Painful sex, vaginismus, vestibulodynia, dyspareunia… What ever you want to call it – it means that sex hurts. This is a blog post that I’ve been meaning to write for a long time, for a few reasons. 1) This issue is so very common (between 10-30% of women will experience painful sex during their lifetime). 2) Women don’t really talk about it all that often, leading them to feel like they are the only ones with this problem. But I can tell you that this problem FILLS my office on a weekly basis. 3) There are lots and lots of reasons why this can happen, and most of them have some sort of treatment option with very good results.
Where and When it Hurts:
Typically, there are two general areas where pain with sex happens. 1 – Near the vaginal opening, or more specifically, the vestibule. This is where the term vestibulodynia comes from. This area is inside the inner labia and is where the skin changes from what looks like outside skin, to mucous membrane looking skin (kind of like the inside of your mouth).
A lot of women will tell me that they feel their pain in their vagina, but when I press on this area, it is the source of their pain. We seem to have a poor sense of exactly where our vestibule is, leading to some confusion when describing this pain. But most women will describe it in a similar way. “It feels like burning/dryness/tearing/sharp pain with penetration”. For some, it feels like this throughout the entire sexual event. For others, once the initial penetration is done, their pain lessens.
This pain can be caused by tight or overactive pelvic floor muscles, dermatological conditions, scars from surgery, trauma or vaginal deliveries, not enough natural lubrication, hormone imbalances, low sex drive, sensitivities to ingredients in condoms or lubricants, infections, cancer treatments, menopause…
The second area of pain is described as deep inside the vagina. Sometimes women tell me that it’s up near their cervix (the lowest part of the uterus), around their ovaries, their low abdomen or near their belly-button. It tends to occur with specific positions or upon thrusting. It can be described as sharp, tender or cramp-like.
This type of pain can be caused by scar tissue from organ or abdominal surgeries, tight pelvic floor or abdominal muscles, having a shorter length of vaginal canal, adhesions (fibrous bands of tissue that form between organs, connective tissue and muscles), medical conditions like endometriosis, interstitial cystitis, infections, or inflammation of the cervix…
Treatments are dependent on the cause of the issue. Sometimes they require medications to manage the pain, deal with inflammation, regulate hormones or clear up an infection. Sometimes pelvic floor physiotherapy is used to relax and stretch muscles, work on adhesions, or desensitize certain tissues. Sometimes psychologist or sexologists are encouraged to help with the strain that painful sex can have on relationships, or help improve sex drive, or help make returning to intercourse less intimidating (*Just because a psychologist may help, does NOT mean that the pain is in your head – see MYTHS below). Sometimes surgeries are necessary for specific conditions.
Myths About Painful Sex
• It is NOT in your head
• A glass of wine and “just relaxing” will NOT fix it
• Aggressive sex will NOT fix it
• It is NOT normal to have painful sex
• It’s NOT your fault
If you are suffering with painful sex, I encourage you to reach out to your family doctor, gynecologist or pelvic floor physiotherapist, and keep asking for help until you get the treatment that you need.
Katie Kelly, Physiotherapist
BSc., MSc. PT