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.((Seehusen, D. A., Baird, D., & Bode, D. V. (2014, October 1). Dyspareunia in Women. American Family Physician. https://www.aafp.org/afp/2014/1001/p465.html.))
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 region 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).((Armstrong, C. (2011, September 15). ACOGACOG stands for the American College of Obstetricians and Gynecologists (a professional membership organization for obstetrician–gynecologists). Guideline on Sexual Dysfunction in Women. American Family Physician. https://www.aafp.org/afp/2011/0915/p705.html.)) Taken together, this can produce discomfort that leads to pain during sex (dyspareunia).
Your psychological mindset also interacts with what is physically happening down there. It all comes from the pleasure centers in the brain that send signals down the spinal cord when you’re aroused.((Azadzoi, K. M., & Siroky, M. B. (2010). Neurologic factors in female sexual function and dysfunction. Korean Journal of Urology. 51(7), 443–449. https://doi.org/10.4111/kju.2010.51.7.443)) Those signals stimulate the Bartholin’s glands in the vagina to begin secreting endogenous 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 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 reason. There are also several structural reasons why women experience painful intercourse.((Sorensen, J., Bautista, K. E., Lamvu, G., & Feranec, J. (2018). Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus. 10(3), e2379. https://doi.org/10.7759/cureus.2379))
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 of dyspareunia include:
- Endometriosis (more on this later)
- Uterine fibroids
- Pelvic inflammatory disease (PID)
- Pelvic adhesions
Research has found that women who take birth control pills may suffer from reduced sex drive and arousal. This goes hand in hand with an increased likelihood of dyspareunia due to vestibulitis and vaginal dryness.((Jean-Jasmin M.L. Lee, Lian Leng Low, Seng Bin Ang, Oral Contraception and Female Sexual Dysfunction in Reproductive Women, Sexual Medicine Reviews, Volume 5, Issue 1, 2017, Pages 31-44, ISSN 2050-0521, https://doi.org/10.1016/j.sxmr.2016.06.001. (https://www.sciencedirect.com/science/article/pii/S2050052116300221))
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 ever feel pain associated with sex (during, before, or after sex), contact your healthcare provider. It can difficult to discuss these symptoms, but it is important that your doctor gets the full picture.
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.((MacNeill C. Dyspareunia. Obstet Gynecol Clin North Am. 2006 Dec;33(4):565-77, viii. doi: 10.1016/j.ogc.2006.09.003. PMID: 17116501.))
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 of these types of dyspareunia doesn’t exclude you from having the other. Sometimes, individuals will 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.((When Sex Is Painful. ACOGACOG stands for the American College of Obstetricians and Gynecologists (a professional membership organization for obstetrician–gynecologists).. (2018, August). https://www.acog.org/womens-health/faqs/when-sex-is-painful.)) 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 come and go, and it may not have a rhyme or reason. However, it’s important to note that this kind of pain can be a warning sign of another underlying gynecologic disease. If you experience pain during sex that is persistent, reach out to a health care provider for a pelvic exam.
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 pain during sex?
If dyspareunia doesn’t resolve on its own, then there are a couple of options for treatment. 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:((Sorensen, J., Bautista, K. E., Lamvu, G., & Feranec, J. (2018). Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus. 10(3), e2379. https://doi.org/10.7759/cureus.2379))
- 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
- Mental health counseling, such as individual or partnered therapy
- Consultation with sexual wellness specialists
- Integrative or functional medicine (i.e. herbal and/or nutritional healing, medicinal cannabis, acupuncture, massage therapy)
Treating any underlying cause for the pelvic pain is also so 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.((Witzeman, K., Antunez Flores, O., Renzelli-Cain, R. I., Worly, B., Moulder, J. K., Carrillo, J. F., & Schneider, B. (2020). Patient-Physician Interactions Regarding Dyspareunia with Endometriosis: Online Survey Results. Journal of Pain Research, 13, 1579–1589. https://doi.org/10.2147/JPR.S248887))
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.
- Dyspareunia 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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