Painful Sex (Dyspareunia): Causes, Treatments & When to Seek Help

In this article, we cover:

What is painful sex?

What to do when sex hurts

What causes painful sex

How Sex Therapists and Sexologists treat painful sex

When to seek professional help for pelvic pain

Painful sex is also medically known as dyspareunia, as Genito-pelvic pain/penetration disorder or commonly as vulvodynia and vaginismus.

According to a recent study, it’s estimated that painful sex affects up to 20% of us women at some point in our lives. Just to put that in perspective, that means it’s more common than asthma, cancer and heart disease. 

It impacts our enjoyment of sex, can dramatically reduce our sexual desire and can place strain on our relationships – or lead women to avoid relationships completely. 

I often treat women who have been unable to have sex for months or even years as a result of painful sex. 

If you are experiencing sexual pain at the moment you might be feeling frustrated, guilty, confused, upset, embarrassed or, all of the above. 

Painful sex or other pelvic pain may be impacting your self confidence and even your daily functioning. You might feel like your body has let you down, wonder if there’s something wrong with you – and you may worry that it will mean the end of your relationship.

So, firstly let me tell you that you’re not alone. 

Painful sex doesn’t mean there’s something wrong with you. And it doesn’t have to mean the end of your relationship. As a Relationship Counsellor and Sexologist, I’ve been supporting individuals and couples with painful sex for almost two decades.

And I want you to know there’s hope.

What is painful sex

You might have heard painful sex and genital pain referred to by a number of different names which can be incredibly confusing.

Some of the terms you might have heard are:

• Clitordynia
• Vulvodynia 
• Vestibulodynia
• Vaginismus
• Dyspareunia
• Genito-pelvic pain/penetration disorder

What do all these mean? 

These different names refer to different kinds of pain and to specify where the pain is. All of them mean that you experience pain in the pelvis or genitals – and that sucks. 

What to do when sex hurts

One of the numerous challenges with sexual pain can be getting a doctor or professional to take you seriously and help get the support you need.

For so many women I speak to, the experience of trying to talk to someone about their sexual or pelvic pain has only added to the trauma and emotion they feel around it. Let me stress to you that this shouldn’t be the case.

Sadly I know that many women are told by doctors that the pain is just ‘all in their heads’ or they can’t find anything physically wrong. 

I also hear women receiving advice such as:

• You just need to relax. 
• Have a glass of wine. 
• Just do it anyway. 

None of this advice is helpful. 

It can actually make the problems worse. 

I want you to know that although what exactly is causing painful sex can often be difficult to diagnose, there is always a reason and usually treatments that can be found.  There are also caring, understanding and qualified professionals that can help you through the process.

Understand the ‘type’ of pain you experience

Knowing the ‘type’ of pain you feel and where exactly it’s located is vital in being able to understand your pain and get you the right treatment. For example, some pain is ‘deep pain’ feeling like it’s inside, other pain is more on the surface.

Understand if there are any particular triggers to your pain – and if anything makes it better

Some pain is chronic and is there continuously, some pain will be on penetration, other pain during or after sex.

Understand the cause of your pain

Once you know where and when the pain is there, you may be able to self diagnose or see a professional to help understand the root cause

 Take steps to treat the pain

Once you understand the cause, you can take steps, alone or with professional support to treat the pain.

What causes painful sex?

Pain during sex, or dyspareunia, can intertwine a range of physical, psychological, and relational factors, sometimes making it a complex and persistent issue. Here’s a deeper look into the multifaceted causes of painful sex:

• Inadequate Foreplay and Lubrication: One of the most common causes of pain sex is not enough time spent in foreplay and inadequate lubrication before penetration.
• Tight pelvic floor muscles: Known as vaginismus, tight pelvic floor muscles can cause burning, stabbing or deep pain and even make penetration impossible, like hitting a brick wall.
• Hormonal changes: Common during menopause, postpartum, or due to medications, leading to vaginal dryness or thinning of the vaginal wall.
• STIs or yeast infections: Thrush and STIs like chlamydia, gonorrhoea or herpes can inflame skin and cause soreness.
• Other infections: Bladder and Urinary tract infections or Pelvic Inflammatory Disease can also cause pain.
• Post-Childbirth/Post-Surgical Changes/Ectopic Pregnancy: Physical changes or complications from childbirth or surgery, and pregnancies outside the womb can cause severe pain.
• Skin Conditions: Conditions such as Lichens Sclerosus, Lichens Planus, Psoriasis, or eczema pain at the vaginal entrance.
• Psychological and Emotional Factors: Past trauma, anxiety, fear of sex or negative beliefs about sex can all cause tightening of the pelvic floor muscles leading to pain during sex.
• Relational Stress: Conflicts or dissatisfaction in relationships can contribute to painful intercourse.
• Nerve Pain: Nerve pain during sex can arise from various conditions affecting the nerves in the pelvic region. 
• Physical Health Conditions: A multitude of additional physical conditions such as a tilted or retroverted uterus, thickened hymen, Endometriosis/Adenomyosis, Uterine Prolapse, Fibroids, Ovarian Cysts, Irritable Bowel Syndrome, Interstitial Cystitis, Multiple Sclerosis and other conditions can also cause painful sex.

Addressing painful sex involves a multifaceted approach, focusing on the underlying causes, whether they are physical, psychological, or both. 

How Sex Therapists and Sexologists help treat painful sex

1. Helping You Understand the Pain: We start by helping clients understand their pain’s nature. This process involves discussing various types of pain, such as superficial versus deep pain, and identifying possible triggers.
2. Giving Guidance for Medical Diagnosis: Many cases of painful sex require a medical diagnosis to rule out or confirm conditions like endometriosis, infections, or hormonal imbalances. Sex therapists often collaborate with medical professionals to ensure that clients receive comprehensive care.
3. Advising on Seeing Other Professionals: If the pain’s causes extend beyond the scope of sex therapy, we provide referrals to other professionals. This could include specialised physiotherapy, gynaecological care, or other medical support necessary for comprehensive treatment.
4. Providing Emotional Support: We create a supportive environment that allows you to express and navigate your emotions—validating your feelings, addressing relationship stress, and managing the emotional impacts of pain. Our goal is to ensure you feel supported and not alone.
5. Overcoming Psychological Barriers: Tackling fears, past trauma, and misconceptions about sex is crucial in managing painful sex. We use techniques like dialogue, mindfulness, and relaxation exercises to help you work through these issues.
6. Helping You Improve Your Relationship: We focus on enhancing communication skills with a partner, intimacy exercises, and finding ways to maintain connection without painful intercourse. This includes advising on pain-reducing positions and alternative methods for connecting that don’t exacerbate your pain.
7. Education on Lubrication and Aids: Educating clients about the use of lubricants, pelvic aids, or dilators is vital. These tools can significantly reduce discomfort during intercourse, facilitating a less painful and more enjoyable experience.

​​As a Relationship Counsellor, Sex Therapist and Sexologist, I’ve countless individuals and couples overcome the profound challenges that painful sex can bring to their lives and relationships.

Many clients feel nervous, embarrassed or sceptical when they first arrive for therapy. It’s normal to feel overwhelmed – or over talking about the problem.

Here’s what one of my past clients had to say about working with me:

“From the first meeting, Isiah was the first person who really listened and was very non-judgmental on what I thought and felt. She let me cry, laugh, yell, get angry and there was never anything to make me feel uncomfortable or that how I was feeling was wrong… Seeing Isiah has really helped me get back on the road to feeling better again, mentally and physically.”

My extensive experience and empathetic approach have been instrumental in guiding many towards understanding, healing, and reconnection and my entire team of therapists is now trained in how to offer this holistic support.

When to seek professional help for pelvic pain

If you’ve tried extending foreplay and using high-quality lubricants but still experience pain during sex, it’s crucial to consult a professional. 

Remember, sex shouldn’t hurt, and there are effective treatments available that can significantly improve your quality of life. 

Starting with a trusted doctor or a Sexologist is a great first step. These professionals can provide a comprehensive evaluation to identify the underlying causes of your pain and recommend appropriate treatments or referrals to specialists if needed. Ensure that any professional you do see takes your pain seriously and offers a way forward. 

You don’t have to face this alone; professional support can guide you toward a pain-free intimate life.

Create a happy relationship and satisfying intimacy

My team and I are here to help. We offer proven advice and practical tools so that you can create a harmonious, loving and intimate relationship. Book a call to see how we can help you.

Book a call