Understanding and treating painful intercourse (dyspareunia)

When sex is painful, specialist care can help you identify the cause and restore comfort and intimacy

Painful intercourse, medically known as dyspareunia, is a common but often unspoken problem that can significantly impact your physical health, emotional wellbeing, and relationships.

If sex is consistently painful, whether during penetration, throughout intercourse, or afterwards, you don’t have to accept it as normal. Pain during sex is a signal that something needs attention, and with proper diagnosis and treatment, most women can return to comfortable, enjoyable intimacy.

At The Women’s Health Vulvo-Vaginal & Genitourinary Clinic, we specialise in diagnosing and treating the many causes of painful intercourse. Our team provides compassionate, comprehensive care in a safe, judgement-free environment.

Painful sex is not something you have to live with. Let us help you find answers and restore intimacy.

Do you experience painful intercourse?

You may have dyspareunia if you experience:

Pain during initial penetration
Deep pelvic pain during or after intercourse
Burning, stinging, or tearing sensations
Pain that persists after sex
Difficulty with penetration or complete inability to have intercourse
Vaginal dryness that makes sex uncomfortable
Muscle spasms or tightening that prevents penetration

If this sounds familiar, it’s time for a specialist assessment.

Common causes of painful intercourse

1. Vaginal Atrophy (Genitourinary Syndrome of Menopause)

After menopause, declining oestrogen levels can cause the vaginal walls to become thin, dry, and less elastic. This is one of the most common causes of painful intercourse in post-menopausal women.

2. Vulvodynia

Chronic vulvar pain that can make any touch or pressure, including intercourse, extremely painful. The pain is often described as burning or stinging.

3. Pelvic Floor Dysfunction

Tight, overactive pelvic floor muscles can cause pain during penetration and deep pelvic pain during intercourse. Many women are surprised to learn that “weak” pelvic floors aren’t always the problem.

4. Endometriosis

Endometrial tissue growing outside the uterus can cause deep pelvic pain during intercourse, particularly with deep penetration.

5. Lichen Sclerosus or Lichen Planus

Inflammatory skin conditions that can cause fragile, painful skin and scarring, making intercourse uncomfortable or impossible.

6. Vaginismus

Involuntary tightening of the vaginal muscles that makes penetration difficult or impossible. This can be caused by anxiety, past trauma, or physical conditions.

7. Infections or Inflammation

Yeast infections, bacterial vaginosis, or other infections can cause temporary pain during sex. Chronic inflammation from conditions like desquamative inflammatory vaginitis can cause ongoing discomfort.

8. Scarring or Adhesions

Previous surgery, childbirth trauma, or radiation therapy can cause scarring that makes intercourse painful.

How we diagnose and treat dyspareunia

Comprehensive history

We’ll discuss:

When the pain started and how it’s progressed
The type and location of pain (superficial or deep)
What makes the pain better or worse
Your sexual history and relationship factors
Previous treatments and their effectiveness
Medical history, including surgeries or trauma
Menopausal status and hormonal factors

Thorough examination

A gentle, careful examination can help identify:

Signs of vaginal atrophy or dryness
Skin conditions affecting the vulva
Areas of tenderness or pain
Pelvic floor muscle tension
Scarring or anatomical changes
Signs of infection or inflammation

Appropriate testing

When needed, we may perform:

Vaginal swabs to rule out infection
Pelvic ultrasound to assess for endometriosis or other conditions
Referral for further investigations if deep pelvic pathology is suspected

Personalised treatment plan

Treatment depends on the underlying cause and may include:

Topical oestrogen, moisturisers and lubricants for vaginal atrophy
Anaesthetics, oral medications and pelvic floor physiotherapy for vulvodynia
Physiotherapy, manual release and relaxation techniques for pelvic floor dysfunction
Corticosteroids and barrier creams for skin conditions
Dilators, physiotherapy or counselling for vaginismus

Frequently asked questions

Q: Is painful sex normal?

A: No, sex should not be painful. Whilst occasional discomfort can happen, persistent pain is a sign that something needs attention.

Q: Will I ever be able to have pain-free sex?

A: With proper diagnosis and treatment, most women can return to comfortable, enjoyable intercourse. The key is identifying the underlying cause and addressing it appropriately.

Q: Should I avoid sex until the pain is gone?

A: This depends on the cause. In some cases, continued gentle sexual activity (with appropriate lubrication) can be helpful. In other cases, taking a break whilst undergoing treatment may be advisable. We’ll provide personalised guidance.

Q: Could the pain be psychological?

A: Whilst anxiety and past trauma can contribute to painful sex, there is usually a physical component as well. We take a holistic approach, addressing both physical and emotional factors.

Q: How long does treatment take?

A: This varies depending on the cause. Some women experience improvement within weeks, whilst others may need several months of treatment. We’ll work with you to find the most effective approach.

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Take the first step towards comfortable intimacy

Painful intercourse doesn't have to be a permanent part of your life. With proper diagnosis and treatment, you can restore comfort, intimacy, and connection with your partner.