What is dyspareunia and is it why you feel pain during penetration?

“It has to start with education and us telling our friends, our sisters and our daughters that you should not accept living in pain.”

Whether your first time was as an adventurous teen exploring a new world of sexual possibilities or it came later in life, our first sexual experiences are unforgettable. 

For some, this milestone is a fond memory while others want to forget their first time entirely; a tangle of legs, awkward angles and an unusual feeling or perhaps some slight discomfort.

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While it’s normal for some awkwardness and discomfort to be connected to our first sexual experiences, there’s a difference between feeling uncomfortable and being in pain. Many women are conditioned to recognise bad sex as normal and continue to engage in penetrative sex despite experiencing intense pain throughout.

But painful sex should never be accepted or discounted as normal. Dr Jaclyn Wloszczowski, an obstetrician, gynaecologist and the director of Embrace Women’s Health, defines “pain with sex” as dyspareunia, a term used to describe pain experienced before, during or after vaginal intercourse.

Sadly, Dr Jaclyn believes a lack of education around dyspareunia has led many vulva owners to “assume [painful sex is] their lot in life, and they engage in sex not because they enjoy it, but because they feel it their responsibility as a partner”. 

To shed some light on this relatively unknown symptom of sex, I chatted with Dr Jaclyn about the varied physical, emotional and psychological causes of dyspareunia, how to distinguish between discomfort and pain and why it’s so important to inform vulva owners that sex should “absolutely” never be painful.

What causes dyspareunia?

The two classifications of dyspareunia, superficial and deep, correlate to different causes. Dr Jaclyn tells me superficial, entry pain dyspareunia often occurs from a lack of lubrication, injury, trauma, infections and skin disorders, vaginismus or congenital problems.

“There are many different causes of superficial dyspareunia, and that can be due to hormonal issues, nerve issues, structural issues or muscular [issues]. Muscular issues are a very big cause of deep and superficial dyspareunia.

Specifically, Dr Jaclyn describes “pelvic floor muscle spasm and vaginismus” as significant causes of dyspareunia she often sees. “Vaginismus can occur on its own, or it can be as a side effect of an infection, or an unpleasant sexual experience, or an unpleasant examination with a doctor,” she tells me.

“Whilst it is partly physical, it is partly mental and neurological in that your body is trying to protect you from further harm by making your muscles spasm. So, it is important to look at both the physical, emotional and psychological aspects of it.”

Some instances of dyspareunia stem from low estrogen levels, causing the much dreaded vaginal dryness. “What is very often discounted in women on medication that suppresses their estrogen levels, post-partum [women] that are breastfeeding and post-menopausal [women], is that low estrogen can cause a lot of vaginal dryness. [This] dyspareunia is usually quite easily rectifiable once you acknowledge it.”

Deep pain dyspareunia generally occurs with deeper penetration and is often caused by certain illnesses and conditions, including endometriosis and adenomyosis to name a few, as well as some surgeries.

Discomfort versus pain

So how do you know if you are experiencing dyspareunia? Dr Jaclyn is most concerned with vulva owners simply putting up with pain during sexual penetration. 

“I would differentiate [dyspareunia] from discomfort that is just due to being newly sexually active, [it] shouldn’t be persistent, would only really occur at the very outset and would only improve with time.

“The key difference is discomfort versus pain. Discomfort, to me, is something that is a little bit annoying, but you can totally put up with it. Whereas pain is your body trying to tell you that something is harmful and that we should listen to the body and stop doing it.

“One of the big problems I see is from women or vulva owners that continually try and push through that. That amplifies the pain pathways, without actually dealing with the underlying issues,” she explains.

This pain can occur before, during or after sex, and Dr Jaclyn worryingly tells me it can even “​​last for several hours or days after the event”. If vulva owners are experiencing painful sex at any of these points in time, this should not be discounted as normal.

Targeted treatment

To remove dyspareunia from sexual experiences, the root cause of the pain must be identified, because “treatment is very much dictated by the underlying cause,” Dr Jaclyn informs me.

“If a woman has a recurring candida infection, dilators are not going to help her! If there is an infection, you treat that. If there is vulvodynia, physiotherapy and sometimes topical treatments can be very helpful. Vaginismus and pelvic floor muscle dysfunction respond beautifully to physiotherapy.

“Sometimes, there are structural issues that actually need surgery, and endometriosis… requires an entirely different approach,” she explains.

Where dyspareunia stems from a traumatic sexual experience, a different approach is also required. “If this is a psychological or a learnt experience, or a negative association with sex, then the involvement of a sexologist is hugely important,” she tells me.

Changing the conversation

Dr Jaclyn urges vulva owners to seek the advice of a sexual health specialist where the pain lasts for a period of time after the sensation of touch has ceased, especially where this has occurred more than once.

Dyspareunia can often be cured, but it requires sufferers to recognise that pain experienced during sex is not normal. “As a woman and a mother, it is my job to educate my daughters that sex is not their duty, that sex should be something performed on their terms that they should find enjoyable and certainty not painful.

“We should educate [people] from a very young age that if something does not feel right, just like any injury or any pain signal in your body, that [you should] listen to it and to seek assistance,” Dr Jaclyn expresses to me.

“It has to start with education and us telling our friends, our sisters and our daughters that you should not accept living in pain.”

This article was originally published on April 14, 2022.

For more information about dyspareunia, head here.