Understanding Painful Intercourse

Pain with intercourse is more common than you’d think. While it may feel like you’re on an island some days, know that you’re definitely not alone. This very thing is what took me into the specialty of pelvic health. I was in my twenties, dating the man who would eventually become my husband, and started experiencing painful intercourse. Honestly, I was pissed it was happening. I thought this was something that only happened to women after pregnancy and delivery…so what in the hell was going on with my body?! Instead of going to see someone (healthcare providers are the worst patients ever), I ended up signing up for my first course with Herman and Wallace to explore the world of pelvic health education. That was back in 2013 and now, almost a decade later, it has become my passion and is something that I help women and men navigate every day.

There are different terms associated with painful intercourse. In a general sense, the medical term for painful intercourse is dyspareunia. This refers to pain that occurs just before, during or after intercourse (1). Other common diagnostic terms associated with this condition include vulvodynia, provoked vestibulodynia, vaginismus, male dyspareunia, pudendal neuralgia and dysorgasmia.

What do all of these terms actually mean?

Vulvodynia: pain or discomfort in the vulva (2)

Vestibulodynia: condition characterized by persistent vulva pain, described as sharp, burning and “knife like” (3)

Provoked Vestibulodynia/PVD: pain or discomfort during or after pressure is applied to the vestibule; typically associated with sexual intercourse, tampon insertion, gynecologic examination, prolonged sitting and/or wearing fitted clothing (2,3)

Vaginismus: a painful spasmodic contraction of the vagina and surrounding muscles; this is an involuntary reaction to some or all types of vaginal penetration (4)

Male dyspareunia: recurrent or persistent genital or pelvic pain associated with sexual activity in men (1)

Pudendal neuralgia: pain or discomfort in the distribution of the pudendal nerve; this can present in any or all of its branches (rectal, perineal, scrotal, labial, penile, clitoral) (5)

Dysorgasmia: pain in the abdomen or pelvic area during or immediately after you reach orgasm (6)

How common is it?

The prevalence of dyspareunia varies from 3 to 18% worldwide, and it can affect 10 to 28% of the population in a lifetime. (3) Vulvodynia represents the most common form of dyspareunia with the most common subtype being PVD, representing 80% of cases of vulvodynia (3).

Personally, I would say the prevalence of painful intercourse is underrepresented in the evidence, especially when you consider how much these conditions overlap in regards to their symptom presentation. This is especially true in the postpartum population. This is compounded by two things…one, society shapes and perpetuates silence in this topic of discussion and two, the fact that many healthcare professionals lack the confidence, knowledge and/or experience to discuss intimacy and sexual health with clients within their plans of care. (7) Recent evidence is starting to paint a more realistic picture with various studies determining the prevalence rates of sexual health issues at upwards of 61% at three months postpartum and 20% at twelve months postpartum. (7)

Unfortunately, for our male clients there is very little evidence to understand the prevalence of male dyspareunia and dysorgasmia.

Why does it happen?

The etiology behind painful intercourse is multifactorial, with each client presenting with unique personal health profiles and health histories that contribute to the overall clinical presentation. The factors that contribute include neurologic mechanisms, inflammatory mechanisms, musculoskeletal patterns, genetic predisposition, hormonal factors, structural considerations and psychosocial factors. (3)

The common theme amongst the conditions is the quality of the sensation which lends us towards it being a dysfunction that is primarily manifested by the nervous system. A majority of clients will describe these sensations with qualifying words that lend us towards believing the nerve is a primary driver to symptoms. These descriptions include, but are not limited to, the following:

- sharp

- burning

- knife-like

- stabbing

- shooting

- numbness

- tingling

- itching/itch you can’t scratch

If you’re experiencing any of these sensations surrounding intercourse, know that this is common in pelvic health dysfunction and is something that is VERY TREATABLE.

How do you treat it?

Each practitioner's approach to treatment is unique to their profession, education and knowledge surrounding tissue dysfunction and neuromusculoskeletal conditions. Common approaches can include soft tissue and myofascial releases, dry needling/neuromodulation, joint mobilization/manipulation, other manual or body therapies, exercise prescription, dilator stretching, utilization of assistive devices (like the Ohnut rings), complimentary alternative medicine, use of topical creams, pharmaceuticals or injections. The approach is dictated by the type of practitioner and their training.

Have questions? Don’t hesitate to reach out to connect!

To health + wellness for your pelvis,

Kelly

Resources:

1. Tayyeb M and Gupta V. Dyspareunia. StatPearls. 20 November 2021. NCBI Bookshelf ID:NBK562159

2. National Vulvodynia Association. What is vulvodynia? NVA website. 2022. Accessed February 12, 2022. https://www.nva.org/what-is-vulvodynia/

3. Chisari C, Monajemi MB, Scott W et al. Psychosocial factors associated with pain and sexual function in women with Vulvodynia: a systematic review. European Journal of Pain. 2021;25:39-50

4. National Health Service. Vaginismus. NHS website. 10 February 2021. Accessed February 12, 2022. https://www.nhs.uk/conditions/vaginismus/

5. Ruoss CM, Howard EA, Chan K et al. Topical treatment of vulvodynia, dyspareunia and pudendal neuralgia: a single clinic audit of amitryiptyline and oestriol in organogel. ANZJOG. 2021;61(2):270-274

6. Chamberlain C. Why do I get cramps after sex? Everything you need to know about dysorgasmia. Netdoctor website. 7 June 2020. Accessed February 12, 2022. https://www.netdoctor.co.uk/conditions/sexual-health/a2275/painful-orgasms-dysorgasmia/

7. O’Malley D, Smith V and Higgins A. Sexual health issues postpartum – a mixed methods study of women’s help-seeiking behavior after the birth of their first baby. Midwifery. 2022;104:103196