Dyspareunia (painful sex): causes, treatment and when to see a GP

Dyspareunia means pain during sex. It is a symptom rather than a diagnosis in itself, so the aim is to find what is behind it. The NHS pages on vaginismus, vaginal dryness and endometriosis describe the main possibilities. The NHS describes a burning or stinging pain with vaginismus, soreness or itching with vaginal dryness, and pain felt deep inside during sex with pelvic inflammatory disease.

Pain during sex can be upsetting, but the NHS says conditions such as vaginismus and vaginal dryness can be treated, so it is worth getting checked rather than putting up with it.

The NHS vaginismus page lists other things that can cause vaginal pain during sex besides vaginismus: thrush, sexually transmitted infections, menopause, a bad reaction to condoms, soap or shampoo, pelvic inflammatory disease and endometriosis. The table gathers what the NHS says about the main causes.

Treatment depends on the cause. For vaginal dryness the NHS suggests water-based lubricants before sex, vaginal moisturisers inside the vagina, unperfumed soaps and washes, and different types of foreplay to find what makes you feel more aroused. If dryness is due to changes in hormone levels, a GP may prescribe creams, gels, patches or medicines to increase oestrogen (hormone replacement therapy), which are not recommended for everybody.

For vaginismus the NHS says treatment usually focuses on managing your feelings about vaginal penetration and exercises to gradually get you used to it. Options include psychosexual therapy, relaxation techniques (mindfulness, breathing and gentle touching exercises), pelvic floor exercises, sensate focus, and vaginal trainers, which are tampon-shaped objects in different sizes. Treatment is initially guided by specialised therapists, then you practise some exercises at home, and a partner can be involved if you choose.

Infections such as thrush, STIs and pelvic inflammatory disease are treated according to the cause, and the NHS says PID, if diagnosed early, can be easily treated with antibiotics. Endometriosis has its own treatments; see the endometriosis guide.

The NHS says vaginismus is an automatic reaction you do not have control over, is more common in women in their late teens to early 30s, and can occasionally happen even if you previously enjoyed painless penetrative sex. It does not necessarily affect your ability to get aroused and enjoy other types of sexual contact.

The reasons are not always clear. Things thought to cause it include anxiety or fears about having sex, a painful sexual experience, sexual assault or abuse, an unpleasant medical examination or difficult experience giving birth, believing sex is shameful or wrong, and a painful medical condition like thrush.

The NHS lists vaginal problems among the symptoms of menopause and perimenopause, such as dryness, a burning feeling, irritation or itching in and around the vagina, and says these can also make sex feel painful. Vaginal dryness can also continue after menopause.

Contact your GP if you think you have symptoms of menopause or perimenopause and want to know your options. If you have not had a period for 12 months or more and have any vaginal bleeding, the NHS says it needs to be checked.

The NHS says to see a GP if you have had vaginal dryness for a few weeks and things you have tried yourself are not working, if it is affecting your daily life, if you have unusual discharge, or if you have bleeding after sex, in between periods or after menopause. For vaginismus, see a GP or go to a sexual health clinic.

If you think you have symptoms of pelvic inflammatory disease, the NHS says to ask for an urgent GP appointment or get help from NHS 111, including if you have pelvic pain that comes and goes, or are pregnant. Call 999 or go to A&E for severe or worsening pelvic pain, pelvic pain with heavy vaginal bleeding, sharp sudden intense lower tummy pain, dizziness or fainting, a very high temperature, or feeling very unwell.

The NHS says a GP will ask about your symptoms and may ask to examine your vagina, usually very quickly, to rule out other conditions such as an infection. You can ask to be seen by a female doctor, bring someone you trust for support, and discuss ways to make the examination as comfortable as possible. For possible PID the GP may also check inside the vagina as in cervical screening, and you can ask for a chaperone.

If a GP thinks you have vaginismus you may be referred to a specialist such as a sex therapist. Other referrals can include gynaecology for endometriosis, or a sexual health clinic for infections.

On the NHS you can start with a GP or a sexual health clinic, as the NHS suggests for vaginismus, and be referred on to gynaecology or psychosexual services if needed. Waiting times for specialist therapy vary by area.

Some people choose a private GP, gynaecologist or psychosexual therapist for faster access. It helps if any private clinician shares the findings with your GP.