YES®: Understanding Painful Sex (Dyspareunia): Symptoms, Causes, and Treatment

Painful Sex

Symptoms & Causes

Treatments & Professional help

Resources

Painful sex, also known as dyspareunia, is a common condition that causes pain and discomfort during or after sex. Here, we will explore the symptoms, causes, and treatment options for painful sex, to help you navigate this journey and find relief.

Experiencing pain during sex can be a challenging and distressing situation for individuals and couples.

It's important to remember that painful sex is treatable, and seeking professional help is crucial for proper diagnosis and guidance. By understanding the symptoms, causes, and available treatment options, you can take proactive steps toward overcoming painful sex, restoring sexual pleasure, and improving overall well-being.

Symptoms of Painful Sex

Painful sex can manifest in various ways, and the symptoms may vary between individuals. Some common symptoms include:

sharp or burning pain during penetration
- aching or throbbing pain before, during, or after intercourse
- pain that is localised or more generalised in the genital area
- pain during certain sexual positions or activities
- pain accompanied by bleeding or vaginal dryness, and feelings of tightness or inability to relax the pelvic floor muscles during intercourse
Information taken from [1], [2]

Causes of Painful Sex

Painful sex can be caused by a multitude of factors, which can be physical, psychological, or a combination of both.

Vaginal dryness:

for many women, pain during intercourse will be the result of vaginal dryness, leaving the sensitive vaginal tissues vulnerable during sex. Vaginal dryness is often caused by hormonal changes, lifestyle factors and certain medical conditions. Childbirth, pregnancy, breastfeeding, and menopause, can all cause insufficient vaginal lubrication and lead to friction and discomfort during intercourse [1] Read more about the causes and treatment of vaginal dryness here.

More..

Hormonal imbalances:

fluctuations in oestrogen levels can result in vaginal dryness and thinning of the vaginal walls [1]. This makes the vaginal tissues more delicate and can increase the likelihood of injury and pain during sex.

Psychological factors:
such as lack of desire or low libido, anxiety, depression, stress, low self-esteem, past trauma, relationship problems, or a history of sexual abuse can also affect sexual experiences and contribute to painful intercourse [1] & [4].
Infections:
gynaecological infections such as yeast infections, urinary tract infections (UTIs) and sexually transmitted infections (STIs)[3] may cause pain during sex. In some cases, taking antibiotics can interfere with the vaginal microbiome and cause yeast infections leading to pain during sex [Medical News Today]

Medical conditions:
such as vaginitis, or endometriosis [3], uterine fibroids [5], vaginismus, vulvodynia, vestibulodynia, or skin conditions such as Lichen Sclerosus.
Cervical cancer:
in very rare cases, cervical cancer may be the cause of painful sex. If you are also experiencing unusual vaginal bleeding, vaginal discharge or pain in the area between the hip bones (pelvis) it is important to see your GP or gynaecologist. Read more about cervical cancer here.
Treatment for cancer.
Certain cancer treatments may cause vaginal dryness or hormonal changes leading to painful sex. Read more about cancer and vaginal dryness here.

Guest Blog by Dr Sarah Ball:Testosterone Replacement in Menopause – is it the ‘missing’ female hormone?

Blog: Mind over menopause. The effects on mental health

blog: managing vaginal dryness post cancer treatment

Blog:The best over-the-counter menopause products for 2023 

Medical Conditions Explained

Vaginitis Symptoms of vaginitis include itching, soreness, unusual vaginal discharge, vaginal dryness, pain during sex, vaginal bleeding, sore or swollen skin around the vagina. Vaginitis has many possible causes and effective treatment options. It’s best to see your GP if you are experiencing any of these symptoms. [NHS]

Vaginismus is the sudden tightening of the vagina before or during penetration of any kind [NHS]. In vaginismus, the pubococcygeus muscle (the muscle supporting the vagina) involuntarily tenses, in a similar reflexive manner to someone flinching. The tensed muscle means that penetration becomes difficult or even impossible. Treatment for Vaginismus can include psychosexual therapy, relaxation techniques, pelvic floor exercises and vaginal trainers or dilators [NHS].
Vulvodynia refers to persistent, unexplained vulval pain. This may include burning, stinging or throbbing. Possible causes include previous surgery, childbirth, trapped nerves and a history of severe vaginal thrush [NHS].
Vestibulodynia is pain that occurs at the entrance (vestibule) of the vagina. Pain can also occur in other external parts of the genitals or vulva. Vestibulodynia is a form of vulvodynia.
Endometriosis is a condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. You may experience pain in your lower tummy or back, severe period pain, pain during or after sex, feeling sick, constipation, diarrhoea, or blood in your pee or poo during your period. [NHS]
Uterine fibroids are non-cancerous growths that develop in or around the womb. They can cause heavy periods, tummy pain, lower back pain, constipation and pain or discomfort during sex [NHS].

Lichen Sclerosus (often misspelt as Lichen Sclerosis) is a chronic inflammatory skin condition that mainly affects the vulva in women and female children and also the penis tip in men and boys. Women with Lichen Sclerosus usually develop small white spots and sometimes bruising on the vulva. Read more about Lichen Sclerosus here.
Pelvic organ prolapse (POP) can cause pain with intercourse as well as lower back pain, constipation, urinary leakage and more. POP is defined as the abnormal descent or herniation of the pelvic organs from their normal attachment sites or their normal position in the pelvis. Organs that can “fall” into the vagina from their normal position are the bladder, uterus, small bowel and rectum. [Maze Womens Health].
Ovarian cysts are fluid-filled sacs that develop on an ovary. They usually don’t cause any symptoms unless they rupture. In this case, they may cause pelvic pain, pain with sex and heavy periods. [NHS]

Treating Painful Sex

If you are experiencing any of the conditions above or are not sure of the cause of your pain during, before or after sex, you are not alone. Receiving the right support is vital to finding relief. 3 out of 4 women have experienced painful sex at some point in their lives and many women struggle with ongoing pain or discomfort.

Sex should never be painful, if you’re experiencing it, always seek help. Do not suffer in silence or let embarrassment stop you from seeking treatment.

The treatment for painful sex depends on the underlying cause. Always speak to your GP or healthcare professional to rule out any infections or medical conditions in the first instance.

Pelvic floor physical therapy

For conditions such as vaginismus or if you experience tightness or pain in your muscles before or during sex, consider pelvic floor physical therapy. This is usually a series of treatments that can help to address muscle tension or spasms in your pelvic region, providing relief and improving sexual function [3]. Your physiotherapist may suggest using vaginal dilators alongside treatment (see below).

Vaginal dilators

Vaginal dilators are smooth, cylindrical-shaped plastic tubes in a range of sizes which enable gentle progression as you get used to the dilators. Dilators help to keep the vaginal muscles supple as well as preventing the vaginal walls from becoming stuck together – this should make pelvic examinations and vaginal intercourse easier. Read more about vaginal dilators here.

Psychological counselling or Psychosexual (sex) therapy

Talking therapy can be extremely beneficial in addressing emotional issues, reducing anxiety, and improving overall sexual well-being [1]. This can be done alone or with your partner.

HRT

In cases where hormonal imbalances contribute to painful sex, hormonal replacement therapy (HRT) or vaginal oestrogen may be recommended [1]. This is particularly the case if you are going through perimenopause or menopause. Find out more about menopause and dryness here.

Medical intervention

may be necessary if an infection, disease or inflammation is the cause. In this case appropriate treatments such as antibiotics or antifungal medications may be prescribed [3]. For conditions such as uterine fibroids or endometriosis, surgery may be necessary.

Vaginal Moisturisers

If you believe that vaginal dryness is the cause of your pain or discomfort during sex, try a vaginal moisturiser. Vaginal moisturisers can be used daily to rehydrate dry intimate tissues and provide relief from irritation and pain. If vaginal dryness is affecting your day-to-day life, or is particularly severe, using a vaginal moisturiser as well as a lubricant may be beneficial your overall wellbeing as well as sexual function.

A combination of the above may be most effective at treating painful sex.

Other things that can help

Be honest. It might feel difficult at first but open communication with your partner about your experiences and concerns can provide emotional support and strengthen your relationship [1].
Use water-based and oil-based lubricants during intercourse can alleviate vaginal dryness and reduce discomfort [3]. Using a pH matched water-based lubricant in tandem with an oil-based lubricant can provide both hydration and soothing protection. Find out more about YES® certified organic personal lubricants and vaginal moisturisers below including YES® Double Glide, our combination pack of water-based and plant-oil based lubricant.
Prepare for sex. If you experience low libido or struggle to 'get in the mood’ engaging in foreplay can help reduce anxiety and relax your muscles in the lead up to sex. Experimenting with toys and clitoral stimulants can be an effective way to increase desire, arousal and anticipation. Clitoral stimulants are typically topical oils or gels that can be applied to the clitoris to enhance sexual pleasure and sensation. Some sexual stimulants provide warming or cooling sensations, others create a tingling affect.

How to treat painful sex with YES®

Applying lubricant before sex can help to soothe intimate pain, irritation and discomfort. YES® lubricants provide immediate, safe relief thanks to their natural ingredients, offering gentle hydration of your delicate tissues. You can choose between water-based and oil-based lubricants or use both together for ultimate pleasure and comfort. Our products come in tubes as well as discreet applicators which can be applied internally in advance of intercourse.

YES® WB water-based lubricant is a powerfully rehydrating, dual-purpose, long-lasting vaginal lubricant and moisturiser that will protect and lubricate sensitive tissues during intercourse and can be used topically to remedy vaginal dryness. YES® WB is pH matched to the vagina to help maintain a healthy vaginal environment. Its unique, patented plant-based formula provides instant but gentle relief from itching, soreness and painful intercourse. It's designed to feel completely natural without leaving any sticky residue, taste or smell.

YES® VM Vaginal Moisturiser is perfect for everyday use. It quickly re-hydrates dry intimate tissue for up to three days releasing moisture when and where your body needs it most. It is pH matched to the vagina to restore heathy vaginal pH.

YES® OB oil-based lubricant offers a more robust and rich long-lasting lubrication which can give added protection when severe vaginal dryness causes painful intercourse or Dyspareunia. YES® OB contains several ingredients with proven track records as healing skin foods and rich emollients and it is designed to soothe, heal, and offer the smoothest of lubrication. YES® OB is not condom compatible.

YES® DG (double glide) offers the benefits of both YES® WB water-based and YES® OB plant-oil based personal lubricants in a pack containing tubes of each product. YES® DG combines the benefits of both products – the longevity and high viscosity of YES® OB, with the natural feeling of YES® WB, to deliver the best of both worlds. We recommend applying a layer of YES® OB first, followed by one of YES® WB. The WB effectively slides over OB, increasing the degree and duration of the glide.

YES® O YES is our organic clitoral stimulant oil that’s been designed to enhance sensitivity to touch. It’s been created with a blend of organic oils, crafted with care to stimulate desire, quicken arousal, enhance sensation, and intensify pleasure during foreplay and climax.

Professional help; A Glossary

GP

Your GP will most likely be your first line of support. They can refer you to see a gynaecologist or specialist or offer treatment options depending on the cause.

Gynaecologist

A Gynaecologist is a doctor who specialises in the care of women with problems of the female reproductive system (ovaries, fallopian tubes, womb, cervix, vagina).

Psychosexual therapist

Sex therapists are qualified counsellors, doctors or healthcare professionals who have done extra training in helping people with problems relating to sex. A sex therapist can help people with various sexual problems, including: lack of desire, difficulty having an orgasm, pain during sex or inability to have penetrative sex.

Relationship counsellor

Relationship counselling (also known as 'couples counselling' or 'marriage counselling') is an effective form of talking therapy designed to resolve issues within an intimate relationship. This is not limited to sexual problems.

Physiotherapist

Women’s Health Physiotherapy is a specialised field of physiotherapy that helps women with problems affecting their pelvic floor and pelvic health. It can be effective at treating: chronic pelvic pain, bladder dysfunction, bowel dysfunction, sexual pain, pelvic uterine prolapse, pregnancy related problems, menopause related problems and lower back pain.

“Lubrication is a very important part of the physical arousal process and often women will need additional lubrication to help them enjoy stimulation of the vulval area, including the clitoris and vagina. Having tested all the lubrication available on the market, YES® has, in my opinion, proved to be the best in terms of viscosity and maintaining moistness whilst not causing any irritation whatsoever. I recommend it to all my clients and also to the medical students I teach so that they in turn can recommend it to their future patients.”