Pain During Intercourse (Dyspareunia)? & Non-Surgical Treatments


Dyspareunia (a medical term) is the recurrent or persistent pain with sexual activity (intercourse/intimate relationship). Pain during sex; is very common in women at some time of their lives which could be a sign of gynecological problem or caused by problems with sexual response such as lack of desire.

The reported prevalence is 10%-20% but it is believed that is under reported (a taboo).

Pain during sex or Dyspareunia (which is the clinical term) is a complex problem of various reasons & factors that could be physical or psychological. It can be classified as superficial (during penetration), affecting the opening of the vulva or it can be felt deep seated within pelvis (starts only after penetration & may persists for some time). Also, can be primary (dating from the 1st intercourse) or secondary2 (developed later on) or temporary or persistent.

Pain during intercourse/Dyspareunia can have a significant impact on a woman’s mental and physical health, body image, relationships with partners, and efforts to conceive. It notoriously cripples the woman’s quality of life physically & traumatizing her psychologically, disrupting her orgasmic dysfunctions (anorgasmia) and undermines the intimate relationship, her sense of wellbeing & self-confidence. 

There are several reasons of dyspareunia; such as: 

– Atrophic Vulvovaginitis [Syn: Vulvo-Vaginal Atrophy (VVA) or Genitourinary Syndrome of Menopause (GSM)] with chronic vaginal dryness6 especially at menopause is the most common cause or due to general condition like Diabetic neuropathy, atherosclerosis or autoimmune diseases or history of chemotherapy or radiotherapy.

– Lack of enough lubrication (dryness) because of drop in estrogen level after childbirth-postpartum- (episiotomy scars or perineal tears), breastfeeding or menopause or due to some contraceptive pills/ injections or certain medications.

– Defloration Injury or tear after a childbirth (infected or ill-healed lacerations).

– Inflammation like vulvitis, Bartholinitis, cervicitis, salpingo-oophoritis, parametritis, infection (STIs, HPV, Trichomonas & Monilia-fungal infections, pelvic inflammatory disease, specific infections) or skin diseases- like Lichen Sclerosis, Lichen Planus, Herpes, ulcers or eczema, psoriasis- affecting genital area or urinary tract.

-Chronic Epithelial Dystrophies of the Vulva; like leukoplakia vulvae, or Kraurosis Vulvae (atrophic changes due to declining Oestrogen Hormone)

-Vaginismus which is involuntary spasms of the muscles of the pelvic floor & around the vaginal introitus on attempting intercourse

– Congenital abnormality of the genital tract such as absence of fully formed vagina (vaginal hypoplasia), septate vagina, hymenal stenosis, or retroverted uterus or uterovaginal prolapse or prolapsed adnexae.

– Pelvic endometriosis (mostly causes deep dyspareunia).

-post- surgery scar formation of the vaginal wall, vulva or perineum (e.g perineorrhaphy, colporrhaphy, labiaplasty or vulvectomy, vaginal hysterectomy) or due to pelvic adhesions.

– Genital tract tumours & post chemotherapy or radiotherapy

-Vulval or vaginal retention or vestigial cysts or inclusion Dermoid cyst.

-Vulvodynia [is defined by the International Society for the Study of Vulvovaginal Disease as vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurologic disorder. Vulvodynia is classified as provoked, unprovoked, or mixed. In unprovoked vulvodynia, the pain is continuous. In provoked vulvodynia, the pain is triggered by touch, as with tampon insertion or intercourse. There is an association between vulvodynia and psychiatric disorders. Women with depression or anxiety are at increased risk of vulvodynia, and vice versa].

-Irritation mechanical or chemical or allergic reaction following the use of strong douches or deodorants, or irritant cervical discharge.

-Genitourinary or -recto-vaginal fistulae, acute & chronic cystitis, interstitial cystitis, urethritis, urethral diverticulum, urethral caruncle.

-Pelvic swellings e.g fibroid, adenomyosis, ovarian cysts, salpingitis, ruptured corpus luteum cyst notoriously cause deep dyspareunia.25

-Too little arousal before intercourse, inadequate lubrication, chronic pelvic congestion or pelvic floor dysfunction or neuropathies (Diabetes Mellitus, multiple sclerosis, nerve entrapment) 

– Extragenital lesions as colitis, Crohn’s disease, diverticulitis, piles (hemorrhoids) or anal fissures. 

– Psychosocial trauma

Diagnosis & treatment of Painful intercourse

Thorough Gynecological assessment, examination, screening, case selection are to be performed by a knowledgeable & experienced Gynaecologist as this is the key to determine the cause of pain and decide on the personalized course of treatment.

Treatment modalities 

Treatment of Dyspareunia depends on the cause. 

  1. Surgical procedures to treat dyspareunia were the only option to near past like Vaginoplasty, colporraphyies, pelvic repair, perineorrhaphy, labioplasties, Fenton’s procedure, refreshing of perineal scars or removal of pelvic tumours or laparoscopic treatment of endometriosis etc.
  2. Non- Surgical: Until recently, options for treatment of “pain during sexual intercourse” were limited only to traditional gynecological options. However, with the new advances of Non-Surgical Aesthetic treatments , as a Gynaecologist, I now can offer several treatment modalities including Platelets Rich Plasma injections (aka “O” Shot) and implementing the technology of Energy Based Equipment like radiofrequency and laser, and dermal fillers injections to provide an effective remedy to the symptom, and rejuvenation of the tissues of the intimate area which help to regain its normal function and youthful appearance.26, 27

2.1 Platelet Rich Plasma –PRP- therapy stimulates the healing of the vaginal tissue to rejuvenate the vaginal walls. The result is a tighter vaginal wall, plumper labia, regaining of sensation & lubricant function, improving bladder dysfunctions, reduced risk of infection. 28, 29, 30, 31, 32

2.2 Laser vaginal rejuvenation gives women a simple and effective solution to revitalize vaginal skin to reduce the symptoms. Laser treatment uses fractional microablative CO2 laser, or non-fractional laser, along the vaginal walls to stimulate the regrowth of skin cells, blood vessels, and lubrication glands. It also stimulates the production of collagen and elastin. The new blood vessels bring more oxygen and nutrients to the skin to restore moisture and elasticity which results in vaginal rejuvenation. Gynaecological assessment & the procedure are to be performed by an experienced Gynaecologists to prevent any possible complications or side effects.33-37 & 39

2.3 Radiofrequency treatment is also used for vaginal rejuvenation, e.g ThermiVa, Ultrafemme 360, or Votiva.38, 39

2.4 Hyaluronic Acid hydrating filler to the feminine area to improve lubrication function & stimulates vaginal rejuvenation.40

3. Hormonal: topical application of Oestrogen preparations (topical cream, gel or ring pessary or tablet) could help with atrophic changes (menopausal or Oestrogen decline conditions) to improve the healthiness of vaginal tissues39-41

4. Specific for example like Neurotoxin for vaginismus15, treatment of infections, removal of pelvic swellings41-43

5. Non Specific like use of topical analgesics e.g lidocaine gel or lubricating K-Y jelly or steroids or Amitriptyline-Tricyclic antidepressants tablets.26, 31, 44-46

6. Psychosexual, cognitive or behavior therapy when redeemed necessary


Published by Dr. Nadia Yousri, FRCOG, Aesthetic Regenerative Gynaecology Consultant©


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Copyrights are reserved to Dr. Nadia Yousri, OB&GY, Sexual Wellness & Regenerative Medicine, FRCOG, 05/11/2020©©®