Dyspareunia: what it is and how to fight the pain it causes during sex

The term “dyspareunia” may be unfamiliar to some of us, but we’re probably familiar with the discomfort this disorder causes.

In previous posts we’ve talked about respiratory physiotherapy and its connection with the pelvic floor, Pilates exercises to strengthen the pelvic floor and how to fight constipation. Now we bring you another interesting article to help reduce a vaginal pain we may experience at some point in our lives.

Dyspareunia, or coital pain, is pain that appears during sex. According to various studies, 3 out of 4 women experience this discomfort at some point in their sex life. It can occur before, during and after intercourse.

And not only then, but also with any vaginal procedure, such as a gynecological check-up, or something as everyday as inserting a tampon.

It usually shows up as pain located in the structures of the pelvic floor. This has a negative effect on women’s quality of life, as the discomfort increases during and after menopause.

Unfortunately, chronic vaginal pain is still a taboo subject, and many women hide their problem without knowing that there are now many techniques to treat it.

There are three degrees of pain in dyspareunia:

• First stage: there is pain, but it doesn’t make vaginal penetration impossible.
• Second stage: the pain sometimes prevents vaginal penetration.
• Third stage: the pain makes vaginal penetration completely impossible.

What causes dyspareunia?

Coital pain can have various causes. Almost half of patients have vaginal pain for psychological reasons.

• At the moment of penetration there may be a lack of arousal, leading to poor vaginal lubrication. Using lubricants could be an alternative.

• Coital pain can also be caused by sexual abuse in the past or a traumatic experience such as a complicated birth.

• For the same reason, vaginal pain could appear because of a strong fear of pregnancy and motherhood.

• Or even because of nerves the first few times, which make the vaginal muscles contract involuntarily and cause discomfort.

In any of these situations, you should see a psychologist or sex therapist. They’ll be able to help you find the best solution, and may recommend using vaginal dilators or products such as Dilatan, among others.

If, on the other hand, the cause is physical (muscular, as a result of surgery…), we should know that a physiotherapist specializing in gynecology can help us.

The relationship between coital pain and the pelvic floor

As we know, the pelvic floor is made up of muscles, ligaments and fascia that are constantly at work: contracting and relaxing.

In addition, every change in posture, weight or hormones, and every pregnancy with a vaginal birth, can cause muscle knots, tears, changes in muscle tone, descent or excessive shortening of the pelvic floor fibers.

Overworking the pelvic floor and muscle spasms can be the cause of physical dyspareunia.

After a vaginal birth with an episiotomy or tear, we have a scar that can often become harder and less flexible, and can cause vaginal pain. The scar makes the surrounding muscles tenser and prone to abnormal spasms that increase the pain.

At other times, muscle spasms can be caused by:

• Genital surgery
• Vaginal infection
• Too many toning exercises (sportswomen)
• Endometriosis
• Pelvic adhesions after surgery or postpartum
• Cystitis
• Fibromyalgia
• A retroverted or laterally tilted uterus
• Ovarian tumors
• Pudendal nerve entrapment
• Vaginismus
• Estrogen deficiency
• Lack of lubrication

Pelvic floor assessment as prevention

It’s very important to properly assess the pelvic muscles and all the structures of the pelvis to find out the cause of the pain. This assessment examines all the pelvic muscles, their tone and tension, the patient’s ability to contract them voluntarily and relax them consciously, and whether there are scars, how deep they are and how elastic.

If there are muscle knots, fibrosis, adhesions around the scar or tight bands, or if the patient can’t relax her pelvic floor voluntarily, the rehabilitation process is planned. Using biofeedback devices such as the Epi-No helps exercise the pelvic muscles.

In cases of muscular coital pain, physiotherapy treatment usually consists of:

• Learning to relax the pelvic muscles
• Internal vaginal myofascial stretching
• Perineal massage
• Scar stretching
• High-frequency diathermy
• Hypopressive abdominal exercises