Painful Sex (Dyspareunia), Vaginismus and Vulvodynia
What is painful sex?
Painful sex (sometimes called dyspareunia by health care professionals) is a catch all term which usually includes conditions such as vaginismus, vulvodynia, vulval pain or vulval vestibulitis.
All of these terms basically mean that sex hurts. Pain can occur on touch to the vulva (external genitals), or on penetration of the vagina or anus. Pain can happen at the moment of penetration, and last as long as penetration or can even hurt after sex for some people.
Painful sex affects close to 8% of people identifying as women in the UK (NATSAL data, 2013) and can really affect the sex lives of the people experiencing it and their partners. Painful penetration can be experienced by anyone being penetrated no matter how they identify their gender.
What are the causes of painful sex?
There are a range of factors which can lead to genital touch or penetrative sexual intercourse painful. Here’s a breakdown of some of the key ones:
- Having penetrative sex or another type of sexual contact, when we are not turned on, or when we are not turned on enough can be uncomfortable and for some, painful. The reasons for this are that increased blood flow to the genitals when we get turned on make the opening of the vagina or anus more elastic, and lubrication to the vagina makes penetrative vaginal sex more comfortable. Not using enough lube for anal penetration (as the anus is not self-lubricating), can also be a cause of pain.
- Sometimes painful sex is related to a physical problem, such as a genital skin condition, the presence of an STI, changes to the structure of the vagina/anus or pelvic floor muscles or another gynaecological or anatomical problem.
- Conditions like vaginismus (vaginism), where anticipation of pain leads to the contraction of the pelvic floor muscles making penetrative sex feel painful and impossible, can sometimes be related to an expectation that sex will be painful or hurt before we do it, and a vicious cycle gets created over time whereby once it’s hurt once, we start expecting it to hurt and the pain gets worse and more frequent over time.
- Conditions like vulvodynia, where touch to the genitals (often around the vulval vestibule – the skin around the vaginal opening between the vaginal lips/labia) is sometimes associated with increased numbers of UTIs or thrush, is thought of to be an over firing of the nerves in the vulva, creating a sensation of pain when there is no visible damage to be seen.
The one thing that’s for sure about painful sex is that it’s not in your head, it's not something that you should put up with and there is lots that can be done about it.
Treatments for painful sex- what can help?
National guidelines for health care professionals advise that all people experiencing painful intercourse should get a physical examination from a suitably qualified doctor.
You can see your GP to raise any concerns you have about sex hurting, but we realise that this can be a daunting prospect for some people. The knowledge and experience it requires to assess sexual problems can be complex, so it can be beneficial to see a doctor who has specialist training in sexual medicine such as the doctors in our team. As well as ruling out physical causes that need treating, our doctors can also prescribe medications or other medical treatments specifically designed to reduce or manage sexual pain, if this is something that you want.
The best approach with managing pain is always a multi disciplinary one, and having a thorough assessment and plan for the work is key to overcoming this type of pain. If you choose to work with us you might see our doctor only, our physio only or have some sessions with one of our psychologists, or you might have a mixture of all these things- we will make a recommendation about what we feel will be most effective for you, and then you can decide how to move forward.
There are a range of other things that can help, we will work with you to devise a tailored treatment plan which might include some of the following evidence based interventions;
- pelvic floor physiotherapy
- sex therapy with a partner to find ways to minimise the pain and its impact
- using vaginal trainers (sometimes called dilators) to build confidence
- advice about lubes and contraception which might help
- strategies adapted from Cognitive Behavioural Therapy pain management techniques
- mindfulness techniques to manage pain and increase arousal
At the Havelock Clinic, we provide high quality consultations and treatments from our expert team. We can provide holistic treatment for sexual pain that can take into consideration both medical and psychological needs, helping our patients overcome or manage pain and move forward in their sexual lives.
At an initial consultation with any professional in our team we will discuss with you all of the ways in which we can help and make some recommendations. An initial consultation is a way for you to learn more about the process and receive tailored advice before committing to further appointments.
Want to talk more about pain during sex?
We offer an initial phone call so that you can discuss with someone in the team who you should see first, based on your individual circumstances. Click here to send us an e mail and we will call you back and discuss this with you further. Alternatively, feel free to go ahead and book an initial consultation with anyone in the team.