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Pain during sex

Painful sex (dyspareunia) symptoms:

Pain during sex is common and treatable, but often misdiagnosed and left untreated. Sex should not be painful, there are services available in Northern Ireland, some of which may require GP referral. Pain in the genital or pelvic area during sex is called dyspareunia.

You may experience:

  • pain when penetration begins,
  • deep pain during sex,
  • burning, stinging, or aching sensation,
  • pain after sex,
  • tightness or involuntary muscle contraction
  • anxiety, fear or avoidance of sex.

Possible causes:

Some causes of pain during sex can include:

Treatments:

Self help
You may find the following self-help tips useful:
1. Stop trying vaginal penetration during sex if this is painful. Repeating the painful pattern over and over means that the feeling of pain, the distress and anxiety reinforce the response of tightening the muscles.
2. Vulval skin care: Use nothing but water to wash or a soap substitute emollient (for example Oilatum or E45). If your skin is very sore or irritated using a moisturiser once or twice a day (for example Aqueous cream, Emulsifying Ointment or Hydromol) may calm the skin. Even if the skin seems fine, applying an emollient (essentially a basic moisturiser without any additives, colour or perfume) may improve the skin and also allows exploration of the vulval area which can help make it less sensitive.
3. Self-exploration: Getting to know the vulva and vagina can help identify if there are any tender areas that are more likely to cause pain and muscle tightening. Also touching or applying an emollient here can desensitise the area.
4. The body gets more used to being touched here without triggering pain which helps break the cycle that causes muscle tightening.
5. Relaxation techniques, mindfulness or meditation. Finding a way to help the mind and body stop focussing on the pain or the expectation of pain can help reduce the anxiety around penetration. Being able to stay ‘in the moment’ and focus on sensations and arousal without thinking/ worrying about penetration is very important. Intimacy can be very important to a relationship so continuing to touch; stroke and focus on non-penetrative sexual pleasure can help you keep connected while reducing
your anxiety.
6. Pelvic floor muscle exercises that focus on the release of the pelvic floor help develop an awareness of how this area feels. There are some videos and links [link].
7. Vaginal trainers or fingers. Gently exploring the entrance to the vagina with the little finger or the smallest vaginal trainer allows a gradual retraining of the vaginal muscles to accept something being inserted. This may seem difficult at first and can be a slow, steady process. Repeat over and over again until it gradually gets easier and then try increasing the size of the trainer or using larger fingers.

Professional help
While some people are able to help themselves to overcome vaginismus and sexual pain, sometimes professional help is needed if the simple steps described do not seem to work or seem too difficult or frightening to try.
Talking to your GP or practice nurse, however difficult that may seem is a good first step to getting help.
There may be a simple reason for your pain. If referral is needed they can send you to the person best able to help you. Psychosexual therapists, sexual and reproductive health doctors and physiotherapists with an interest in the pelvic floor are some of the people who can provide appropriate treatment and support.

  • Psychosexual difficulties, treatments and support services

    Psychosexual difficulties are problems with sexual feelings, thoughts or physical responses that cause distress or relationship difficulties.

    Common types of psychosexual difficulties:

    • Sexual dysfunction:
      • Erectile dysfunction (impotence, ‘can’t get it up’), premature ejaculation, or delayed/absent ejaculation.
      • Vaginismus (involuntary muscle spasms preventing penetration), dyspareunia (painful sex), or difficulty reaching orgasm.
      • Reduced or no sexual desire (low libido), or loss of sexual pleasure.

    Causes and contributing factors:

    • Psychological: Stress, anxiety, depression, low self-esteem, or guilt.
    • Trauma: Past sexual abuse or negative sexual experiences.
    • Physical/Medical: Illness, disability, medication side effects, or hormonal changes.
    • Relational: Communication issues with a partner or lack of emotional intimacy. 

    Treatments and support:

    • Psychosexual therapy: Specialized counseling to help individuals or couples explore the emotional and physical aspects of their problems.
    • Medical consultation: Visiting a GP or sexual health clinic is recommended first to rule out or treat underlying physical causes.
    • Pelvic physiotherapy for vaginismus

    Psychosexual services – HSC

    Common Youth
    028 90328866 https://www.commonyouth.com

    • Patient self – referral or GP referral
    • Male and female <25
    • Individual therapy
    • Will see IPM membership doctor
    • Can have genital examination
    • Free at point of service

    Dr Helen Sherrey
    GUM/SRH clinic

    BHSCT (Belfast Trust) – Patient access by self-referral via GUM or SRH clinic- 028 9615 2111

    • Male and female
    • Individual therapy
    • Held once a month
    • Will see IPM Membership trained doctor
    • Can have genital examination
    • Free at point of service/NHS

    Shimna House,
    Knockbracken 9063 8854

    • GP referral
    • Females and male
    • Couples therapy available
    • Relate counsellors for CBT
    • Cannot have genital examination
    • Regional service
    • Free at point of service/HSC

    Dr Catriona O’Kane
    Consultant Obs and gynae Antrim Hospital

    • Female only
    • GP referral to Obs and Gynae Northern Trust
    • Individual therapy
    • Will see IPM Membership doctor
    • Can have genital examination
    • Free at point of service

    Some other areas such as local GUM clinics may have others trained in psychosexual medicine who, whilst have no official clinic, may be able to offer some psychosexual therapy for patients.

    For IPM training enquiries, referral information or advice on where to refer please contact Dr Nancy Conroy nihaldane@doctors.org.uk

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