Pain during or after sex is more common than many people realise. It can have a significant impact on wellbeing, relationships and quality of life, yet it is something that many people understandably find difficult to talk about.
The medical term for persistent or recurrent pain associated with sexual intercourse is dyspareunia. There are many possible causes, and experiencing pain during sex should not simply be accepted as something you have to live with.
What can cause painful intercourse?
Dyspareunia can have a number of physical, hormonal and psychological causes. Sometimes several factors are involved.
Possible causes include:
- Pelvic floor muscles that are overly tight or go into involuntary spasm
- Vulvodynia or pain around the vulva
- Changes following childbirth, including scarring following an episiotomy or tear
- Previous pelvic surgery or procedures
- Hormonal changes during perimenopause and menopause
- Vaginal dryness or reduced lubrication
- Breastfeeding-related hormonal changes
- Recurrent urinary tract infections
- Pelvic inflammatory disease
- Endometriosis
- Ovarian cysts
- Some skin conditions affecting the vulval area, including lichen sclerosus, lichen planus, eczema and psoriasis
- Persistent pelvic, hip or lower-back pain
- Previous trauma
- Stress, anxiety or fear associated with penetration
Because there are so many potential causes, it is important not to assume that pelvic pain or painful intercourse has a simple musculoskeletal explanation.
What does dyspareunia feel like?
Symptoms vary considerably from person to person. They can include:
- Pain on penetration
- Deep pain during intercourse
- Burning or stinging
- Aching or cramping
- Pain around the vaginal opening or vulva
- Pain that continues after intercourse
Pain may be superficial, around the entrance to the vagina, or felt more deeply within the pelvis.
Is painful sex common?
Yes. Estimates vary considerably between studies because many people do not seek medical help or feel uncomfortable discussing the problem.
Painful intercourse can occur at any age, although the reasons for it may change throughout life. Hormonal changes around menopause, pregnancy and childbirth, pelvic floor dysfunction and other medical conditions can all play a part.
The important point is that persistent pain during sex deserves proper assessment rather than being ignored.
What might you be asked during an assessment?
Understanding the history of the symptoms is an important first step. A healthcare professional may ask questions such as:
- When did the symptoms begin?
- Where exactly is the pain felt?
- Is the pain superficial or deeper within the pelvis?
- Does it occur every time or only in certain circumstances?
- How long does the pain last?
- Is it related to your menstrual cycle?
- Are there associated bladder or bowel symptoms?
- Have you previously been able to have pain-free intercourse?
- Have you recently given birth or are you breastfeeding?
- Are you experiencing symptoms associated with perimenopause or menopause?
- Have you tried a lubricant and, if so, does it make a difference?
- Is there a history of pelvic surgery, injury or trauma?
These questions can help determine whether further medical investigation or referral to an appropriately qualified specialist is needed.
Can the musculoskeletal system contribute to pelvic pain?
The pelvis does not function in isolation. The lower back, hips, pelvic joints, muscles and surrounding tissues all work together, and problems in one area can sometimes contribute to symptoms elsewhere.
For somebody experiencing pelvic discomfort alongside hip, back or musculoskeletal symptoms, an osteopathic assessment may therefore consider areas such as:
- The lower back
- Pelvis and sacroiliac joints
- Hips
- Surrounding muscles and connective tissues
- Posture and movement
Where symptoms suggest a gynaecological, dermatological, hormonal or other medical cause, appropriate medical assessment is important.
Don’t suffer in silence
Pain during sex can affect much more than physical comfort. It can influence confidence, intimacy, relationships and emotional wellbeing.
There are many possible causes and, importantly, many can be treated or managed once they have been properly identified.
If you experience persistent or unexplained pelvic pain or pain during intercourse, speak to your GP or an appropriately qualified healthcare professional. If musculoskeletal problems involving the back, hips or pelvis are also contributing to your symptoms, an osteopathic assessment may form one part of your overall care.
The Form Practice, Hardwick, Cambridge