real condition.

If you experience discomfort during or after sexual activities, contact your healthcare provider. Discussing these symptoms with your doctor is crucial for accurate diagnosis and treatment.

The difference between dyspareunia and deep dyspareunia

There are two main “types” of dyspareunia; they’re classified based on the location of the pain you experience during sex.⁶

Superficial dyspareunia is pain in the outside parts of the vagina, from the opening of the canal inwards.

Deep dyspareunia, on the other hand, is pain that is felt deep inside the vagina. It can be felt in the vaginal muscles, or even deeper within the pelvis. It can also feel like cervical pain, pain in the lower stomach, or even in the low back. Deep dyspareunia is also felt more commonly with deep penetration (but not always).  

Having one type of dyspareunia doesn’t exclude the other; individuals may experience both simultaneously.  

What are the symptoms of dyspareunia?

Dyspareunia can come in many shapes and sizes, but the core theme is pain associated with sex.⁷ That includes: 

• During initiation of sex
• During intercourse itself
• In the minutes to hours following sex 

It’s also important to mention here that dyspareunia isn’t an experience limited to male-to-female partner pairings. It can happen with any partner pairing, with or without penetration, and with different types of penetration or stimulation. 

The medical definition of dyspareunia also includes recurrence. To be diagnosed with dyspareunia, the pain you experience during sex must have happened more than once or be considered chronic.

Different organizations use different timelines to diagnose dyspareunia. Some say that the definition is chronic pain with sex that has persisted at least three months, others longer. But the technical timeline isn’t as important as how you’re feeling.

Dyspareunia pain can be sporadic but may signal an underlying gynecologic issue. Persistent pain during sex warrants a pelvic exam by a healthcare provider. 

Does dyspareunia go away on its own?

Dyspareunia may go away on its own, especially if it’s due to an underlying cause that resolves on its own. For example, if the pain was due to a local reaction from hair removal, it will probably go away once the irritation subsides.   

This sexual pain may require treatment, especially if it has been happening for a while, and has gotten worse over time.

How do you fix or address painful sex?

If dyspareunia doesn’t resolve on its own, then there are a couple of treatment options. What might those be? The short answer is that the treatment really depends on the cause.

A multifaceted approach to treatment takes into consideration the biological, psychological, and social factors that are related to the pain. This could entail:⁴

• Individualized pain management (i.e. prescription or non-prescription pain medication)
• Physical therapy targeted to your pelvic floor muscles, such as pelvic floor physical therapy or rehabilitation if you had a pelvic floor injury
• Mental health counseling, such as individual or partnered therapy
• Consultation with sexual health and wellness specialists
• Integrative or functional medicine (i.e. herbal and/or nutritional healing, medicinal cannabis, acupuncture, massage therapy)

Treating any underlying cause of the pain is also critical.

Dyspareunia and endometriosis

Studies have shown that there is a fairly strong link between dyspareunia and endometriosis. One estimate suggests that twice as many women with endometriosis report having deep dyspareunia, that can last throughout their sex lives.⁸

Pain with sex is often one of the first symptoms reported by folx before they receive an official diagnosis of endometriosis. For more background on endometriosis symptoms, treatment, and diagnosis, check out the Flex guide to endometriosis.      

Key takeaways: Dyspareunia & pelvic pain during sex

• Dyspareunia (DIIS-puh-roon-yah) is the medical term for pain with sex. It includes vaginal pain (also referred to as superficial dyspareunia) and pelvic pain (referred to as deep dyspareunia).
• Dyspareunia pain can come before, during, or after intercourse. It is often related to penetration but doesn’t necessarily have to be.  
• It is often diagnosed when this pain has lasted longer than three months with no relief. Speaking to a healthcare provider at the earliest sign of it is always a healthy choice.
• The condition sometimes resolves on its own, but it may also require a multifaceted approach to treatment. Therapeutics includes addressing any underlying gynecological issues, incorporating mental health counseling, treatment via medication for pain, and holistic/integrative medicine.

This article is informational only and is not offered as medical advice. It does not substitute a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician.

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