What is Dyspareunia?
As a Sexologist, Holistic Counsellor, Couples Therapist & Sexual Educator, I see a very eclectic array of issues in my practice, but one of the most common concerns I treat, is painful or uncomfortable sex, otherwise known as, Dyspareunia (for those of you boggled by this pronunciation it’s ‘dis-puh-ROO-nee-uh’).
Dyspareunia can come from structural, hormonal, or psychological issues & typically manifests as pain experienced before, during or after sexual activity. Dyspareunia is an issue that can affect anyone, regardless of their biological sex, for Men, rates are around 1-5% & for women, around 60% will experience painful sex at some point in their life. First & foremost, sex should not be painful, if you are experiencing discomfort, seek medical intervention to explore what may be going on & I will put some information in this article to get you started on your healing journey.
Symptoms & Causes of Dyspareunia:
Painful intercourse can be very distressing as it can affect our mood, libido, arousal, impact our relationships & take the pleasure out of sex. Dyspareunia can present as soreness around the entry of the vagina/anus, burning, a deep aching, or even throbbing pain that can last hours after intercourse. People who have dyspareunia may end up avoiding sexual intimacy all together & can experience concurrent psychological & physiological symptoms such as anxiety, pain or discomfort.
Painful sex can have a varied aetiology & is generally broken up into two types of pain, superficial & deep; this will be dependent on where the discomfort is experienced. Addressing the psychological influences of painful sex is an integral part of evaluating & treating the condition; as our brain is our biggest sexual organ & plays a key role in arousal, pleasure & enjoying the erotic.
Psychologically, there are a number of influencing factors that can impact how we experience sex, such as:
Performance Anxiety
Feeling Disconnected from our Partner
Feeling Pressured for Sex
Relationship Distress (Fighting, Arguing, Miscommunication or Infidelity)
History of Sexual Abuse or Trauma
Stress, Guilt or Fear
Cultural or Religious Beliefs
Lack of Sexual Education
Body Image or Self-esteem Issues – this may even include negative feelings about your Genitals
Deep Pain is generally inside the Vagina or Anus & can be characterised by sensations like aching, tearing or burning. Deep pain may be the result of:
Endometriosis – often painful condition where endometrial-like tissue grows outside of the uterus
Infection – such as PID (pelvic inflammatory disease)
Ovarian Cysts
IBS (Irritable Bowel Syndrome)
Uterine Fibroids - noncancerous growths in the uterus
Haemorrhoids - inflamed/swollen veins in the anus or rectum
Adenomyosis – a condition where endometrial tissue grows into the uterine wall
Prostatitis - inflammation of the prostate gland
Trauma - during surgery or childbirth
Tight Pelvic Floor Muscles
Pelvic Organ Prolapse
Superficial Pain is often experienced when penetration is attempted & could be the result of the following:
Lack of Sexual Arousal – this may result in insufficient lubrication & tension in the pelvic floor. Lack of arousal may be due to performance anxiety, pain, emotional or psychological worry.
Tears & Abrasions - the skin on the genitals is very delicate & soft (similar to the skin on your eyelids), which means it can easily crack or split causing pain & discomfort
Hormonal issues – oestrogen assists in blood flow to the genital tissue, lubrication & keeps the lining of the vagina healthy. Hormone levels can be impacted during menopause, breastfeeding, postnatally or after a hysterectomy
Vaginal Atrophy – often caused by lowered oestrogen levels, the vaginal walls can become thin, dry, delicate & inflamed
Peyronie’s Disease – a gradual bending of the penis, caused by fibrous scar tissue, making erections painful
Infections – caused by STIs like HSV (herpes simplex virus), UTIs (urinary tract infections) or PIV (pelvic inflammatory disease)
Imperforate Hymen – the hymen is small stretch of remanent tissue near the entrance of the vagina, this is left over when the genitals form during embryo development. A thickened or intact hymen can sometimes obstruct the vagina, making penetration painful & difficult or impossible
Vaginismus – this is the involuntary contraction of the vaginal muscles, often in anticipation to pain. This contraction causes the vagina to narrow & may make penetration difficult or impossible
Vulvodynia – discomfort, pain or burning around the Vulva with no specific causation
Penile Fracture – rupture that can occur during sexual play, causing a tear in the corpora cavernosa or the penile sheath. If you experience any severe pain, bruising or hear a pop/crack during sex, seek immediate medical attention
Growths, Warts, Skin tags or Lumps on the genital area
Skin Conditions – such as Lichen Sclerosus, Psoriasis, Eczema, Thrush or contact Dermatitis (this can be from washing the genitals with soaps, perfumes or irritants)
Phimosis – tight foreskin, that is generally difficult or impossible to retract below the head of the penis
FGM (Female Genital Mutilation) – surgical alteration of the vulva for non-medical reasons
Mismatch of Size – a larger penis, toy or fingers trying to go into a smaller orifice
Allergic Reaction – to condoms/dams, lubricants or genital washes
As you can see, there is such a broad aetiology for painful sex; this means investigation & correct diagnosis is extremely important.
If you or your partner(s) are experiencing painful sex, I suggest seeing your GP to investigate the issue further. A thorough medical history will generally be taken, along with the exploration of any symptoms you’re experiencing. Sometimes a pelvic examination is required & depending on the diagnosis, you may be referred to a specialist, such as a Gynaecologist or Urologist, for further medical evaluation.
If this all sounds daunting, remember, you can seek assistance from a Sexologist, like me, who practices integrative medicine & can refer you to any specialists you may need. I suggest exploring medical practices like Elgin House, based in Melbourne, who have a really eclectic array of specialists, working as a multidisciplinary team; meaning, you have all your specialists working together, under one roof. Your local family planning or sexual health clinic is also a great place to start your investigation & may be able to point you in the right direction. If you have already been on a journey with other medical specialists & want some assistance re-connecting to your pleasure, your partner or easing the encumbrances of painful sex, don’t hesitate to reach out via my website.
How to build sexual arousal - the importance of warm up time:
When you go for a run, or to the gym, you always warm up your body first with some stretching to prevent cramping or injury; when it comes to sex, we need to take the same approach. Lack of lubrication & arousal are one of the most common reasons people experience painful sex. When we have sex, there are a number of physiological processes that the body goes through to prepare you to experience pleasure. These processes are part of the sexual response cycle (SRC), there are a myriad of models for this cycle, for the purpose of simplicity, I’ll exemplify a basic SRC, which comprises of desire (libido), arousal (excitement), orgasm & resolution. When it comes to sex, I encourage clients to focus on building desire, arousal & excitement. During arousal, we have a number of delicious changes in the body, particularly in our genital area. Arousal increases our heartrate & blood pressure, swells the breasts, erects the nipples, dilates the areolas (how cool is that!), accelerates breathing, increases muscle tension & flushes the genitals with blood, causing vasocongestion.
For those with a penis, this may look like an erection & the swelling & tightening of the testicles. For those with a vulva, this may look like a change in labium colour (flushing with blood), the clitoris becoming erect, tenting of the vagina (it can extend around 4-8inches in length), lubrication of the vagina, elevation of the cervix & uterus. Arousal also happens in our mind as it erotically engages during play & is by far one of the most important processes to having great sex, as it prepares us mentally & physically, to have the most pleasurable experience possible.
When it comes to arousal, we have a little incongruence between those of us with a penis & those with a vulva. I often explain this as biological males being more like a microwave (you press the buttons & they’re hot & ready) & biological females more like an oven (you MUST heat up before anything goes inside). For context, it can take women up to 20mins to be fully aroused, this means, for the female genitals to be at the same space, as a fully erect penis, we need a minimum 20mins of sexual excitement/play. This is a general guideline, not a rule. For some of us, it can take 40mins to be fully ready for pleasure, for others it may take 10mins. With this knowledge fresh in your mind, I invite you to start imaginatively thinking about how you & your partner can get your bodies as highly aroused as possible, before engaging in penetration.
Something important to note about arousal, is arousal non-concordance, this means, we can’t always tell how turned on someone is by their physiological reactions, we must also consider subjective arousal. These two ways that we get turned on & ready for sex are very important, because we ideally need the physiological & mental arousal, to get the most pleasure out of our sexual experiences. Know that sex is completely possible without an erect penis or a lubricated vagina, but preferably, we want your mind & body to be in-line with what’s happening, so you can really enjoy yourself & let go.
Sex is so much more than PIV (Penis in Vagina) & Penetration:
When it comes to sex, we really do live in a society that favours PIV (penis in vagina) & penetrative sex. I’m here to tell you that sex encompasses anything consensual, pleasurable & enjoyable for you &/or your partner(s). Statistically, only around 25% of women can consistently orgasm through vaginal penetration alone. This means there are 75% of us, that need direct, or indirect clitoral stimulation, to experience heightened pleasure. I invite you to start looking at pleasure from a different angle (literally). Try to incorporate tongues, fingers, hands, lips, whatever elicits feelings of pleasure & explore with rubbing, caressing or oral stimulation. For those who experience painful sex, the avoidance & dread that comes with a potential encounter, can be enough to turn anyone off. Integrating mutual masturbation, kissing, sensual touch & massage, may help bridge the pleasure gap, creating a more equally enjoyable experience. Expanding your perception of sex to incorporate all these delicious types of stimulation, gives you & your partner(s) the opportunity to really explore pleasure & sensation; hopefully diminishing the likelihood of painful sex.
Recommendations from the Sexual First Aid Kit™:
For those of you just starting your sexual journey or experiencing sexual pain, I suggest looking purely at external stimulation (for now). Until we know why you’re experiencing pain, this will get you warmed up & ready for penetration. Where you refocus your energy, will be dependant on where you experience pain. If it’s penile pain, let’s explore the testicles, anus & erogenous zones. If your pain is in the Vagina or Anus, lets stick to clitoral or penile stimulation. Remember, sex is so much more than PIV & penetration. Use your hands, mouth, lips, fingertips or choose something sumptuous from the Sexual First Aid Kit™.
My recommendations from the Sexual First Aid Kit™ include some of the incredible toys by Iroha, particularly, the Midori & Mikazuki. These beautiful products are soft, supple & the perfect introduction to a vibrator or dildo. Iroha is designed by women, for women, & bring with them all the delicious elements required for the perfect self-pleasure & self-care session. If you’re currently experiencing deep pain, let’s hold back from putting these toys inside you just yet, use them to gently trace the vulva & clitoral area, against the tip of the penis, or between the testicles, building pleasure slowly. Another fantastic external toy is the Womanizer Premium, this little ‘clit sucker’ is by far one of the best toys on the market for building female pleasure & arousal. Womanizer Premium is quiet, made of hypoallergenic medical grade silicone & is one of the most recommended products in my Sexual First Aid Kit™. I also suggest exploring the Wand by We-Vibe™, this is a must-have clitoral & penis stimulator. Wand by We-Vibe™ is cordless, quiet, made of body-safe, soft touch, silicone & has powerful rumbly vibrations. Most of these toys are water proof or resistant, so you can set up a lovely space for yourself to explore. Don’t forget to leave the gender bias at the door & get creative with these toys, no matter who you’re playing with.
The Importance of Lubrication:
When it comes to lubricant, my motto is, the wetter the better! No matter who you are, you can benefit from adding some ‘liquid gold’ to your sexual play. There is a lot of chemistry involved in sex, our physiology is made so perfectly that it can often provide what the body needs to have slick, wet, play; unfortunately, there can be many impacting factors that can make lubrication challenging.
Hormonal changes are one of the most impacting factors; menopause, breastfeeding & even post-childbirth, the body experiences drops in hormones like oestrogen, the hormone needed to stimulate lubrication. Some medications, such as the injectable contraception & antidepressants can also impact lubrication or arousal.
The brand I keep in my Sexual First Aid Kit™ & recommend to clients is Pjur; they not only have lubricants that are registered medical products, but they use high quality ingredients & have such a huge range, there is truly something for every-body. If you are adjusting to hormonal changes, have sensitive skin, or just want something gentle to start with, I recommend exploring Pjur Med Sensitive Glide or Pjur Med Repair Glide. Both of these lubricants are water-based, so they won’t stain your sheets or damage your toys & they are some of the most body-safe, gentle products on the market; making them a great place to start your exploration of lubricant. When it comes to anal play, unlike the vagina, the anus does not self-lubricate; for this reason, I suggest keeping some Pjur Back Door Glide on hand, to make sex more comfortable & pleasurable.
Treatment:
Treatment of Dyspareunia will always depend on your diagnosis. There are lots of supports available for sexual health & your treatment will depend on the specialist you work with. I suggest taking a holistic approach, so you can understanding the issues from a technical (learning how to increase arousal), physiological (such as relaxation techniques & physiotherapy), psychological (how it affects your mental health & wellbeing) & social (impact on partner(s) & relationship) perspective.
Here are some common general treatment options, depending on your diagnosis & where the pain is experienced:
Changing sexual positions – this is helpful if you’re experiencing deep pain, as some positions penetrate deeper than others. I suggest having the person who is experiencing pain on top, this way they can better control the depth & motion of movement
Communicate – this is really important so you can let you partner know where, when & how you experience the least pain so you can both work this into your sexual play
Build Sexual Arousal – remember, we need the mental & physical arousal to experience the most heightened pleasure
Use LOTS of Good Quality Lubricant – I can’t stress this enough, the wetter the better!
Talk to your Doctor about HRT (hormone replacement therapy) or oestrogen creams – to help counteract any hormonal imbalances
Take the focus off Penetrative Sex – remember, sex encompasses anything consensual, pleasurable & enjoyable for you &/or your partner(s). Discover what sex is like with your entire body & look into new ways you can explore pleasure; like with a tool from the Sexual First Aid Kit™
Physiotherapy – learning to pinpoint, relax & release tense pelvic floor muscles
Counselling & Sex Therapy – learning to manage the psychological impact of pain or discomfort on self/relationships & reconnecting to your pleasure
I hope you’ve gained some wisdom & insight from this article; sex truly is an ongoing learning experience & adventure. Whatever sexual barriers you’re experiencing, know that sex therapy can help you unpack, unravel & understand yourself, your partner & your sexuality, on a deeper more intimate level.
If you are ready to rekindle your sexuality, find your greatest wisdom & deepest pleasure, bookings & enquiries can be made via my website www.teganmcgie.com