Dyspereunia (Painful Intercourse)


sex act,sexual congress,sexual intercourse,sexual relation.

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Dyspareunia is a medical term for painful intercourse affecting the genitals. The pain in the genitals can occur before, after, or during intercourse. The condition can occur both in males and females. The pain experienced during, before, or after sex can range from moderate to severe. The pain may include the entire vagina, and it can be throbbing or burning pain.

Causes of Dyspareunia:

The causes of Dyspareunia may be many, but they are categorized into:

a.     Psychological factors

b.     Medical factors

c.     Other factors

Psychological Factors

There are many psychological factors responsible for Dyspareunia like:

a.     Depression, anxiety, and fear during sex, resulting in a problem with arousal leading to vaginal dryness or vaginismus.

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b.   Trauma in the past or history of a sexual abuse (Meston et al., 2013)

c.     Domestic violence

d.     Stress (Bodenmann et al., 2010)

Medical factors

a.     Vaginal atrophy is one of the common conditions causing thinning, inflamed, or drying of the vaginal lining (Palma et al., 2018). The condition is very common in post-menopausal women.

b.     Certain infections like urinary tract infections, yeast infections, and sexually transmitted diseases like herpes, genital warts, or candida can also cause Dyspareunia.

c.   Some skin conditions like lichen sclerosus and psoriasis can also result in painful sex.

d.    Bacterial infection of the bladder causing interstitial cystitis can also cause Dyspareunia.

e.    Endometriosis, where uterine tissues are formed in other places of the body, also causes Dyspareunia.

f.   A functional disorder of the digestive tract called irritable bowel syndrome can also cause pain during sex in some women.

g.   Fibroids are benign tumors present on the wall of the uterus. These fibroids may also cause you to have pain during sex.

h.     PIVD or pelvic inflammatory disease

i.      Uterine prolapse

j.      Ovarian cysts

k.    Congenital abnormalities like vagina not formed fully (Vaginal Agenesis) or imperforate hymen, which means the development of a membrane blocking the vaginal opening

Other factors

There may be some other factors, too, causing the Dyspareunia, like side effects of some drugs or allergies caused due to spermicides, condoms, or clothing.


The symptoms to look for Dyspareunia are:

a.    Pain during penetration of penis during sex

b.  Pain with every penetration, including insertion of tampons

c.    Pain felt during thrusting

d.    Dull aching or burning pain

e.    Pain that lasts for hours after intercourse

How is the condition diagnosed?

If you are experiencing any of the above symptoms, you must visit your doctor, who may ask you questions related to your sexual, medical, and surgical history. If you are involved with multiple partners, you may be asked if the pain occurred only with certain partners.

Your doctor may also perform a pelvic exam to rule out any form of pelvic infection. Based on a pelvic exam, your doctor may recommend you an ultrasound, blood and urines tests, or a visual exam of the vagina.


Your doctor will find out the cause of the Dyspareunia and treat the condition accordingly. When Dyspareunia is due to vaginal dryness, the doctor will prescribe lubricants and will suggest prolonging the foreplay. Your doctor will give you antibiotics when you have infections or sexually transmitted diseases. If your Dyspareunia is due to a hormonal problem, hormonal therapy may be prescribed. For uterine fibroids and endometriosis, you will need surgical intervention. If the cause of Dyspareunia is psychological, you may need psychological counseling.

Physiotherapy intervention

A woman can benefit from Dyspareunia by doing stretch exercises of the pelvic floor muscles. In addition, strengthening of the pelvic floor can also be beneficial in pain associated with Dyspareunia.

Kegel Exercises

Kegel exercises can help you with the pain of Dyspareunia. Kegel exercises are very beneficial in urinary incontinence post-childbirth (Cavkaytar et al., 2014). Research has proved that Kegel exercises are very effective in treating conditions such as vaginismus and Dyspareunia. Your therapist would suggest you a simple exercise to strengthen your pelvic floor.


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To know your pelvic floor, you should perform a test. Go to the bathroom and start urinating. Stop the flow of urine and then start again. Do it a few times. You can start and stop your urine with the help of pelvic floor muscles. Don’t forget to empty your bladder completely. Now that you have identified the muscles keep contracting and relaxing these muscles. However, you don’t have to do these exercises during urinating. Once you understand the movement, you can do it while sitting anywhere, not necessarily in the bathroom. This exercise will help you in gaining control over vaginal muscles, which will improve your pain due to Dyspareunia.

To do the Kegel exercises, hold and squeeze your pelvic floor for three seconds following by its relaxation for the next three seconds. Repeat the exercises ten times or until you have completed 15 repetitions of the same.

Initially, you will face problems in contracting your pelvic floor individually, which is fine; you can use other muscles like glutes, abdominals, etc. Once you get hold of the movement, it will become automatic.

Breathing with Kegel exercises

You can sync your Kegel exercises with breathing exercises. Your diaphragm is connected with the pelvic floor, which means that with shallow and poor breathing techniques, the tension in your pelvic floor muscles can worsen. If you cannot relax during sex, the pain is going to happen.

Follow these steps to keep your body relaxed. You can coordinate your pelvic floor exercises with breathing patterns. Focus on your breath initially. Inhale and exhale a few times deeply to relax. Now inhale deeply and hold your breath for a few seconds, and at the same time, contract your pelvic floor strongly. Relax these muscles when you exhale. Repeat these exercises a few times.

Manual muscles manipulations

Manual muscle manipulation is also known with the terms like Pelvic floor releasing or manual therapy. The main aim of manual muscle manipulations is to decrease tension, pain, and pressure that are caused by muscles trigger points.


Biofeedback is a procedure where real-time signals from the muscles are sent which creates a visual representation of the way you can contract and relax your pelvic floor. This way, you can understand more easily how to contract and relax your pelvic floor. Biofeedback along with Kegel exercises can be very effective in conditions like Dyspareunia, fecal incontinence, urinary incontinence, etc (Mundet et al., 2021). Using a computer model, your therapist can teach you how to coordinate Kegel with breathing exercises and to relax the pelvic floor for improvement in pain.

By a combination of treatment like stretching, strengthening, and training of pelvic floor, manual muscles manipulations, etc., you can enjoy your life without having to worry about the pain of Dyspareunia. A professional physiotherapist from Progressive Care can help you in getting rid of Dyspareunia.


1.     Meston, C. M., Lorenz, T. A., & Stephenson, K. R. (2013). Effects of Expressive Writing on Sexual Dysfunction, Depression, and PTSD in Women with a History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial. The Journal of Sexual Medicine, 10(9), 2177–2189. 

2.     Bodenmann, G., Atkins, D. C., Schär, M., & Poffet, V. (2010). The association between daily stress and sexual activity. Journal of Family Psychology, 24(3), 271–279. 

3.    Palma, F., Xholli, A., & Cagnacci, A. (2018). The most bothersome symptom of vaginal atrophy: Evidence from the observational AGATA study. Maturitas, 108, 18–23. 

4.   Cavkaytar, S., Kokanali, M. K., Topcu, H. O., Aksakal, O. S., & Doğanay, M. (2014). Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence. Journal of Obstetrics and Gynaecology, 35(4), 407–410. 


5.    Mundet, L., Rofes, L., Ortega, O., Cabib, C., & Clavé, P. (2021). Kegel Exercises, Biofeedback, Electrostimulation, and Peripheral Neuromodulation Improve Clinical Symptoms of Fecal Incontinence and Affect Specific Physiological Targets: An Randomized Controlled Trial. Journal of Neurogastroenterology and Motility, 27(1), 108–118. 

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