Dyspareunia is recurrent or persistent pain during sex which can occur during initial or deep penetration, thrusting, or with lack of lubrication. Dyspareunia has been estimated to affect up to two-thirds of women at some point in their lives. It can occur due to both medical and/or musculoskeletal reasons. Conditions including infections, hormonal changes, sexually transmitted diseases, and dermatologic problems can cause vaginal irritation. Often times the pelvic floor muscles become tight causing pain with sex even after the underlying medical condition has resolved.
The pelvic floor muscles can become spasmed causing pain with any type of penetration. There may also be scarring, adhesions, skin irritation, muscle tenderness or hypersensitivity in these muscles. Rebalance physical therapists specializing in pelvic floor pain can evaluate this area and start treatment to improve sexual function.
Symptoms of dyspareunia can include:
Pain with direct sexual penetration
Pain with gynecologic exams
Pain with tampon insertion
Deep pelvic pain with intercourse
Throbbing ache after intercourse
Lower abdominal discomfort with intercourse
Dyspareunia can be a symptom of other diagnoses including:
Vaginismus: Spasm of the pelvic floor muscles making penetration difficult, painful, or impossible.
Endometriosis: Presence of cells in locations outside the uterus that result in painful menstruation, lower back pain pelvic pain, pain with penetration, and possible infertility.
Polycystic Ovarian Syndrome: Syndrome in which numerous small cysts located along the outer edge of an enlarged ovary. It is characterized by infrequent or prolonged menstrual periods, excess hair growth, acne, obesity and infertility.
Interstitial cystitis/Painful Bladder Syndrome: Syndrome characterized by pain above the pubic bone noticed with bladder filling, urinary urgency/frequency, urethral burning, pelvic and lower abdominal pain
Pudendal neuralgia: Nerve-like pain in the groin, buttock, vaginal, and/or rectal regions that is typically worsened with sitting
Irritable Bowel Syndrome: Dysfunction of the bowel characterized by abdominal pain, bloating, and disturbed defection or bowel movements.
Vestibulodynia (Vulvodynia, Vulvar Vestibulitis): Vulvar discomfort characterized by burning, rawness, stinging, and sensation of ripping in vaginal region, typically entrance to vagina.
Physical Therapy treatment of dyspareunia includes balancing the musculoskeletal dysfunction causing the pelvic floor muscles to spasm and become overactive. Treatment consists of manual release of the soft tissue in the pelvis, hips and spine. This is followed by education on home stretching, muscle relaxation, sexual health, and proper posture to maintain alignment.