Dyspareunia is a term used to describe female pain or discomfort during sexual intercourse. There are a number of reasons, both physical and psychological, why it might occur:
- in some cases it may be due to vaginal dryness, a common symptom of the menopause;
- in others it may be due to the presence of an infection in the reproductive tract;
- and it can sometimes be caused by an involuntary response by the vaginal muscles, called vaginismus.
The ‘1 in 10’ headline
Recently, a survey was undertaken in the UK to try and determine how common the problem is. There were several institutions involved in collating and analysing the results, including University College London, the University of Glasgow, the University of Southampton, and the London School of Hygiene and Tropical Medicine.
The results of the study were published in BJOG: An International Journal of Obstetrics & Gynaecology, in January 2017. They were widely reported in the media, with several news outlets claiming that ‘one in ten’ women experienced pain during sex.
In actuality, 7.5% of the sexually active women surveyed responded that they had found sex painful (which is approximately one in 13).
Pain during sex was defined as that experienced in the last year, lasting for three months or longer.
It was a large study, canvassing almost 7,000 women. The researchers did ask the respondents questions relating to their feelings about sex, and some other sexual problems that dyspareunia could possibly be caused by. For instance, 45% of respondents who found sex painful also reported uncomfortable vaginal dryness; and 21% of those with dyspareunia also harbored feelings of anxiety regarding sex.
However, an assessment by NHS Choices concluded that while these findings do give an indication of the prevalence of association between painful sex and the issues described, they do not necessarily mean that one was causing the other.
In any case, the NHS advises women who do experience pain during sex to speak to a doctor.
Pain during sex can occur for several reasons, a number of which we’ve outlined below.
Some of these may require treatment; while others may require further discussion and help from a sexual therapist.
One common cause of pain during sex is vaginal dryness, and this is often a problem for women going through the menopause. In such cases, it is caused by a natural drop in oestrogen levels.
Statistics cited by the NHS state that around 84% of menopausal women experience dyspareunia.
Some types of hormonal contraception, again due to the way they alter oestrogen levels in the body, can also cause vaginal dryness. In other cases, a lack of arousal prior to sex can also be a factor.
Where vaginal dryness is particularly severe or accompanied by other symptoms which indicate a hormonal imbalance, such as trouble sleeping and flushing, then it is advisable to speak to a GP.
But for other cases where vaginal dryness prior to or during sex is relatively mild, there are some measures women and their partners can try to reduce discomfort.
One is practising foreplay for longer. This gives the woman more time to become aroused and can increase the production of vaginal fluid (thereby reducing dryness, and associated discomfort).
Another is applying a lubricant prior to penetration.
Once more, if these measures do not help, a doctor may be able to offer further advice and treatment.
There are numerous different infections which can cause pain during sex. It is strongly recommended where these are present to avoid having sex until treatment has sufficiently cleared the infection, so that you do not exacerbate the situation and make the pain worse, or risk passing the infection on to your partner.
Chlamydia and Gonorrhoea
Dyspareunia can sometimes be a symptom of a sexually transmitted infection, such as chlamydia. This is caused by a type of bacteria called C. trachomatis, which may induce inflammation in the vagina (resulting in pain). It can also cause bleeding during and after sex, and pain when going to the toilet. However, eight out of 10 female cases of chlamydia will be asymptomatic.
Gonorrhoea is another STI which can cause vaginal pain during sex. Like chlamydia, it can often be symptomless. Roughly 50% of infected women will display no outward or noticeable signs.
If you are sexually active and suspect you may have come into contact with an STI, it is important to get tested as soon as possible. Because bacterial STIs like chlamydia and gonorrhoea do not cause noticeable signs in many instances, people who are sexually active are also advised to have routine screening on a regular basis too.
Sexually active persons should ideally be tested:
following any instance of unprotected intercourse;
in addition to at least once a year, even where they are practising safe sex.
Pelvic inflammatory disease, which is sometimes a consequence of untreated chlamydial or gonococcal infections, can also result in pain during sex. Typically, this pain will be experienced in the pelvic region. PID is a condition requiring immediate medical attention, as it can become serious when not treated.
Genital herpes causes blisters and sores to appear around the genitals and on the cervix, and this can also be a source of pain during sex. When this condition is active, it’s recommended to refrain from sex until at least five days after the affected area has healed. Once more, seeing a doctor and getting treatment can help. While herpes creams and tablets cannot cure the condition, they will help to speed up recovery.
Where these occur in the vagina, they are commonly referred to as thrush. They are caused by an overabundance of a particular kind of fungi in the body, a situation which typically develops when the balance of natural fungi becomes upset. This can result in discharge and inflammation, which again might induce pain during intercourse.
There are over-the-counter pessaries, creams and tablets available for thrush infections. However in some cases, it may be necessary to see a doctor for prescription treatment.
Another potential cause of dyspareunia is the presence of fibroids. These are fibrous tissue growths which can appear in the womb. Why they occur is not fully understood, but oestrogen levels are thought to play a role in their development.
Fibroids often do not cause any symptoms, but where they do, they may also cause:
more frequent urination,
lower back or abdominal pain,
and heavy or painful menstruation.
Whether or not fibroids are treated depends on whether they are causing symptoms, how severe these are, and the likelihood of complications developing. Anyone who has the above symptoms should still see a doctor, so that they can rule out other conditions and provide a diagnosis.
This is where the muscles around the vagina contract involuntarily. It may occur prior to sexual intercourse, which can lead to pain when penetration commences. It can also occur before a gynaecological procedure is due to take place. The degree of muscle contraction vaginismus causes can range from mild (where sex is possible but painful) to severe (where the vagina effectively closes).
It can often be caused or exacerbated by one or more psychological issues related to the genitals, such as:
negative or unpleasant thoughts associated with sex
having had pain or vaginal problems related to sex in the past
injury to the vagina sustained during childbirth
or a separate physical condition causing vaginal soreness.
Where a physical problem is causing vaginismus, treating this may help to relieve the condition. However, those experiencing vaginismus related to psychological issues may need to be referred to a therapist for counselling. CBT and other techniques may be employed to reduce symptoms.