Dyspareunia

The most common symptom of dyspareunia is pain at the opening of the vagina or pain deep in the pelvis during intercourse. One small area can be affected, or you may feel pain in your entire genital region.

If you have dyspareunia, you may experience:

• a sharp or burning pain upon or during penetration

• deep pain during thrusting

• a throbbing or aching feeling after intercourse

• cramping in your pelvic area

• spasms or muscle tightness

Some women may also notice dryness, itching, or soreness before or after intercourse.

Dyspareunia can be caused by both physical and psychological problems. Physical causes can be grouped depending on whether the pain occurs upon initial penetration (entry) or with deep thrusting.

Entry pain may happen as a result of:

• poor lubrication due to reduced oestrogen (after menopause, childbirth, or during breastfeeding)

• taking certain medications such as antidepressants, blood pressure tablets, sedatives, antihistamines, and certain birth control pills

• vaginal injury, trauma, or irritation – for example, from an accident, pelvic surgery, female genital mutilation (FGM), or an episiotomy

• skin irritation, inflammation, or infection – such as a urinary tract infection (UTI), thrush, a sexually transmitted infection (STI), or eczema

• allergic reaction to latex condoms or perfumed hygiene products

• vaginismus – a condition where the muscles of the vaginal wall tighten involuntarily

• rare congenital issues like vaginal agenesis or an imperforate hymen

Deep pain can be worse in certain positions and may be caused by:

• endometriosis

• pelvic inflammatory disease

• uterine prolapse

• retroverted uterus

• uterine fibroids

• cystitis

• irritable bowel syndrome (IBS)

• pelvic floor dysfunction

• adenomyosis

• haemorrhoids 

• ovarian cysts

• scar tissue from medical treatments such as hysterectomy, radiation and chemotherapy

Emotional factors that may cause dyspareunia include:

• stress, anxiety, depression, or poor self-esteem 

• fear of pain or intimacy

• relationship difficulties

• past trauma or sexual abuse

It can sometimes be complex to identify the cause of dyspareunia, as the physical and emotional factors that can cause it can be so intertwined. Sometimes, physical pain can lead to anxiety about sex, which in turn increases discomfort – creating a cycle that can be difficult to break without support. At Welbeck, our specialists take the time to understand your symptoms and their possible causes, helping to restore your comfort and enjoyment of intimacy.

At your initial consultation, your gynaecologist will discuss your symptoms with you and will ask about your medical and sexual history. 

Further tests may include: 

• pelvic or rectal examination

• vaginal swabs or urine tests to check for infection

• smear test 

• internal ultrasound or laparoscopy (keyhole surgery to look inside the pelvis) to look for underlying causes such as endometriosis or cysts

Your gynaecologist will use this information to identify any physical and emotional factors contributing to your pain, and work with you to make a tailored treatment plan.

While not all cases of dyspareunia can be prevented, there are several steps you can take to help protect your vaginal health and reduce the risk of discomfort during sex. Prevention focuses on maintaining vaginal moisture, avoiding irritation, and supporting both physical and emotional wellbeing.

Tips to help prevent dyspareunia:

• use adequate lubrication – a water-based lubricant can reduce friction and dryness

• avoid irritants such as scented soaps, bubble baths, and vaginal douches

• practice safe sex – using condoms helps prevent infections such as thrush and sexually transmitted infections (STIs), which can lead to pain and inflammation

• stay hydrated

• wear breathable cotton underwear to help reduce dryness and irritation

• manage stress – emotional tension and anxiety can tighten pelvic floor muscles and increase pain

• have regular gynaecological check-ups to detect early changes, such as hormonal imbalance or pelvic conditions, before they become painful

• talk openly and honestly about comfort levels with your partner – taking things slowly can reduce anxiety and help rebuild confidence during intimacy

If left untreated, dyspareunia can have a significant impact on both physical and emotional wellbeing. Persistent pain can affect more than just sexual comfort – it can influence mood, relationships, and self-esteem. Addressing the underlying cause early can help prevent these wider effects.

Possible complications include:

• emotional distress such as feelings of frustration, anxiety, or low mood

• avoidance of intimacy, which may affect relationships or cause tension between partners

• pelvic muscle tension, which worsens discomfort

• worsening of underlying conditions – if dyspareunia is caused by infection, endometriosis, or another medical problem, delaying treatment may allow symptoms to progress

With the right diagnosis and support, most women can achieve significant improvement and prevent these complications from developing further.

Your treatment plan for dyspareunia will vary depending on its cause. Following your diagnosis, your gynaecologist will fully explain the options available to you. 

Treatment may involve: 

• medications for infections or inflammation

• water-based lubricants

• oestrogen therapy (creams, tablets or rings) to improve dryness and elasticity

• allergy management

• exercises or physiotherapy to relax tight pelvic muscles

• sex therapy, counselling, or cognitive behavioural therapy (CBT), where anxiety or fear plays a role

• vaginal dilator therapy to help stretch the vagina or vulval area over time 

Vaginal dilator therapy

At Welbeck, our Women’s Health centre offers vaginal dilator therapy for women experiencing discomfort or tightness. The therapy uses plastic or silicone dilators in different sizes to gradually and gently stretch the vaginal tissues. With expert guidance from our clinical nurse specialist, you’ll learn how to use them safely and at your own pace. Over time, this can help restore comfort, confidence, and enjoyment of intimacy.

At Welbeck, our gynaecologists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.