Why Am I Experiencing Painful Intercourse

Guest blog by Karen Bang, Registered Physiotherapist

Dyspareunia is the medical term used to describe pain experienced during intercourse. Many people can experience painful intercourse every now and then, but for some, it can be more of a persistent condition. A study completed in the United Kingdom, revealed that the prevalence of dyspareunia in sexually active British women was 7.5%. A recent Canadian study found that more than 30% of women experience painful intercourse at 3 months postpartum. These numbers highlight how common dyspareunia is experienced, but unfortunately, is not always addressed within our society and healthcare system.

So why might you be experiencing dyspareunia?

What contributes to an individual having a positive and/or pleasurable sexual experience is multifactorial. This can make it difficult to answer the question as to why someone may be dealing with dyspareunia. Here are some potential causes to pain during sex:

• Increased pelvic floor muscle tone – this describes that there is a component of tightening or over-activity of the muscles of the pelvis. This tension could be present constantly throughout your day-to-day life, or it could more transient and become only apparent during intercourse.
  
  
• Physical changes to the vulva – women nearing the menopausal stages of their lives are likely to experience changes to the integrity of their vulvas, secondary to differences in hormone levels. They may notice more vaginal dryness, less elasticity of their tissues, differences in colour, and sensations including burning.
  
  
• Postpartum changes – when experiencing childbirth, multiple processes and/or procedures can lead to changes to the pelvic floor anatomy. This can include perineal tears and subsequent painful scars, episiotomies, use of forceps, and other forms of trauma to the pelvic floor.
  
  
• Psychosocial factors – depression, anxiety about sex, persistent stress, pain catastrophizing, and sexual relationship factors have all been found to contribute to the development of dyspareunia. 
  
  
• Underlying conditions – some people may be experiencing other conditions that can lead to pain with intercourse. Sexually active individuals with vaginismus, endometriosis, vulvodynia, or Lichen’s sclerosis often report dyspareunia as a symptom.

What can you do if you have dyspareunia?

The first step is to figure out what may be the root cause or causes to the pain experienced during intercourse. Find a trusted healthcare provider like a pelvic health coach, pelvic floor physiotherapist or a gynaecologist who can assist you with this investigation. It may be helpful to:

• gather information regarding your health history, psychosocial wellbeing, and physical health 
• get recommendations on how to improve vulvar skin health (example: use of lubricants, moisturizers, topical hormones)
• use hands-on techniques or treatment to address physical changes to the pelvic floor, including scar release, tension reducing techniques, stretching, and pelvic floor relaxation exercises
• Discuss strategies to improve psychosocial wellbeing and sexual function. This may include a referral to a sex therapist, psychotherapist and/or psychologist.

References:

https://pelvichealthsolutions.ca/knowledge-base/dyspareunia

https://pubmed.ncbi.nlm.nih.gov/35115480/

https://pubmed.ncbi.nlm.nih.gov/28120373/