Written by: Heidi Wright, BSN, RN, PCCN
Did you know that painful sex, also known as dyspareunia, can actually make it harder for you to get pregnant? If you are experiencing pain with intercourse, you’re not alone. About 75% of people with ovaries will experience some form of painful sex during their lifetime. And it’s not just something that affects anatomically female bodies – it can also affect male bodies, too. Researchers have identified a high prevalence of sexual dysfunctions in people diagnosed with infertility (as much as 61% of those studied). Dysparenunia can interfere with fertility (your ability to get pregnant) in two ways. First, it may be an indication of an underlying medical condition that is negatively impacting your fertility. Second, the pain itself can make it difficult or even impossible to conceive, especially around ovulation. It's crucial to learn what's considered normal and what's not regarding sexual pain, be aware of medical conditions that may cause painful intercourse, and how to seek proper medical attention if you're experiencing these problems. In this article, we will dive in to learn a bit more about what causes painful sex and what you can do to feel better.
What Causes Pain With Sex (Dyspareunia)?
Dyspareunia is the medical term for painful intercourse or pain with sex. It can be caused by a variety of factors, including vaginal dryness, vaginal infections, endometriosis, pelvic inflammatory disease, pelvic floor disorders (PFD), vaginismus, and vulvodynia. Let’s discuss some of these causes in more detail.
What is The Difference Between Dyspareunia, Vulvodynia, and Vaginismus?
Dyspareunia, vulvodynia, and vaginismus are related conditions that involve pain during sexual intercourse, but they are not the same thing. Dyspareunia refers to pain during or after sexual intercourse and can affect all bodies. It can be caused or triggered by a variety of factors, including physical conditions like infections, endometriosis, or pelvic inflammatory disease, as well as psychological factors like anxiety, past trauma, or relationship issues. Vulvodynia and vaginismus are more specific conditions, so let’s look at those in more detail.
What is Vulvodynia?
Vulvodynia affects an estimated 7% of reproductive-age people with vulvas in the United States. Vulvodynia is chronic pain in the vulva area, which is the outer part of an anatomically female body’s genitals. The pain may be described as burning, itching, stinging, or rawness. It can occur during sex or other activities, like sitting or wearing tight pants. The cause of vulvodynia is unknown (called idiopathic vulvodynia), but it may be related to nerve damage or irritation. It is considered a pelvic floor disorder.
What is Vaginismus?
Vaginismus is a painful condition where the muscles around the vagina involuntarily tighten, making penetration painful or impossible. The muscle spasms are triggered by the insertion of something into the vagina; whether it be a tampon, penis, finger, or even a medical instrument like a speculum at your annual health checkup. The exact cause of vaginismus is unclear. It can be triggered early or late in life, and possibly set off by physical factors such as past surgeries or childbirth, or psychological factors, such as a history of sexual abuse or anxiety about sex. It is also considered a pelvic floor disorder.
Pelvic Floor Disorders and Infertility
Sometimes you may get a more generalized diagnosis from a healthcare provider of pelvic floor disorder. Pelvic floor disorders (PFD) are a potential cause of painful intercourse and can also impact your fertility. Pelvic floor disorders are a group of conditions that affect the muscles, ligaments, and connective tissues in the pelvic region. PFD is often diagnosed by an OBGYN physician or a specialty-trained GYN called a urogynecologist and treated by a specialty-trained physical therapist called a pelvic floor physical therapist.
What Are the Symptoms of Pelvic Floor Disorder?
Here are some common symptoms of pelvic floor disorders:
- Pain or discomfort in the pelvic area
- Pain during sexual intercourse
- Difficulty or pain during urination
- Difficulty or pain during bowel movements
- Incontinence (loss of bladder or bowel control)
- Pelvic organ prolapse (a bulging or dropping of pelvic organs, such as the bladder or uterus, into the vaginal area)
- Persistent constipation or straining during bowel movements
- Lower back pain or discomfort
Pelvic floor disorders can make sex painful or uncomfortable, and can also impact sexual desire and arousal, which can further complicate matters when trying to conceive. It is important to note that vulvodynia, vaginismus, and other pelvic floor disorders can occur simultaneously, further complicating sex and TTC (trying to conceive).
What is the Connection Between Dyspareunia and Infertility?
Dyspareunia in anatomically male bodies can make it difficult to conceive naturally because it can cause pain during intercourse, which can make it difficult to achieve ejaculation. For anatomically female bodies, pain with sex not only often stops sex from happening, it can also add a lot of psychological stress to try to time sex during ovulation and have sex often enough to get pregnant. Additionally, if the cause of dyspareunia is related to an underlying medical condition, that condition could also be impacting your fertility, such as endometriosis, PID (pelvic inflammatory disease), PCOS, and infections such as STIs, UTIs, or yeast. It is important to seek medical attention if you are experiencing pain during sex. A good place to start is your OBGYN or family healthcare provider.
What is the Treatment for Dyspareunia?
If you are experiencing pain with sex, don’t lose hope. There are so many treatment options to help you feel better! The right treatment for dyspareunia and pelvic floor disorders will depend on the underlying cause of your symptoms. For example, for someone with vaginal dryness, a home treatment like high-quality lubricant before sex may be helpful (if you’re trying to conceive, make sure to use a fertility friendly lubricant like Good Clean Love). But if the underlying cause of pain with sex is more complicated, such as anatomical abnormalities, uterine fibroids, adhesions, vaginismus, PTSD, or pelvic inflammatory disease – just to name a few examples – medical treatment is necessary. Treatment options may include medication, pelvic floor physical therapy, surgery, pain specialists, psychological therapy, or lifestyle changes like practicing self-care and stress management. Keep reading, we’re going to talk about some self-care things you can do at home to help with pain relief.
How Do I Talk to My Doctor About Painful Sex?
You do not need to suffer in silence. There are effective treatments for dyspareunia and your doctor can help guide you to determine the right diagnosis and underlying cause. Consider writing down your symptoms and questions before your appointment so you’re prepared to discuss them with your healthcare provider. Some common symptoms of dyspareunia to consider include
- Pain or discomfort with sexual intercourse during entry
- Deeper pain during sex
- Pain before intercourse, in the vulva area
- More painful sex during ovulation or around menstruation
- Burning, stinging, or itching sensations in the genital area
- Pain during penetration (finger, tampon, penis, or other)
- Anxiety, panic, or racing thoughts surrounding sex or intimacy
- Pain with sex during certain positions or thrusting
- Pain or discomfort in the pelvis or abdomen during or after sex
- Pain during or after ejaculation
- Vaginal tightness or muscle spasms, unable to enter to have sex
Did you know that some people with dyspareunia may experience pain during any sexual activity, while others may only experience it during certain types of activity or with certain partners? The severity and duration of the pain can also vary widely. If you are experiencing any of these symptoms, please advocate for yourself with your healthcare provider!
What Are Some Alternative Options for Conception at Home (How Can I Get Pregnant Without Having Sex)?
Often dyspareunia prevents you from having sex or having sex frequently enough to conceive. In addition to managing the underlying cause and symptoms of pelvic floor disorders and dyspareunia, there are several things you can do at home to help improve your chances of getting pregnant. Intracervical Insemination (ICI) or Intravaginal Insemination (IVI) is a home fertility treatment option that involves placing sperm directly at or near the cervical opening using a syringe. It is typically recommended for individuals with a healthy uterus, who are ovulating and have at least one functioning fallopian tube. The Mosie Kit was created specifically for intravaginal insemination (IVI) at home. It has a smooth-edged tip with a slit opening which is ideal for those who experience insertion pain or painful spasms with insertion. The Mosie Baby Kit can take the stress off of timing sex around your ovulation period. Intravaginal insemination at home can give you and your partner the time and space you need to heal from dyspareunia but also allows you to try to conceive during your healing journey. Always check in with your doctor before trying at-home insemination!
What Are Some Self-Care Things I Can Do At Home for Painful Sex?
Some self-care practices to consider include:
- Practicing stress management techniques like deep breathing or meditation before sexual intercourse
- Yoga and relaxation exercises
- Avoiding irritants like scented soaps or douches
- Using fertility-friendly lubricant during intercourse
- Undergoing biofeedback and using pelvic floor exercises like kegels under the direction of a pelvic floor physical therapist
- Communicating with your partner about your likes and dislikes, what feels good and what doesn’t
- Scheduling time for sex when neither you nor your partner is rushed, tired, or anxious
- Finding sexual activities that do not cause you pain (oral sex or mutual masturbation)
- Exploring different pain-relieving options before and after sex such as warm packs or cool packs applied to the outer genitals
- Trying non-sexual but sensual activities with your partner like massage or assisted stretching
- Preparing for sex with a pre-sex pain relieving medication or treatment
Dyspareunia, vulvodynia, vaginismus, and other pelvic floor disorders can have a significant impact on your fertility and sexual health. Seeking help is the first step towards a healthier and happier quality of life. If you are experiencing pain during sex or other symptoms related to pelvic floor disorders, it is important to seek medical help. Ignoring these symptoms can lead to more severe complications in the future, such as difficulty getting pregnant. If your doctor is not addressing or is dismissing your concerns, seek a second opinion. Pain with sex is not normal and should not be dismissed. It should be addressed, diagnosed, and treated. Don’t be afraid to be candid about your symptoms and their impact on your quality of life.
The good news is there are treatment options available for pelvic floor disorders and dyspareunia. These can range from simple lifestyle changes, counseling, and self-care practices to medical interventions such as physical therapy or surgery. By working with a healthcare provider and exploring various treatment options, many people have successfully managed their symptoms and improved their chances of conceiving! It’s crucial to remember that everyone's experience with dyspareunia and pelvic floor disorders is unique, and what works for one person may not work for another. It’s important to work with your healthcare provider to develop an individualized treatment plan.
We’re here for you on your TTC journey! Please don't hesitate to contact us here at Mosie Baby if there is anything we can do to support you. We are sending you our warmest hugs and hoping for the best possible outcome.
- American College of Obstetricians and Gynecologists. (2021). When Sex Is Painful. Retrieved from https://www.acog.org/womens-health/faqs/when-sex-is-painful
- Cleveland Clinic. (2021). Vaginismus. Retrieved from https://my.clevelandclinic.org/health/diseases/15723-vaginismus
- Faye RB, Piraccini E. Vulvodynia. (2023). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430792/
- Mayo Clinic. (2021). Dyspareunia. Retrieved from https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
- MedlinePlus. (2022). Orgasmic dysfunction in women. Retrieved from https://medlineplus.gov/ency/article/001953.htm
- Acta Clinica Croatia. 2019 Sep; 58(3). Infertility and Sexual Dysfunctions: A Systematic Literature Review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971809/
Heidi Wright, BSN, RN, PCCN is a Registered Nurse passionate about public health and expanding healthcare resources and prenatal care to diverse, rural, and underserved Hispanic, African American, American Indian, and Alaska Native communities. With 20 years of experience in healthcare, Heidi specializes in supporting patients with chronic illness and reproductive system disorders.