Pain during Sex: Common Causes of Dyspareunia and When to Seek Support

Experiencing pain during sexual intercourse – a condition known as dyspareunia – is more common than many women think. Occasionally, mild discomfort during sexual intercourse can occur, often due to hormonal changes or lack of lubrication. But persistent pain is not normal and should always be examined.

In London, many women refrain from seeking help for these conditions due to embarrassment or believing them to be just a part of getting older. Painful intercourse can have a number of treatable physical and emotional causes, and knowing and getting timely assessment for these from a private gynaecologist in London can ensure comfort and confidence for women again.

What is Dyspareunia?

Dyspareunia is recurrent or persistent pain which occurs during sexual intercourse. The pain can take place:

• At the entrance of the vagina (superficial dyspareunia) and may be experienced as a burning or stinging sensation.
• Deep inside during penetration (deep dyspareunia) which is, at times, related to pelvic or internal conditions.

The discomfort can happen before, during, or after sexual intercourse, and can be mild discomfort, or cascading to acute, piercing, sharp pain. Some women experience anxiety, emotional discomfort, or avoid intimate relationships.

Dyspareunia can occur at any age, but it is particularly common:

• after childbirth
• around the time of menopause
• in women with hormonal imbalances
• after gynaecological surgery
• when painful or discomforting conditions like endometriosis or infections occur

Why You Shouldn’t Ignore Pain during Sex

Pain during sex can be a sign of a problem that can be easily treated, involving the vagina, ovaries, uterus, or pelvic floor muscles. If you dismiss or ignore pain during sex, you may develop worsening inflammation, chronic pain, or mental health issues over time.

Seeking medical help early gives your gynaecologist the chance to get to the bottom of the issue – be it physical, hormonal, or emotional – and to develop a treatment plan tailored to your needs.

Common Causes of Pain during Sex

1. Vaginal Dryness

This is one of the most common reasons for superficial pain. Vaginal dryness happens when natural lubrication is diminished or sometimes not produced at all. It can be due to:

• Reduced oestrogen levels (for example menopause, breastfeeding or contraception)
• Antihistamines or anti-depressant medications
• Anxiety or stress

If the vagina is not sufficiently lubricated, sexual activity may involve friction on delicate tissues, resulting in soreness and burning. Using water-based lubricants and tackling the hormonal imbalance is often effective in resolving this symptom.

2. Vaginal or Pelvic Infections

Vaginal infections such as bacterial vaginosis, thrush, trichomoniasis and chlamydia can lead to inflammation, pain and itching.

Common symptoms include:

• Unusual discharge
• Odour
• Swelling or redness

Diagnosis is usually straightforward using vaginal swabs. If an infection is identified, treatment with a short course of antibiotics or antifungal medication typically resolves symptoms quickly.

3. Endometriosis

Endometriosis is a condition in which tissue similar to that which lines the womb, grows elsewhere in the body – commonly on the ovaries, bladder, or fallopian tubes.  This tissue still reacts to hormonal changes every month, leading to pain and inflammation, particularly with deep penetration. 

In addition to pain during penetration, many women with endometriosis may also experience:

• Painful or heavy periods
• Pelvic pain outside of menstruation
• Fatigue or bloating

A pelvic ultrasound or laparoscopy may be required to confirm a diagnosis. This may be followed up with hormonal or surgical treatment options. 

4. Vaginismus (Pelvic Floor Tightness)

Vaginismus is a form of involuntary pelvic floor tightening or spasms that change penetration from painful to impossible.  Vaginismus is usually related to anxiety and fear of pain, or negative sexual experiences in the past.  

The most effective treatment is physical therapy and desensitisation, along with psychological support. 

5. Hormonal Changes after Menopause

After menopause, reduced oestrogen can thin the vaginal lining and reduce elasticity — changes collectively known as genitourinary syndrome of menopause (GSM). Symptoms related to GSM can include irritation, dryness, and burning during penetration.

6. Psychological and Emotional Factors

A significant link exists between our emotional health and sexual well-being. Anxiety, stress, problems in relationships, or past trauma may contribute to physical tension, which limits lubrication and makes pain more likely. The impact of a multidisciplinary approach that combines medical treatment with counselling or pelvic floor physiotherapy can be life-changing.

7. Gynaecological Surgery or Trauma Due to Childbirth

Tears, episiotomies, or scar tissue can create tenderness for months following childbirth, while surgery such as hysterectomy or pelvic surgery can affect vaginal elasticity temporarily. Your gynaecologist can assess whether you are healing, consider scar management, or refer you to a women’s health physiotherapist.

When You Should See a Private Gynaecologist

You should book an appointment without delay if:

• Pain is frequent or worsening
• Unexpected bleeding is occurring after sex
• The discharge looks or smells unusual
• There is pelvic or lower abdominal pain
• There are feelings of fear or distress about intimacy

These symptoms of persistent discomfort are not something you should have to live with. Many of the causes of painful intercourse can be diagnosed and effective management can be offered in a single appointment.

At the Gynaecology Clinic London, we provide private female gynaecology consultations and same-day diagnostic provisions for hormonal blood test, pelvic ultrasound, or vaginal swab – all in a discreet setting and relaxed environment.

How Sex Pain Is Diagnosed

Consultations typically involve a check of:

• A detailed history: Discussing your symptoms and pattern to your menstrual cycle, medications you are taking, and your emotional health.
• Physical examination: A gentle examination of your pelvis to look at the vaginal muscles, tissues, and any signs that include dryness or infection.
• Ultrasound scan: Used to identify ovarian cysts, fibroids, or signs suggestive of endometriosis, which may contribute to deep pelvic pain.
• Hormone testing: If they suspect an imbalance or menopause history.

With these tests, your health care provider can identify whether your pain is medically, hormonally, or psychologically based to provide you with the proper treatment.

Treatment for Dyspareunia

Treatment is based on the underlying cause, but typically involves a combination of the following:

1. Medical Treatment

• Topical oestrogen cream or pessaries for vaginal atrophy or dryness
• Antibiotics or antifungals for an inflammatory response
• Hormone Replacement Therapy (HRT) for symptoms of menopause
• Pain management medications for conditions such as endometriosis

2. Pelvic Floor Physiotherapy

Physiotherapy can increase the potential to retrain and relax the pelvic muscles to decrease spasm and pain related to vaginismus or a childbirth injury.

3. Psychological Support

Therapies like CBT or sex therapy that support areas of anxiety, fear, or relationship factors that may contribute to pain.

4. Lifestyle Measures

• Using gentle, pH-balanced cleansers (eliminate perfumed soaps)
• Use water-based lubricants during sexual intercourse
• Communicate openly with your partner about comfort levels
• Maintain a balanced diet and stay hydrated to promote healthy tissues

Conclusion        

You should not suffer in silence with pain during sex. Painful sex can be related to infections, changes in hormones, emotional stress, ormuscle tension -- all of which are treatable by a medical professional.

By making an appointment with a private gynaecologist in London, you can identify the underlying issue, get treated, and regain comfort and confidence related to your intimate health.

With a right diagnosis and more importantly a compassionate practitioner, intimacy can feel comfortable, fulfilling, and pain-free.

Don’t Suffer in Silence

If having sexual intercourse has become painful, there is always a cause and almost guaranteed a treatment option. Book your private gynaecology consultation today.

BOOK ONLINE NOW 02071832153