Medical Advice

Dyspareunia: the biggest passion killer of all.


Dyspareunia simply means “pain with sex”.

There isn’t a woman on the planet who hasn’t had some pain with sex from time to time. This is usually due to “not being ready” for sex: for example, not enough foreplay, or “not being in the mood”. Many women find that certain sex positions can be uncomfortable, and this can be caused by the penis pushing more on the front wall of the vagina than the back wall.

More frequent dyspareunia is definitely not normal, and needs to be checked by a doctor. This dyspareunia is almost always caused by a physical problem.

Doctors talk about “entry/vaginal/superficial” and “deep/abdominal” dyspareunia. Entry dyspareunia is usually caused by a problem in the vagina. Deep dyspareunia occurs when there is a sore spot right at the top of the vagina, on or above the cervix.

Dyspareunia in women who are having periods.

You don’t need more oestrogen. If your dyspareunia is vaginal, the likely problems are either dermatitis or vaginal muscle spasm (which itself can have many causes). If you have tummy pain during sex, then the possibilities include endometriosis, pelvic inflammatory disease, bowel problems like constipation, or even back pain.

Dyspareunia in post-menopausal women

You might need more oestrogen! If your vagina feels “dry”, your doctor will probably prescribe a course of vaginal oestrogen. You should try this for 4-6 weeks to see if it will help. Remember though, low oestrogen levels are only one of many causes for pain after the menopause, and if oestrogen doesn’t help you, you need to talk with your doctor again about other possible causes.

Dyspareunia in breast-feeding women

You might need oestrogen as well, but if a 4-6 week trial of oestrogen doesn’t improve things, then you shouldn’t continue to use it. If you have pain over the site of any stitches, your doctor will check to make sure it has healed properly. But pain over the stitches may not be actually caused by the stitching itself, but by other secondary issues like dermatitis or muscle spasm.

Women who have always had painful sex

There is a group of women who may have a fundamentally psychological cause for their dyspareunia. It is a sad fact of life that one in five women have been sexually abused as children, and this can make it very difficult to have a normal sexual life as an adult. In other women who have been brought up very strictly, and who have been taught that sex outside marriage is wrong, some can develop a fear of sex that then makes a normal sexual response after marriage very difficult to achieve. Even though some women who have always had painful sex have a problem which is primarily psychological, it is always important to rule out physical causes such as a thick hymen, and skin problems.So see your doctor and try not to be scared to talk about it.

What about “vaginismus”?

This word describes painful sex caused by vaginal muscle spasm. Many doctors still think that any woman with this problem has a fundamentally psychological reason for the spasm. We think this attitude is not correct. Any woman with dyspareunia caused by muscle spasm needs to carefully checked for physical problems.

In conclusion...

Please don’t put off sorting out your dyspareunia. An accurate diagnosis of the cause will lead to effective treatments for your pain. The longer you have painful sex, the more likely you are to develop secondary problems, such as a fear of having sex, psychological vaginal muscle spasm and relationship difficulties.