Dyspareunia is a term referring to painful sex, or pain that is experienced just before, during, or after sex. Dyspareunia can refer to pain from any type of sexual activity, but is commonly used in reference to penetrative sex.

Many individuals experience dyspareunia, but often hesitate to seek treatment due to embarrassment or the impression that pain with sex is normal. Pain is not normal, nor should anyone be embarrassed to seek treatment for sexual health!

All health matters, and everyone deserves to be able to live a healthy lifestyle. 

Not only is it common, but anyone can experience dyspareunia regardless of their genitals. However, it is significantly more common for those with a vagina. Symptoms of dyspareunia can vary from person to person…

For those with a vagina, dyspareunia may present the following symptoms:

• Pain with insertion at the vaginal opening
• Pain with deeper insertion in the pelvis
• Pain with orgasm
• Pain during certain positions
• Pain after sex
• Muscle spasms

For those with a penis, dyspareunia may cause:

• Pain in the penis, testicles, or pelvic area
• Pain on the head of the penis
• Painful erections
• Skin irritation or rash on the penis

Dyspareunia can range from mild to severe, and can develop at any point of a person’s life. Even if someone has not had struggles with sexual activities before, there are many causes that may create dyspareunia later in life. The pain may be often described as dull, throbbing, sharp, or burning.

Painful sex is not only a physical condition, but also emotional—causing anxiety, stress, and low self-esteem for individuals who struggle with sexual activities.

Therefore, it is important to consider multidisciplinary treatment that encapsulates both physical and mental health.

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Dyspareunia can be caused by a variety of factors, including a mix of emotional and physical aspects. Some individuals may find that their potential causes are a combination of both.

Physical Causes of Painful Sex

Physical causes of dyspareunia often refer to conditions or aspects that create or worsen pelvic pain, vaginal pain, pain in the penis, or pain with sex.

Pelvic Floor Dysfunction

The pelvic floor is an incredibly important group of muscles that each and every person has. These muscles play major roles in urinary and bowel functions, and also allow for sexual function and appreciation.

For those with a vagina, they aid in arousal, sensation, and orgasm. For those with a penis, they allow for erection, sensation, and ejaculation.

When these muscles are tight, weak, overactive, or uncoordinated, sexual function becomes difficult or painful. Additionally, the presence of trigger points in the muscles can create intense pain during sexual activity.

Therefore, in order to have successful and pleasurable sexual function, the pelvic floor needs to be in good health!

Pelvic floor dysfunction can be caused by a variety of factors, such as pelvic conditions, childbirth, poor posture, misalignment of the body, muscle imbalances, harmful restroom habits, and more.

Pre-Existing Conditions

Individuals with pre-existing conditions may be more likely to have pelvic floor dysfunction or worsened pain with sex, due to the symptoms of their conditions.

Some common conditions that contribute to dyspareunia include the following:

Pelvic or genital conditions:

• Endometriosis
• Vulvodynia
• Vaginismus
• Interstitial cystitis
• Vulvar pain disorders
• ​​Peyronie disease
• Vaginal atresia

Infections:

• Pelvic inflammatory disease
• Vaginal infections
• Prostate infections
• Urinary infections
• Sexually transmitted infections

Neurological conditions:

• Pudendal neuralgia: This condition involves the compression or irritation of the pudendal nerve. This nerve allows for sensation and function of the pelvic floor and genital areas, so dysfunction of this nerve can lead to dyspareunia.
• Central sensitization: Certain conditions that create chronic pain often cause central sensitization, which is a heightened sensitivity to pain. This means some individuals experience higher levels of pain even to low amounts of stimulation.
• Nerve hypersensitivity: Pre-existing conditions, injuries, or trauma can lead to nerve irritation, even in the pelvic region.

Hormonal Changes

Hormonal changes from causes such as menopause, pregnancy, and birth control can create decreased arousal and less vaginal lubrication, which in turn can create more discomfort for those with a vagina.

Scar Tissue

Scar tissue and adhesions, such as from inflammation, injury, or surgery can reduce mobility and comfort in the pelvic region, contributing to pain.

This can include scars from previous childbirth experiences or pelvic surgeries. Endometriosis, infections, injuries, and other conditions can often cause adhesions due to inflammation.

Allergic Reactions

Some individuals are more sensitive or allergic to ingredients found in sexual aids, including condoms, lubricants, and other products. These items can cause irritation and discomfort during sex.

Emotional Causes of Painful Sex

Emotional causes are just as powerful as physical causes. The combination of pelvic floor dysfunction and negative emotions creates a cycle of symptoms.

This is because emotional responses like fear or anxiety can create pelvic floor tightness, which results in pain during sex. This pain only worsens the anticipation for the next sexual activity, leading to more fear, more tension, and more pain.

There are many negative emotions that can impact sexual pleasure and pelvic floor tension, all of which can derive from different causes or life experiences:

• Anxiety and fear can often result from previous negative sexual experiences, such as sexual trauma or pain during the first attempt at intercourse. 
• Many individuals may struggle with body image and confidence, leading to anxiety and nervousness associated with sexual activities—which in turn creates pelvic floor tension.
• Some individuals may have cultural or religious experiences that affect their perception of sexuality and sex in general. These experiences can contribute to feelings of shame or anxiety, which often results in worsened pelvic floor tension.
• Stress or depression from other factors in your life can affect arousal and relaxation, which may make intercourse more difficult and painful.

In many cases, acknowledging these emotions and why you may be feeling them can be the first step towards improving your sexual health.

You can’t (and shouldn’t) ignore your feelings. Emotions are strong, and they can affect your body’s physical response to intimacy!

Therefore, consider talking to your partner(s) about your struggles, as well as incorporating a mental health professional into your overall care plan for dyspareunia.

Next, we’ll discuss how pelvic floor physical therapy can play a role in improving your sexual health and decreasing pain with sex.

Pelvic floor physical therapy is just one piece of the puzzle for treating dyspareunia—but it can significantly improve function, lessen pain, and encourage better confidence for patients experiencing painful sex.

Hive’s physical therapists are also ready to collaborate with other health professionals as needed in order to provide a holistic care experience for their patients, including: Sex therapists, gynecologists, mental health professionals, and more.

When it comes to treatment at the clinic, there are many methods your physical therapist may use!

They will first discuss your medical history and symptoms, as well as perform a physical examination (with your consent) in order to best identify possible causes of your pain.

Hive’s physical therapists understand that seeking treatment for dyspareunia can be scary or difficult, and always do their best to make their patients feel comfortable and welcome in the clinic.

While internal and external examinations can provide important information for your plan of care, you are not required to partake in anything you are not comfortable with—and that goes for treatment, too.

Our pelvic floor therapists will do their best to work with you and your comfort level, so don’t let fear of treatment or examination stop you from seeking health care!

So, what treatments can you expect for dyspareunia? Treatment plans can vary from person to person, but we’ll discuss some examples below. Most of the treatments will focus on reducing tension, relieving pain, and restoring your pelvic floor to good health!

Manual Therapy and Pain Management

For those with tight, painful pelvic floor muscles, manual therapy can help manipulate and mobilize those muscles to encourage relaxation and decrease tension. Manual therapy can relieve pain and even help improve painful scar tissue (if applicable).

Manual techniques can be done internally via the vagina or rectum, or externally to the pelvis, hips, lower back, or abdominals. These areas of the body can affect pelvic floor tension, too!

For individuals receiving internal manual techniques, this treatment can be helpful in desensitization, allowing you to become more accustomed to touch and sensation, thanks to tools like dilators (more on that soon)!

Pelvic Floor Training

As mentioned before, the pelvic floor plays a major role in sexual appreciation and function. So in order for you to gain better control over those muscles, your pelvic floor therapist will utilize pelvic floor training techniques!

This can include neuromuscular re-education and biofeedback, which are treatments that help you recognize and feel your pelvic floor muscles as they contract and relax.

This is incredibly important not just for control, but also for allowing those muscles to relax and coordinate as needed for sexual function.

Speaking of relaxation, your physical therapist will teach you techniques such as diaphragmatic breathing, which helps to relax your pelvic floor—and your mind, too!

For individuals looking to improve their tolerance of penetration, there are tools called dilators that will help you improve your comfort and control. Dilators are insertable tools that range widely in terms of size, so you can go at your own pace and start small if necessary.

While dilation therapy may seem straightforward, there is a correct way to practice it—which is why your pelvic floor therapist will help provide all the information and instruction you may need!

While dilators are applicable for vaginal penetration, there are also anal dilators for individuals experiencing anodyspareunia (pain with anal intercourse). Your pelvic floor physical therapist can provide information and guidance on that too, if needed.

Exercises

In order to improve your pelvic floor health, your care plan at Hive will include exercises.

While relaxing your pelvic floor muscles via manual therapy or breathing techniques is important to reduce pain, your muscles may still be weak, which reduces sexual function. Additionally, your body’s muscles may be imbalanced, which can lead to more pelvic tension.

Therefore, you can expect:

• Exercises and stretching to balance the muscles in your pelvis, hips, abdominals, and back.
• Exercises and stretching to improve the strength and flexibility of your pelvic floor muscles, for better function and sexual appreciation!

Having strong, flexible pelvic floor muscles can decrease pain, improve sensation, and even improve orgasms (again, no matter your genitals)!

A weak pelvic floor has a harder time supporting optimal sexual function and satisfaction, so it is essential for your pelvic floor therapist to help you build strength through exercises.

Behavioral Modifications

Hive Therapy and Wellness values preventative treatment as well, meaning your physical therapist will help solve any harmful habits you may have that are contributing to pelvic floor tension.

Having poor posture or misalignment, straining on the toilet, holding urine for long periods of time, having inadequate fiber or hydration—these habits may seem irrelevant to sexual health, but your pelvic floor controls more than just sexual functions! It controls your bladder and bowels, too.

Therefore, doing things that can create tension in the pelvis can affect all aspects of your pelvic floor.

Education and At-Home Care

Education is a very important aspect of sexual health. Your pelvic floor therapist can teach you all about your body, your pelvic floor, how the pelvic floor allows for sexual function and appreciation, and advice for at-home practice in terms of stretching, relaxation, and dilation.

Additionally, your physical therapist can suggest a huge range of resources and tools that can support your sexual health journey, including suggestions for sex-related books, sexual aids such as lubricants or tools, and even advice on positions that may be more comfortable for you.

As you can see, there are many ways a pelvic floor therapist can help treat dyspareunia. Your sexual health matters, and Hive wants to encourage you to take the next steps at achieving optimal health!

If you are still unsure or have questions—or you just want to know more about Hive and our providers—feel free to check out our free discovery call.

At Hive Therapy and Wellness, our physical therapists are dedicated to providing holistic and individualized care to our patients.

While receiving pelvic floor physical therapy at our clinic for dyspareunia, you may receive any of the following treatments as a part of your comprehensive plan of care:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback