AH! YES®: Understanding Painful Sex (Dyspareunia): Symptoms, Causes, and Treatment

Painful Sex

Symptoms & Causes

Treatments & Professional help

Resources

Painful Sex

Symptoms & Causes

Treatments & Professional help

Resources

Painful sex, also known as dyspareunia, is a common condition that causes discomfort and pain during or after sexual activity. Here, we will delve into the symptoms, causes, and treatment options for painful sex, providing you with valuable information to address this issue and find relief.

Experiencing pain during sexual activity can be a challenging and distressing situation for both individuals and couples. It's important to recognize that painful sex is a treatable condition, and seeking professional assistance is essential for accurate diagnosis and guidance.

By gaining insight into the symptoms, causes, and available treatment methods, you can take proactive steps to overcome painful sex, restore sexual satisfaction, and enhance overall wellbeing.

Symptoms of Painful Sex

Painful sex can present itself in various ways, with symptoms varying among individuals. Some common indicators include:

sharp or burning pain during penetration
- aching or throbbing pain before, during, or after intercourse
- pain that is localised or more generalised in the genital area
- pain during certain sexual positions or activities
- pain accompanied by bleeding or vaginal dryness, and feelings of tightness or inability to relax the pelvic floor muscles during intercourse
Information taken from [1], [2]

Causes of Painful Sex

Painful sex can be caused by a multitude of factors, which can be physical, psychological, or a combination of both.

Vaginal dryness:

for many women, pain during intercourse will be the result of vaginal dryness, leaving the sensitive vaginal tissues vulnerable during sex. Vaginal dryness is often caused by hormonal changes, lifestyle factors and certain medical conditions. Childbirth, pregnancy, breastfeeding, and menopause, can all cause insufficient vaginal lubrication and lead to friction and discomfort during intercourse [1] Read more about the causes and treatment of vaginal dryness here.

More..

Hormonal imbalances:

fluctuations in oestrogen levels can result in vaginal dryness and thinning of the vaginal walls [1]. This makes the vaginal tissues more delicate and can increase the likelihood of injury and pain during sex.

Psychological factors:
such as lack of desire or low libido, anxiety, depression, stress, low self-esteem, past trauma, relationship problems, or a history of sexual abuse can also affect sexual experiences and contribute to painful intercourse [1] & [4].
Infections:
gynaecological infections such as yeast infections, urinary tract infections (UTIs) and sexually transmitted infections (STIs)[3] may cause pain during sex. In some cases, taking antibiotics can interfere with the vaginal microbiome and cause yeast infections leading to pain during sex [Medical News Today]

Medical conditions:
such as vaginitis, or endometriosis [3], uterine fibroids [5], vaginismus, vulvodynia, vestibulodynia, or skin conditions such as Lichen Sclerosus.
Cervical cancer:
in very rare cases, cervical cancer may be the cause of painful sex. If you are also experiencing unusual vaginal bleeding, vaginal discharge or pain in the area between the hip bones (pelvis) it is important to see your GP or gynaecologist. Read more about cervical cancer here.
Treatment for cancer.
Certain cancer treatments may cause vaginal dryness or hormonal changes leading to painful sex. Read more about cancer and vaginal dryness here.

Endometriosis Awareness Month: Tips on how to enjoy sex with endometriosis

Blog: 5 reasons for experiencing painful sex during pregnancy

blog: managing vaginal dryness post cancer treatment

Blog: Sex after cancer treatment: Intimacy tips

Medical Conditions Explained

POP can cause pain during sex, lower back pain, urinary leakage, constipation, and more. It refers to the abnormal descent or herniation of pelvic organs from their normal positions, including the bladder, uterus, small bowel, and rectum. [6].

Vaginitis This can lead to itching, soreness, unusual vaginal discharge, dryness, pain during sex, vaginal bleeding, or swollen skin around the vagina. Many factors can cause vaginitis, but there are effective treatments. If you're dealing with any of these symptoms, it's wise to consult your healthcare provider. [NHS]

Vaginismus Vaginismus is when your vaginal muscles suddenly tense up before or during any kind of penetration [NHS]. This involuntary muscle reaction can make penetration difficult or impossible. Treatment options include psychosexual therapy, relaxation techniques, pelvic floor exercises, and the use of vaginal trainers or dilators. [NHS]
Vulvodynia This condition involves persistent, unexplained pain in the vulva, which can manifest as burning, stinging, or throbbing sensations. Possible causes include prior surgery, childbirth, trapped nerves, or a history of severe vaginal thrush. [NHS]
Vestibulodynia Vestibulodynia causes pain at the entrance of the vagina or in other external genital areas. It's a type of vulvodynia.
Endometriosis With endometriosis, tissue similar to the uterine lining grows in other areas like the ovaries and fallopian tubes. Symptoms may include lower abdominal or back pain, severe menstrual pain, discomfort during or after sex, nausea, constipation, diarrhea, or blood in urine or stool during your period.
Uterine fibroids Non-cancerous growths that form in or around the womb can lead to heavy periods, abdominal pain, lower back discomfort, constipation, and discomfort during intercourse. [NHS]

Lichen Sclerosus This chronic skin condition primarily affects the vulva in women and female children, as well as the tip of the penis in men and boys. Women with lichen sclerosus often develop small white spots and sometimes experience bruising on the vulva.
Pelvic organ prolapse (POP) POP can cause pain during sex, lower back pain, urinary leakage, constipation, and more. It refers to the abnormal descent or herniation of pelvic organs from their normal positions, including the bladder, uterus, small bowel, and rectum. [NHS].
Ovarian cysts These are fluid-filled sacs that can form on an ovary. They typically don't cause symptoms unless they rupture, which can result in pelvic pain, pain during intercourse, and heavy menstrual periods. [NHS]

Treating Painful Sex

If you are experiencing painful sex or uncertain about the underlying cause of your discomfort, know that you are not alone. Seeking appropriate support is essential for finding relief. A significant portion of women have encountered painful sex at some point in their lives, and many continue to grapple with ongoing pain or discomfort. Do not hesitate to reach out for help or let embarrassment hinder you from finding help.

The treatment approach for painful sex depends on the underlying cause. It's advisable to consult your doctor or gynecologist initially to rule out infections or medical conditions.

Pelvic floor physical therapy

For conditions such as vaginismus or muscle tightness and pain before or during sex, pelvic floor physical therapy can be beneficial. This treatment involves a series of sessions aimed at addressing muscle tension or spasms in the pelvic region, leading to relief from pain and improved sexual function.

Vaginal dilators

Smooth plastic tubes of varying sizes, vaginal dilators help maintain supple vaginal muscles and prevent the vaginal walls from adhering together, making pelvic exams and intercourse more comfortable.

Psychological counselling or Psychosexual (sex) therapy

Talking therapy can be highly effective in addressing emotional concerns, reducing anxiety, and enhancing overall sexual well-being. This can be undertaken individually or with a partner.

HRT

In cases where hormonal imbalances contribute to painful sex, HRT or vaginal estrogen creams may be recommended, especially during perimenopause or menopause.

Medical intervention

If an infection, disease, or inflammation is identified as the cause, appropriate treatments like antibiotics or antifungal medications may be prescribed. Surgery might be necessary for conditions like uterine fibroids or endometriosis.

Vaginal Moisturisers

If you believe that vaginal dryness is the cause of your pain or discomfort during sex, try a vaginal moisturiser. Vaginal moisturizers can be used daily to rehydrate dry intimate tissues and provide relief from irritation and pain. If vaginal dryness is affecting your day-to-day life, or is particularly severe, using a vaginal moisturizer as well as a lubricant may be beneficial your overall wellbeing as well as sexual function.

A combination of the above may be most effective at treating painful sex.

Additional Strategies to Consider

Open communication: Discussing your experiences and concerns with your partner can provide emotional support and strengthen your relationship.
Lubricant use: use water-based and oil-based lubricants during intercourse can alleviate vaginal dryness and reduce discomfort. Using a pH matched water-based lubricant in tandem with an oil-based lubricant can provide both hydration and soothing protection. Find out more about AH! YES® certified organic personal lubricants and vaginal moisturisers below.
Preparation: Engaging in foreplay can help reduce anxiety and relax muscles before sex, especially if you experience low libido.
Sensation enhancement: Exploring sexual stimulants like oils or gels designed to enhance pleasure and sensation can be effective in increasing desire and arousal.

Relieving painful sex with AH! YES®

Applying lubricant before sex, particularly products like AH! YES® lubricants made from natural ingredients, can offer safe and immediate relief.

AH! YES® WB water-based lubricant provides gentle hydration and protection for sensitive tissues, while AH! YES® OB oil-based lubricant offers robust and long-lasting lubrication for severe vaginal dryness. Use AH! YES® OB and WB together to experience the benefits of both.

AH! YES® VM Vaginal Moisturiser is perfect for everyday use. It quickly re-hydrates dry intimate tissue for up to three days releasing moisture when and where your body needs it most. It is pH matched to the vagina to restore heathy vaginal pH.

AH! YES® COCO personal lubricant contains nourishing coconut oil and is a great alternative to silicone lubricants. It is designed to respect the vagina with certified organic ingredients and contains no glycerin, hormones, parabens, or gluten.

Professional help; A Glossary

Healthcare Provider

Your primary care physician can provide initial support, refer you to a gynecologist or specialist, and suggest treatment options.

Gynaecologist

Specializing in female reproductive system care, a gynecologist can offer expertise and treatment options.

Psychosexual therapist

These trained professionals can help address various sexual problems, including desire issues, difficulty orgasming, pain during sex, or penetration challenges.

Relationship counsellor

This form of therapy aims to resolve issues within intimate relationships, not limited to sexual problems.

Physiotherapist

Women's Health Physiotherapy focuses on pelvic floor and pelvic health issues, offering treatments for conditions like chronic pelvic pain, bladder dysfunction, sexual pain, and more.

“Lubrication is a very important part of the physical arousal process and often women will need additional lubrication to help them enjoy stimulation of the vulval area, including the clitoris and vagina. Having tested all the lubrication available on the market, YES® has, in my opinion, proved to be the best in terms of viscosity and maintaining moistness whilst not causing any irritation whatsoever. I recommend it to all my clients and also to the medical students I teach so that they in turn can recommend it to their future patients.”