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You don’t need to suffer in silence: Understanding painful sexual intercourse in Women

February 06, 20244 min read

Dyspareunia, often referred to as painful intercourse, is a distressing and often overlooked issue that affects many women. Despite its prevalence, there is a noticeable silence surrounding this condition, leading many women to endure discomfort silently.

In my opinion, it’s so important to shed some light on dyspareunia, emphasizing that it is not something women should just put up with, as it is not normal. In this blog post, I would like to explore the causes, symptoms, and possible treatment options for dyspareunia.

Understanding Dyspareunia:

Dyspareunia is characterized by persistent or recurrent pain during sexual intercourse. This pain can occur at different points – during initial penetration, deep inside, or even after intercourse. 

Women can have pain externally in the vulvar region — to the labia (lips of the vagina) or at the opening to the vagina. Some feel the pain internally or lower abdomen. 

There are multiple potential causes of dyspareunia which may include physical, psychological, and emotional factors.

In addition to the physical pain, couples often suffer from loss of intimacy or experience strain in their relationship as a result.

Common Causes of Dyspareunia:

  • Dryness: Insufficient lubrication can lead to friction and discomfort during intercourse. This dryness may be due to hormonal changes during or following pregnancy or menopause, medications, or insufficient arousal.

  • Vaginal atrophy the vaginal lining can lose its normal moisture and thickness and become dry, thin, and inflamed – as above it can be due to hormonal changes.

  • Infections: Infections such as yeast infections, bacterial vaginosis, or sexually transmitted infections can cause pain during intercourse.

  • Musculoskeletal Issues: Conditions affecting the muscles and joints of the pelvic region, such as pelvic floor dysfunction – especially increased muscle tone of the pelvic floor muscles, vaginismus (spasm of the vaginal muscles) hip pain and reduced range of movement can contribute to dyspareunia.

  • Skin disorders of the genitalia such as lichens sclerosus, Bartholin gland cysts, lichen sclerosus, and lichen planus.

  • Following childbirth tears sustained during labour, episiotomies causing pain early on following childbirth but also the scar tissue resulting further down the line. 

  • Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, this can cause increase pressure and pain during intercourse.

  • Psychological Factors: Stress, anxiety, past trauma, or negative sexual experiences can contribute to dyspareunia.


The symptoms of dyspareunia can vary from woman to woman but may include:

  • Sharp or burning pain during penetration.

  • Aching pain during or after intercourse.

  • Low tummy pain

  • Muscle spasms in the pelvic region.

  • Difficulty relaxing the pelvic floor muscles.

  • Pain that persists even with gentle touch.

Treatment Options:

In my opinion, addressing dyspareunia requires a fully holistic approach that may involve medical, psychological, and physiotherapeutic interventions. Some potential treatment options can include.

  • Medical Interventions: Depending on the underlying cause, medical treatments may include HRT, topical oestrogen treatment, antibiotics for infections, or surgical procedures for conditions like endometriosis.

  • Psychological Support: Therapy or counselling can be beneficial for addressing any psychological or relationship factors contributing to dyspareunia.

  • Use of effective vaginal moisturizers and lubricants. 

  • Pelvic Health Physiotherapy: An important aspect of improving dyspareunia involves pelvic health physiotherapy. Your physiotherapist will work with women to assess and address musculoskeletal issues in the pelvic region. Through targeted exercises, breathing exercises, manual therapy (hands on treatment), and education, symptoms of pelvic pain can be improved. Role of Pelvic Health Physiotherapists:

Pelvic health physiotherapy helps in managing dyspareunia by:

  • Assessing Pelvic Floor Function: Physiotherapists can assess the strength, tone, and coordination of the pelvic floor muscles to identify any dysfunctions.

  • Providing Personalized Exercise Programs: Tailored exercises can help strengthen or relax specific pelvic floor muscles, addressing underlying issues contributing to dyspareunia.

  • Breathing exercises: by encouraging and restoring better breathing patterns through mobilising lower ribs, loosening spinal joints and muscles, and improving the diaphragm descent with breathing in, this can help restore pelvic floor muscle relaxation.

  • Manual Therapy: Physiotherapists may use hands-on techniques to reduce tone and improve flexibility in the pelvic floor muscles.

  • Educating on Self-Care: Education on proper posture, relaxation techniques, and self-care strategies empowers women to take an active role in managing their pelvic health.


Dyspareunia should never be dismissed as a normal part of a woman's life. By understanding the causes, recognizing the symptoms, and exploring comprehensive treatment options, women can take proactive steps toward addressing and overcoming this condition. It is so important to seek specialized care for a holistic and personalized approach to pelvic health and overall well-being. Breaking the silence surrounding dyspareunia is the first step toward empowering women to prioritize their health and seek the support they deserve.

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