Dyspareunia Might Be the Mysterious Reason Sex Is Painful for You
Chances are, you haven't heard about dyspareunia, even if you have it yourself. Let's talk about the silent condition affecting at least 1 in 5 women.
Of all the illnesses no one talks about, the one that takes the cake might just be dyspareunia. Haven't heard of it? That's not surprising-but what is surprising is that upwards of 40 percent of all women experience it. (Other estimates go as high as 60 percent, per the American Academy of Family Physicians, though statistics have varied over the years.)
By definition, dyspareunia is an umbrella term for genital pain just before, during, or after intercourse, but the causes aren't always clear, nor are they the same. In fact, it's not always physical-in many cases, the condition has been linked to emotional trauma, stress, a history of sexual abuse, and mood disorders like anxiety and depression.
Sex is supposed to feel good. If it doesn't ever, talk to your doctor. In the meantime, if you think dyspareunia might be to blame for your painful sex, keep reading for more info.
Symptoms of Dyspareunia
"Typically, the symptoms of dyspareunia are any form of pain in the vagina during penetrative sex," says Navya Mysore, M.D., a One Medical physician. More specifically, that means:
- Pain at penetration (even if it's only felt at the first entry)
- Deep pain with every thrust
- Burning, aching, or throbbing sensations that last for an extended period of time after intercourse
However, it may not be painful every time you have sex, says Dr. Mysore. "One person might experience pain 100 percent of the time, but another may only experience it sporadically."
Physical and Psychological Causes
"Assuming there's no infection or inflammation present, dyspareunia can be the byproduct of a preexisting condition," says certified sexologist and osteopathic physician Habib Sadeghi, D.O., author of The Clarity Cleanse, (who's seen hundreds of patients for this disorder at his practice in Agoura Hills, CA.)
Some physical causes of dyspareunia include:
- A retroverted (tilted) uterus or uterine prolapse
- Conditions like uterine fibroids, ovarian cysts or PCOS, endometriosis, or pelvic inflammatory disease (PID)
- Scarring in the pelvic or genital region (due to surgeries like hysterectomy, episiotomy, and C-sections)
- Atrophy of cranial nerve zero (CN0), according to Dr. Sadeghi (more on this below)
- Lack of lubrication/dryness
- Inflammation or skin disorder, such as eczema
- Recent IUD insertion
- Bacterial infections, yeast infections, vaginosis, or vaginitis
- Hormonal changes
Scarring: "About 12 percent of the [female patients] I see have dyspareunia, with the most common cause being the scar from a previous C-section," says Dr. Sadeghi. "I don't think it's a coincidence these days that one in three babies are born via C-section, and one in three women experience some level of dyspareunia."
What's the big deal with scarring? According to Dr. Sadeghi, it can impact the nervous system. "Both internal and external scarring can disrupt the flow of energy throughout the body," he says. "Interestingly, in Japan, where C-sections are far less common, the incision is made vertically, not horizontally, in order to minimize such disruptions."
Kecia Gaither, M.D., M.P.H., who's double board-certified in ob-gyn and maternal-fetal medicine, agrees that scarring from C-section incisions could be a potential contributing factor to dyspareunia. "A mucocele-a small defect in the healing of the scar, containing mucus-within a very low transverse uterine incision can cause pain, bladder urgency, and dyspareunia," she said.
She also noted that, as Dr. Sadeghi mentioned, the horizontal incision of U.S. C-sections could, in theory, cause more issues than a vertical incision. She said that everything from dehydration to "other people's negativity" can disrupt the energetic flow within the body and that the physical trauma from a cesarean section would certainly be a disruptor that could contribute to dyspareunia.
CN0: "Another reason may be the deactivation or atrophy of cranial nerve zero (CN0), a nerve that picks up signals from pheromones received in the nose and transfers them back to the areas of the brain that deal with sexual reproduction," says Dr. Sadeghi. The process that primes our sexual readiness is highly dependent on the release of the hormone oxytocin or the "love" hormone that generates human bonding, he explains. "Pitocin (synthetic oxytocin) is administered to women to induce labor, and can dysregulate all 13 cranial nerves, including CN0, resulting in dyspareunia as an aftereffect."
While CN0 hasn't been extensively studied in humans, a 2016 report on the collection of data on CN0 found that this nerve may coordinate "environmental adaptive functions, sexual activity, reproductive and mating behaviors." Dr. Gaither corroborated this, noting that the researchers suggest CN0 is involved in triggering arousal either independently or through interactions with other circuits within the brain.
Hormonal shifts: "One of the most common causes is a hormonal shift, which can result in a change in the pH of vaginal secretions," said Dr. Mysore. "A classic example of this is the shift into menopause, which is when sex can become very uncomfortable because the vaginal canal is much drier."
Vaginismus: "Another common cause of pain during sex is vaginismus, meaning the muscles around the vaginal opening involuntarily contract in response to penetration," said Dr. Mysore. If you've experienced a couple of episodes of painful sex, for example, your muscles can react by freezing. "It's almost a reflex-your body is programmed to avoid pain, and if the brain begins to associate sex with pain, muscles can involuntarily react to avoid that pain," she says. "Tragically, this can also be a condition secondary to sexual abuse or sexual assault." (Related: 8 Reasons Why You Could Have Pain During Sex)
Psychological causes: As noted, emotional trauma and circumstances can contribute to painful sex as well. "Psychological causes usually involve physical or sexual abuse, shaming, or other types of sexually related emotional trauma," says Dr. Sadeghi.
How to Treat Dyspareunia
Depending on the root of a patient's condition, there are a number of different approaches to of treatment. Regardless of the root cause, it's important to see your doctor to create a plan. They may recommend you try different positions, consider using lube (honestly, everyone's sex life can be made better by lube), or to try taking pain relievers in advance.
In the case of scarring: For patients with scar tissue causing painful sex, Dr. Sadeghi uses a specific treatment. "I perform a treatment on the scar known as integrative neural therapy (INT)," said Dr. Sadeghi. This is also known as German acupuncture. This procedure numbs the scar and helps break down some of the rigidity and stored energy of the scar tissue, he explains.
If you have a tilted uterus: If your pain is due to a retroverted (tilted) uterus, pelvic floor therapy is the best treatment, says Dr. Sadeghi. Yep-physical therapy for your pelvic floor, vaginal muscles and all. It involves a series of manual manipulations and soft tissue release to alleviate the tension in the pelvic floor, he explains. Good news: You may see some results almost immediately. (Related: 5 Things Every Woman Should Know About Her Pelvic Floor)
If it's from cranial nerve zero atrophy: "In cases of cranial nerve zero atrophy, activities that involve high levels of oxytocin production are recommended, such as breastfeeding if one happens to be a new mother, and highly intimate activity that does not involve actual penetration," says Dr. Sadeghi.
If you have inflammation or dryness: You could try CBD lubricant. In fact, cannabis-based lube has been the solution for many women who've experienced dyspareunia from a myriad of causes. Users have raved about its ability to transform their sexual experience, eradicate pain, and help them access orgasm like never before. Dr. Mysore was also an advocate for using lubricant, as well as addressing dryness with hormone therapy if it stems from a shift like menopause.
If you have an infection: "Other causes of pain during sex include yeast infections, UTIs, or bacterial vaginosis, which each have their own protocols for treatment that should alleviate the painful symptoms," said Dr. Mysore. "For people who are experiencing or prone to yeast infections or bacterial vaginosis, I'm a huge fan of using boric acid suppositories in addition to treatment to help balance vaginal pH." (Related: The Step-By-Step Guide to Curing a Vaginal Yeast Infection)
In addition, Dr. Mysore recommends taking probiotics: "Many people associate probiotics only with improving bacteria in the gut, but probiotics can similarly impact the vaginal environment and help to balance or restore proper pH," which can lead to pain-free sex.
After an IUD insertion: "Women who have just had IUDs implanted can also experience painful sex," said Dr. Mysore. "IUDs are progesterone-only, but since the hormones have a localized effect, it can change the consistency and quality of discharge," she said, which can lead to dryness. "[Patients] also may not be producing as much natural lubrication," she explains, but note that your body should eventually recalibrate. "In most cases, the body will gradually rebalance and the pain and dryness should subside, but it's a good idea to talk to your doctor if you continue to experience pain since the IUD placement may be off." (Related: Does Your IUD Make You More Susceptible to This Scary Condition?)
If it's vaginismus (spasming): The treatment for vaginismus often includes using vaginal dilators. Typically, this involves a set of phallic-shaped objects that range in size from a pinky finger to an erect penis. You start with the smallest size and use it every day (with lots of lube!) moving it in and out of the vagina until you feel comfortable, typically two to three weeks, before moving to the next size up. This gradually reprograms the vaginal tissue, and, hopefully, leads to the person experiencing less or no pain during penetration. A person can use dilators alone or with a partner-the benefit of involving a partner is that the process can also help to develop trust and empathy in the relationship.
If it's psychological: Many women have pain that comes from psychological blockages-perhaps anxiety is causing pelvic floor tension. In this case, your body is literally creating a blockage based on an emotional experience.
"If your dyspareunia stems from any kind of psychological or emotional abuse, always seek professional counseling," said Dr. Sadeghi. His suggestions are detailed in his book, The Clarity Cleanse, which focuses on emotional healing to treat physical ailments. "Particular emphasis is placed on reframing sex as an expression of love and beauty where it's safe to trust and be vulnerable"-something that's imperative for survivors of abuse, he says. "Experience has shown me that when the patient heals emotionally, the body responds better physically to treatment."
Tips for Dealing with Dyspareunia
It's important to have a patient partner. Dr. Sadeghi emphasized this point. "Educate them as much as you can about what you're experiencing and why; This will alleviate any tension between the two of you and reassure them that the change in your sex life isn't due to anything they're doing," he said.
While you seek treatment, avoid intercourse. "Use this time as an opportunity to explore all the other beautiful aspects of sex on a much deeper level," says Dr. Sadeghi. "Take the time to explore new levels of intimacy without the pressure of penetration dominating the moment. There are many ways to share intimacy with a partner during your healing process. Once you're free of dyspareunia, your sex life will be all the better for it."
Find a therapist. Regardless of whether your dyspareunia is psychologically or physically triggered, having a safe outlet to work through your emotions with a psychological professional is crucial. Obviously, this especially comes into play if you feel that past trauma or fears surrounding sex are impeding your ability to enjoy it-and dammit, you should enjoy it! (Now: How to Go to Therapy When You're Broke AF)