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The Gist: What is Dyspareunia?

Also known as: pelvic pain, painful sex

Dyspareunia is pain in the vagina or lower pelvis, primarily with intercourse, that is unrelated to any organ disease. You can have symptoms before, during, or after penetration. So, you may experience pain during initial entry, pain throughout with every thrust, or pain that lasts for hours after intercourse. You may also have pain using a tampon or during pelvic exams.

The Anatomy of Dyspareunia

One of the functions of the pelvic floor is sexual function. The pelvic floor consists of three layers, the superficial, the middle, and the deep layer. A functional pelvic floor and vaginal wall allow for proper lubrication, penetration, and orgasm.

Dysfunction in any one or more of the pelvic floor layers can be the cause of dyspareunia. The muscles can be too tight, injured during trauma, too dry, inflamed, or irritated by an infection or skin disorder.

Who gets Dyspareunia? When does it occur for women?

Postpartum dyspareunia is common, though not widely talked about. It is often the result of overactive pelvic floor muscles (PFM) after delivery. During a vaginal delivery, the pelvic floor must both stretch and contract during the pushing phase. After delivery, the pelvic floor can fatigue and go into spasm, similar to a hamstring cramp during a marathon. Often, a new mom won't realize that her pelvic floor is tight or in spasm until she is cleared for intercourse after 6 weeks. Imagine not knowing you have a hamstring cramp for 6 weeks, and then trying to run another marathon.

Dyspeurenia can also be caused by inadequate lubrication in the vagina due to estrogen deficiency. During breastfeeding, estrogen levels are low, which can lead to dryness and pain with penetration. Estrogen levels are also affected in women using oral contraceptives. Dyspareunia can be a side effect of oral birth control in women with no previous history of pregnancy, delivery, or pain.

Dyspeurenia can also be the result of painful scar tissue and delayed healing after a vaginal delivery, particularly if you underwent an episiotomy or had perineal tearing. Other causes include chronic UTIs, repeated yeast infections, STIs, endometriosis, or skin disorders.

The Origin Way: Physical Therapy for Dyspareunia

At Origin, we look at your entire history to assess the root cause of your dyspareunia. We take a comprehensive approach that includes not only addressing the pelvic floor but also the way you move, exercise, and even breath. We find the driver of your symptoms, and create a plan of care that is right for you.

If your pelvic floor is too tight, your plan will center around downtraining and lengthening your pelvic floor. If your symptoms are due to scar tissue, your Physical Therapist will focus on scar mobilization, movement, and work through other tissue restrictions. A typical plan of care includes manual therapy techniques, breathing and relaxation training, as well as mobility and lengthening exercises to improve your pelvic floor range of motion. Your Physical Therapist may also recommend the use of dilators or EMG, which is pain free visual or audio biofeedback about your pelvic floor muscle tone, as part of your plan of care.

How long does it take?

Because treating dyspareunia involves downtraining and creating length in the pelvic floor, it can take months to resolve your symptoms. A typical course of treatment lasts anywhere from 4-12 months. While this can feel like a long time, you may start to see improvements after 2-4 treatments.

What to expect in the future

Once your physical therapy is complete, we recommend that you continue the prescribed lengthening and relaxation exercises because your symptoms could come back at some point in the future, particularly if your symptoms are due to an underlying condition. However, you will have the techniques, tools, and exercises to manage your symptoms or you can return to your Physical Therapist for support at any time.

Additional Reading and Sources

Lee, Jean-Jasmin M.L., et al. "Oral Contraception and Female Sexual Dysfunction in Reproductive Women." Sexual Medicine Reviews, Elsevier, 30 June 2016, www.sciencedirect.com/science/article/abs/pii/S2050052116300221

Morrison, Pamela & Spadt, Susan & Goldstein, Andrew. (2015). The Use of Specific Myofascial Release Techniques by a Physical Therapist to Treat Clitoral Phimosis and Dyspareunia. Journal of Womenʼs Health Physical Therapy. 39. 17-28. 10.1097/JWH.0000000000000023.

Wurn, Lawrence J, et al. "Increasing Orgasm and Decreasing Dyspareunia by a Manual Physical Therapy Technique." MedGenMed : Medscape General Medicine, Medscape, 14 Dec. 2004, www.ncbi.nlm.nih.gov/pmc/articles/PMC1480593/

Rosenbaum, Talli Y., and Annette Owens. "Continuing Medical Education: The Role of Pelvic Floor Physical Therapy in the Treatment of Pelvic and Genital Pain-Related Sexual Dysfunction (CME)." The Journal of Sexual Medicine, Elsevier, 16 Dec. 2015, www.sciencedirect.com/science/article/abs/pii/S1743609515319627

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