What Is Dyspareunia? Meanings, Causes and Treatment Options for Pain During Sex

In this guide, I would like to clarify the terms “dyspareunia” and “vaginismus”. Numerous questions from our customers and from my clients as a therapist have shown that information explaining the difference between dyspareunia and vaginismus would be helpful. Both conditions cause significant pain during sexual intercourse involving penetration or can make sexual intercourse impossible, yet they differ considerably.

The official medical diagnoses relating to dyspareunia, vaginismus and other forms of pain during sex are highly complex. Since they also differ partly from one another, they can be difficult for non-professionals to understand, especially as therapists themselves often describe the transition from one “condition” to another as gradual. Both conditions belong to the group of so-called sexual dysfunctions that cause pain during sex, particularly during penetration. For this reason, this guide is primarily aimed at affected women and their partners, if applicable.

Your Benefit From This Guide:
The following content is not based on AI, but on:
– my experience as a therapist
– discussions with people affected by genital health problems in the therapeutic blog
– the development of therapeutic tools.
In addition:
– After discussing physical and psychological treatment methods, I will introduce effective tools for self-treatment.
– You can continue learning through guides on related topics (list at the end of this article).

Contents:

What Is Dyspareunia?

The term “dyspareunia” encompasses various conditions affecting the female genital area.

The official definition according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems) of the WHO (World Health Organization) distinguishes between two forms:

• Organic dyspareunia (Code N94.1)
• Non-organic (psychogenic) dyspareunia (Code F52.6)

Both forms of dyspareunia are considered chronic.

A more detailed explanation is provided by the DSM IV, the handbook of the American Psychiatric Association. It describes dyspareunia as “recurrent genital pain associated with penetration (> 6 months), not associated with inadequate lubrication or medical conditions”.

This means that a woman has experienced pain during sex (sexual intercourse) for more than six months, which is not caused by insufficient vaginal lubrication. The statement that it is not associated with medical conditions can be confusing, because this is exactly the case with the organic form.

A) Organic Dyspareunia

Organic means physical causes that are actually present and can be identified clinically.

Here too, two variants are distinguished:

• Deep Organic Dyspareunia

The best-known and most common forms include:

• • Atrophy (thinning of the tissue of the vagina and possibly the vulva)
  • Inflammation of the vagina, bladder or urethra
  • Endometriosis (growth of endometrial tissue outside the uterine cavity)
  • Retroverted uterus (a uterus tilted backwards)
  • Tumours and cysts
  • Scar tissue
  • Hemorrhoids
  • Irritable bowel syndrome
  • High-tone pelvic floor dysfunction (hypertonicity = very high tension of the pelvic floor muscles)

• Superficial Organic Dyspareunia

The most common examples are:

• • Inflammation of the vulva, vagina, urethra or Bartholin’s glands
  • Atrophy (see above)
  • Vulvodynia – dyspareunia affecting the vulva, with a wide range of possible causes
  • Vulvar vestibulitis syndrome – similar to vulvodynia, but primarily affecting the vaginal opening
  • Hymen anomaly (an unusual structure of the hymen, whose significance remains highly controversial)
  • Skin conditions such as lichen disorders and psoriasis
  • Scarring
  • Radiotherapy
  • An unusually large penis

It is easy to imagine how all of these conditions can make sexual intercourse difficult, painful or even impossible. Naturally, treatment initially focuses on relieving and, ideally, resolving the physical symptoms. However, even in cases of organic dyspareunia, possible accompanying psychological factors should be considered.

B) Non-Organic Dyspareunia

This term initially includes all people who experience pain during sex without any visible physical cause – more specifically, pain during penetration, meaning conventional sexual intercourse. Interestingly, this condition is not limited to women but can also affect men. The official ICD-10 definition (see explanation above) already reveals some important differences compared with vaginismus:

ICD-10 Code F52.6: Non-organic dyspareunia
“A dyspareunia (pain during sexual intercourse) occurs in both women and men. It can often be attributed to a local pathological condition and should then be classified under the corresponding disorder. This category should only be used when no other primary non-organic sexual dysfunction is present (e.g. vaginismus or insufficient/absent vaginal lubrication).”

Differences Between Dyspareunia and Vaginismus

I hope it has become clear that the challenge of distinguishing between vaginismus and dyspareunia relates only to the non-organic form.
In both dysfunctions, the muscles are responsible for the symptoms – more specifically, the pelvic floor muscles. In vaginismus, these muscles contract involuntarily, which is why the condition is commonly referred to as a “vaginal spasm”.
All information about vaginismus can be found here: Vaginismus: Causes, Symptoms and Treatment Options

The cause of non-organic dyspareunia is often muscular hypertonicity. For many years, pelvic floor problems were primarily associated with weak muscles. Today, experience and research have shown that many pelvic floor problems are actually caused by muscles that are too tight, too tense and lacking flexibility. The frequent occurrence of this phenomenon may be linked to the pressures and fast pace of modern life. The main cause of non-organic dyspareunia is therefore excessive muscle tension or even muscle spasms. Despite adequate lubrication (vaginal moisture), penetration of the vagina may be impossible or extremely difficult and causes pain during penetrative sex. The painful experience of penetration can then trigger an escalating cycle of fear and pain. This, in turn, often affects sexual arousal, which may gradually diminish or even disappear completely.

Diagnosis of Dyspareunia

In practice, there are many cases of pain during sex that cannot be clearly assigned to a single diagnosis. In addition, not every gynaecologist specialises in this area. Interdisciplinary cooperation between gynaecologists, dermatologists and urologists where appropriate, sexologists and specialists in muscular disorders can help establish a more precise diagnosis and improve treatment outcomes.
In cases of organic dyspareunia, the first step is to treat the physical symptoms. Another important aspect is helping affected women understand the complexity of this dysfunction. Many patients initially want to see the cause only on a physical level. They often need encouragement to also acknowledge the psychological component.

Treatment of Dyspareunia

To begin effective treatment, it is often advisable to refrain from sexual intercourse for a certain period of time. This helps prevent further painful experiences during penetration and allows those experiences to fade as much as possible. On the one hand, this gives the body an opportunity to heal without additional strain. On the other hand, it supports the process of breaking the cycle of pain and fear.

The following is a condensed excerpt from a scientific text by Dr Karoline Bischof, gynaecologist and sexologist from Zurich:
“Women with chronic dyspareunia appear to process pain differently from women who are not affected. Pain is experienced as particularly severe. There is often anxiety as well as hypervigilance or hypersensitivity to pain (similar to patients with fibromyalgia and other chronic pain conditions). Broadly speaking, they tend to overestimate pain-related symptoms and frequently experience feelings of helplessness.
An important element of treatment is desensitisation and resensitisation. In other words, the woman learns to identify the painful areas of her genitals and, through regular gentle touch and skin-care products, gradually create sensations other than pain – initially neutral sensations, then increasingly pleasant sensations and, over time, sexual arousal. An essential prerequisite for this process is movement and relaxation of the pelvic floor, later combined with abdominal breathing, pelvic circles and pelvic tilts, as excessive muscle tension plays such a significant role in the development of pain.”

It is also important to explore yoursexual biography and identity: How have you experienced your femininity, how do you feel about it, what values do you associate with it, and do you accept your sexuality? Do you enjoy touching, looking at and smelling your own body?

Another important aspect of treating dyspareunia is learning to improveawareness of the pelvis and especially of yourmuscle tension.

Suitable Tools

Conical Dilators

To treat the physical symptoms, dilators are usually the best option, ideally a dilator set. There are significant differences between dilators in the following areas:

• The number of available sizes: This determines how gradual the progression between sizes can be. Especially among the smaller sizes, jumps of up to 33% are common, which is far too much.
• The maximum size: If your goal is comfortable penetration during sex, a final size of only 30–35 mm is often insufficient, particularly during more passionate movement.
• The material: Silicone is the most common material. However, there are significantly better options, especially regarding glide, hygiene, tactile sensation and sustainability.
• The shape: Dilators are normally conical, meaning they become thicker towards the end. This creates tissue compression, meaning the deeper you insert the dilator, the more resistance you have to overcome. In addition, conical dilators work in only one direction – inward. That does not necessarily have to be the case.

Theros® FMS Dilators Are Different:

• You can assemble your own set from up to 27 finely graduated sizes and even exchange individual sizes if needed.
  
• They are made from mouth-blown borosilicate glass: highly smooth-gliding, permanently hygienic (even sterilizable) and exceptionally sustainable.
• Even the smallest dilators are just as long as the largest because, unlike silicone, they retain their shape.
• FMS dilators work in both directions and provide a gentle massage during back-and-forth movements.

And with Theros® Vagina Stents, you can make the results achieved with FMS dilators more sustainable by inserting them after dilator use and wearing them during daily use:

Learning new flowing and gentle movement patterns is also part of relaxing the pelvic floor and the muscles of the vagina. This should take place within the framework of a comprehensive therapy programme.

For your mind and emotional wellbeing, I recommend relaxation exercises such as meditation, breathing exercises and guided visualisations.

You May Also Be Interested In:

• Vaginismus: Causes, Symptoms and Treatment Options
• Lichen Sclerosus: Symptoms, Progression and Measures to Prevent Narrowing