Dyspareunia is a common problem with women and affects approximately 10% to 20% of U.S. women. Women with dyspareunia have increased risk of sexual dysfunction, anxiety, depression, relationship problems, and diminished quality of life.⁽¹⁾ Dyspareunia is pain with initial and/or deep penetration and is associated with pelvic floor dysfunction (PFD). Your pelvic floor is a network of muscles that support your uterus, bladder, and bowels. Pain with intercourse is just one symptom of pelvic floor dysfunction.

Symptoms/Functional Problems
Dyspareunia describes a painful sensation during sexual intercourse (burning, searing, shooting pain) and may linger for hours or days afterwards.

Causes
There are several conditions that cause dyspareunia:

• Overactive pelvic floor muscles (PFM): This is when the PFM do not relax or may even contract instead of relaxing. Your pelvic floor muscles need to functionally contract or relax for sexual intercourse, voiding urine, and having a bowel movement.
• Postpartum: After giving birth, either vaginally or via cesarean, many women report pain with intercourse. Most physicians recommend waiting at least six weeks to allow healing of the sensitive tissues in the vagina before engaging in sexual intercourse. One study describes almost 20% of women still reported pain with intercourse up to 8 months after giving birth and beyond with no difference between those who gave birth vaginally or via cesarean. ⁽²⁾ Other issues that may contribute to dyspareunia postpartum include perineal tearing, scar tissue from episiotomy, and breast feeding.
• Vaginal dryness: This may be caused by menopause or breast feeding due to a decrease in estrogen levels. The insufficient levels of estrogen in a woman’s body can cause impaired vaginal lubrication which leads to pain with intercourse.
• Pelvic trauma: There are many types of pelvic trauma which can cause dyspareunia. The most common include episiotomy from childbirth, falling on your tailbone, and history of sexual abuse/rape.

Other causes of dyspareunia are:
• Yeast and/or urinary infections
• Vulvodynia, or pain centered in the vulva area
• Vaginitis, or inflammation of the vagina
• Endometriosis
• Pelvic Inflammatory Disease (PID)
• Irritable bowel syndrome

FAQ
Q: Is it normal to have pain with intercourse after giving birth?
A: Yes. 85% of women report pain during sex the first time after giving birth. ⁽³⁾
Q: Will the pain with sexual intercourse get better over time?
A: 1 in 5 women continue to report pain with intercourse up to 12 months postpartum and beyond. ⁽⁴⁾
Q: Is it normal to have insufficient vaginal lubrication during sexual intercourse?
A: Yes! One study estimates that up to 33% of women report decreased sexual satisfaction, likely due to insufficient vaginal lubrication. ⁽⁴⁾ Vaginal dryness is common with menopausal women and those breast feeding.
Q: Do I have pelvic floor dysfunction if I have pain with sexual intercourse after having a baby?
A: As a postpartum mother, you have a higher risk of dyspareunia if you experienced internal or external injuries during child birth. For example, if you had an episiotomy you have a higher risk of experiencing pain and insufficient lubrication which may also contribute to the discomfort.
Q: Can I do kegals to help improve the pain with dyspareunia?
A: It is important that you see a pelvic floor specialist to identify if your pelvic floor muscles are contracting or relaxing as needed. Kegals may not help and could exacerbate your pain.
Q: Would I benefit from pelvic floor physical therapy (PFPT)?
A: If you are experiencing pain with sexual intercourse, you may benefit from PFPT. This specialized therapy is useful in identifying the cause of your discomfort and how to treat it to improve your comfort during sexual relations.

Treating and Managing Your Dyspareunia
Pelvic floor therapy is an important component to help improve the significant discomfort of dyspareunia (pain with sexual intercourse). Women who participate in pelvic floor rehabilitation experience less pain with sexual intercourse compared to women who do not receive therapy. ⁽⁵⁾ 50-83% of women with pelvic floor dysfunction report having sexual dysfunction, and pelvic floor muscle training is a first-line treatment for improving sexual function. ⁽⁶⁾

At N-Balance Physical Therapy, we offer a comprehensive treatment plan that includes a thorough evaluation to identify the cause of the pain you are experiencing and implement an individualized treatment plan to improve your symptoms, quality of life and sexual function.

References

1. Dean, A.S., Drew, C.B., David, V.B. (2014). Dyspareunia in Women. Am Fam Physician, 90(7), 465-470.
2. McDonald, E. A., Gartland, D., Small, R., & Brown, S. J. (2016). Frequency, severity and persistence of postnatal dyspareunia to 18 months post partum: A cohort study. Midwifery, 34, 15–20. https://doi.org/10.1016/j.midw.2016.01.01
3. Maamri, A., Badri, T., Boujemla, H., & El Kissi, Y. (2019). Sexuality during the postpartum period: study of a population of Tunisian women. La Tunisie medicale, 97(5), 704–710.
4. Molin, B., Sand, A., Berger, A. K., & Georgsson, S. (2020). Raising awareness about chronic pain and dyspareunia among women – a Swedish survey 8 months after childbirth. Scandinavian journal of pain, 20(3), 565–574. https://doi.org/10.1515/sjpain-2019-0163
5. See note 2 above
6. See note 3 above