Dyspareunia

Dyspareunia is a chronic or recurrent pain experienced during sexual intercourse or immediately afterwards, which does not result solely from transient discomfort or insufficient sexual preparation. This condition can affect both women and men, although it is diagnosed far more often in women. Dyspareunia represents a complex medical problem encompassing somatic, neurological, hormonal and psychogenic components. The contemporary clinical approach regards it as a disorder requiring multidisciplinary diagnostics and treatment, due to its significant impact on quality of life, partner relationships and mental health.

Dyspareunia – what is it?

Dyspareunia is defined as pain associated with sexual activity, which may occur during penetration, during deep intercourse, or after its completion. In medical classifications (including ICD-11 and DSM-5-TR) it is considered a sexual dysfunction, often coexisting with other dysfunctions such as desire disorders or difficulties achieving arousal.

In clinical terms, several key features of dyspareunia are distinguished:

chronic or recurrent nature,
association with sexual activity,
absence of an exclusively mechanical cause (e.g., trauma),
significant impact on psychological well-being and sexual functioning.

Pain can vary in intensity – from a burning sensation and discomfort to severe, acute pain preventing sexual intercourse. Dyspareunia often remains undiagnosed due to communication barriers, patients' embarrassment, and the mistaken belief that pain during intercourse is a physiological phenomenon.

Dyspareunia – causes

The etiology of dyspareunia is multifactorial and includes both organic and psychological causes. In clinical practice their coexistence is most commonly observed.

Somatic causes:

inflammatory conditions of the genital organs (e.g., vaginitis, vulvitis),
infections (bacterial, fungal, viral),
endometriosis,
atrophic vaginitis (estrogenic atrophy),
postoperative and post-traumatic scars,
vaginal dryness (e.g., during menopause or with hormonal disorders),
dermatological diseases (e.g., lichen sclerosus).

Functional and neurological causes:

hyperreactivity or dysfunction of sensory nerves,
disorders of pelvic floor muscle tone,
chronic pain syndromes (e.g., vulvodynia).

Psychogenic factors:

fear of pain or intercourse,
traumatic experiences (e.g., sexual violence),
chronic stress,
relationship problems.

It is worth emphasizing that treating a single factor in isolation rarely brings complete improvement – effective therapy requires a holistic approach.

Dyspareunia – types of pain

Dyspareunia can be classified depending on the location and nature of the pain, which is of significant diagnostic importance.

According to location:

superficial (introital) dyspareunia – pain occurs at the entrance to the vagina, often associated with dryness, inflammation, or muscle tension,
deep dyspareunia – pain felt during deep penetration, often associated with pathologies of the pelvic organs (e.g., endometriosis, ovarian cysts).

According to the nature of the pain:

burning,
stabbing,
dull,
radiating to the lower abdomen or sacral area.

According to the time of occurrence:

primary pain – present from the onset of sexual activity,
secondary pain – appears after a symptom-free period.

Accurately determining the type of pain is a key element of differential diagnosis and guiding therapy.

Dyspareunia and pelvic floor tension

One of the most frequently underestimated mechanisms of dyspareunia is excessive pelvic floor muscle tension (hypertonia). These muscles, responsible for stabilizing the pelvic organs and controlling urination and defecation, also play an important role in sexual function.

When they are excessively tense, this leads to:

limited tissue elasticity,
increased sensitivity to mechanical stimuli,
impaired local blood flow,
formation of trigger points (trigger points).

Symptoms suggesting the involvement of muscle tension include:

difficulty with penetration,
a feeling of "tightness" or blockage,
pain that worsens when attempting to relax,
coexisting complaints such as painful menstruation or difficulty urinating.

Treatment in such cases includes:

urogynecological physiotherapy (manual and neuromuscular),
body awareness training,
relaxation and breathing techniques,
pharmacological therapy in selected cases.

This approach is highly effective, especially when the problem is functional in nature.

Dyspareunia – when to see a specialist

Specialist consultation is indicated in any case of persistent pain during intercourse. Particular attention should be paid to the following situations:

pain persisting for more than a few weeks,
increasing severity of the symptoms,
presence of additional symptoms (e.g., bleeding, discharge, burning),
lack of improvement despite using moisturizing preparations,
coexisting problems with urination or defecation,
impact on partner relationships and quality of life.

Diagnostic evaluation should include:

a detailed medical and sexual history,
a gynecological examination,
assessment of pelvic floor muscle tension,
imaging and laboratory tests if necessary.

Depending on the cause, treatment may include:

pharmacological therapy (e.g., topical estrogens, anti-inflammatory medications),
urogynecological physiotherapy,
psychological or sexological support,
procedural treatment in selected cases.

Early diagnosis and initiation of appropriate management significantly improve the prognosis and enable a return to a satisfactory sexual life.