Rubbing You the Wrong Way: Dyspareunia & Painful Sex

Dyspareunia: it may sound scary, but it’s just a term used to describe genital pain before, during, or after intercourse. Genital pain can be a whole bunch of sensations that include burning, stinging, pulling, ripping, tearing, sharp, aching, throbbing, and shooting (yeah... not super fun). This is associated with many, many different diagnoses and can be structural, inflammatory, infectious, neoplastic, traumatic, hormonal, and psychosocial in nature. But don’t worry babe, we've got you. There are many options to manage and treat dyspareunia despite the different causes it may be from.  

Experiencing pain with sex is so common. A study reports about 60% of women nationally experience episodes of pain within the vaginal canal, vulva, clitoris, abdomen, and/or hips with intercourse and 10-20% of women in the U.S experience their pain in the entrance, at the clitoris, rectally, or deep to the cervix that can last for a seconds to even after participating in intercourse. Women who want to experience sex with a partner but have pain are at an increased risk of sexual dysfunction, decreased quality of life, anxiety, and depression. It can really impact how someone feels in a relationship with a decrease in affection, fear that physical touch will arouse their partner and that they will have to say they are not interested, or a loss of how to communicate each person’s needs to each other.

Men can also experience dyspareunia with sexual activity. Symptoms may include penile, scrotal, rectal, abdomen, hip pain and/or pain with ejaculation. A study reports about 46% of women and men in the U.S. Both experience symptoms of dyspareunia. That’s almost half the population!  

Sources of pain with sex:

Hormonal:

Dyspareunia can be due to a variety of reasons such as lack of lubrication, decreased estrogen (a hormone that helps keep vaginal tissue healthy and hydrated), and can be a component of endometriosis. Conditions involving the vulva and vagina that include vaginismus, vaginal atrophy, and vulvodynia can cause pain with sex due to increased sensitivity or involuntary muscle contractions during insertion.  

Skin and connective tissue conditions:

Scar tissue and dermatologic diseases such as lichen planus, lichens sclerosus, and psoriasis and infections can cause pain with sex as well. Pressure or friction on irritated skin already doesn’t feel good if the skin is on a leg or arm: so sex can cause a lot of discomfort if there is skin sensitivity down there.  

Psychosocial:

Painful sex not only takes a toll on an individual physically but psychologically as well. It can affect sexual desire or arousal, create increased feelings of anxiety around sex, and increase risk for depression and decreased general happiness. Dyspareunia can also be due to a history of abuse as well that contributes to increased risk for anxiety, depression, and fear around intercourse that can contribute to more feelings of pain with sex. This can all lead to a lower libido which can impact our immunity, hormones, and our sense of wellbeing.  

Musculoskeletal:

We have muscles in our pelvic floor that can be very tight which can cause pain with sex. Increased pelvic floor tension can be due to stress, anxiety, impaired intra-abdominal pressure management, prolonged sitting, and trauma. Pain with sex can also occur if hip muscles are tight, therefore causing hip pain.  

The Academy of American Family Physicians created a table here that gives an overview of different diagnoses related to dyspareunia.  

Okay, so that was a lot of information about the different diagnoses and causes of dyspareunia. What can we do about it?  

Pelvic Floor Physical Therapy

Myofascial release of trigger points

• A release in the pelvic floor muscles, piriformis, or iliopsoas promotes proper muscle length and relaxation to decrease tightness and pain with penetration.

Perineal desensitization

• Pain can be due to increased skin sensitivity to stretch or friction. Perineal desensitization techniques can help the superficial muscles of the pelvic floor to relax and allow for entry that is not painful.

Pelvic floor muscle training

• Pelvic floor exercises to assist these muscles to contract and relax normally can help decrease pain, increase blood flow to these muscles, and promote good general genitourinary health.

Diaphragmatic breathing

• Implementing diaphragmatic breathing increases relaxation and lengthening of the pelvic floor muscles that can allow for more stretch to decrease pain with entry or deeper penetration.

Pain education

• Increasing knowledge about pain and its multifactorial nature can help individuals develop tools and techniques on how to manage pain, how to frame your mindset about pain, and how to desensitize pain receptors to decrease highly sensitive tissues.

Cognitive Behavioral Therapy

• Therapy can help decrease anxious thoughts around sex and penetration to assist relaxation, positive framing, and arousal during sex.

Vagina Estrogen

• Estrogen is important for cell growth and maintaining a healthy urinary tract and vaginal health. This hormone can help people who experience vaginal dryness or atrophy to increase natural lubrication and decrease pain with sex.

Lubricant

• Finding the right lube for you may take some trial and error. We recommend avoiding any lubricant that has aloe vera in it, as that can be irritating to the vaginal tissue. Try sticking to lubricants that have minimal ingredients and rave reviews. If you have severe burning or stinging that improves as you have sex but then gets worse again, you may need to reapply lubricant and you may need something that lasts longer.
• Silicone lube lasts longer, but is a little thinner than water-based lube and can interfere with condom effectiveness. If you're looking for a good silicone-based lube, we like this&this.
• Water-based lube is thicker than silicone, but may need more frequent re-application. We use this in our office, it's great for sensitive tissue!
• We also recommend using both kinds of lube at once to extend how long the lubrication lasts and provide enough tissue protection for friction.

Kindra V Relief Serum & Daily Lotion

• This serum is a non-hormonal formula that calms skin sensitivity, burning, and stinging by restoring moisture and rebuilding the skin barrier function. Apply once or twice daily and use about 30-45 minutes before sex to help reduce your pain. We recommend pairing it with use of their Daily Lotion, which shares this desensitizing peptide formula and is moisturizing too. You can find more ways to use these products on their website. Use our discount code: HEYBABE for 30% off!

This post only begins to scratch the surface on dyspareunia and what you can do for it. Because there are so many different ways to address pain with sex, we highly recommend seeking out a physical therapist who can perform a thorough assessment and provide the movement and desensitization strategies for *you*.

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Resources  

https://www.aafp.org/pubs/afp/issues/2021/0515/p597.html  

https://www.aafp.org/pubs/afp/issues/2001/0415/p1535.html#epidemiology  

https://www.hoag.org/featured-news/what-happens-to-relationships-when-sex-hurts/  

https://www.ncbi.nlm.nih.gov/books/NBK562159/  

https://academic.oup.com/jsm/article-abstract/8/3/666/6844691  

https://link.springer.com/article/10.1186/s12905-023-02532-8

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