Dyspareunia – pain with intercourse

Dyspareunia is persistent or recurrent pain during sexual intercourse. It is quite common, but it is not something that people feel particularly confident in talking about, therefore people don’t realise just how many people are affected by it. It can affect individuals of any age and can be caused by physical, hormonal, or psychological factors, to name just a few. Regardless of the cause, dyspareunia can significantly impact quality of life, relationships, and emotional wellbeing.

Pelvic health Physiotherapy is one of the most effective, evidence-based approaches to treating dyspareunia. By addressing the underlying dysfunctions of the pelvic floor muscles and surrounding structures, physiotherapy helps reduce pain, restore normal function, and rebuild confidence with intercourse.

Dyspareunia refers to pain experienced before, during, or after vaginal penetration. This pain may be:

• Superficial – pain at the vaginal opening

• Deep – pain felt inside the pelvis during deeper penetration

• Primary – present since first attempt at intercourse

• Secondary – developed after a period of pain-free intercourse

Common causes include pelvic floor muscle hypertonicity, scar tissue from childbirth or surgery, hormonal changes (e.g., menopause), infections, endometriosis, vaginal dryness, and even stress or anxiety.

How can physiotherapy help Dyspareunia?

Pelvic health/women’s health physiotherapists are trained to assess and treat the muscles, nerves, joints, and connective tissues of the pelvis. Treatment generally focuses on restoring balance, mobility, and function within the pelvic region.

1. Assessment

A pelvic physiotherapy assessment may include:

• Detailed history taking (symptoms, medical history, lifestyle, stress factors)

• Postural and movement analysis

• Breathing pattern assessment

• External pelvic and abdominal examination

• Internal vaginal examination (with consent)

Understanding the root cause is essential for personalised treatment.

2. Pelvic Floor Muscle Relaxation and Down-Training

Dyspareunia is often associated with tight or overactive pelvic floor muscles. Instead of being weak, these muscles may be gripping constantly, similar to a clenched fist, which leads to pain and difficulty with penetration.

Physiotherapists can use techniques such as:

• Manual therapy to release trigger points

• Biofeedback to teach muscle relaxation

• Breathing and relaxation strategies to reduce pelvic tension

• Stretching and mobility exercises for hips, pelvis, and lower back

3. Manual Therapy and Trigger Point Release

Internal and external manual therapy helps lengthen tight muscles, improve blood flow, and release painful trigger points. This may include:

• Myofascial release

• Mobilisation of scar tissue (e.g., C-section or episiotomy)

These techniques improve tissue elasticity and reduce pain during penetration.

4. Education and Pain Neuroscience

Understanding how pain works is a crucial part of recovery. Physiotherapists can educate clients about:

• The role of the pelvic floor in sexual function

• Protective muscle guarding patterns

• The influence of stress, anxiety, and past pain on current symptoms

This empowers individuals and reduces fear around intercourse.

5. Use of Vaginal Dilators (If Indicated)

Dilators can be helpful for:

• Stretching tissues gradually

• Reducing hypersensitivity

• Increasing tolerance to penetration

6. Graded Exposure to Penetration

As pain decreases, physiotherapy supports a gradual return to comfortable sexual activity. This may include:

• Self-touch or mirror work to build confidence

• Relaxation before and during intercourse

• Positions that reduce pressure on pelvic structures

• Use of lubrication to prevent tissue irritation
  

7. Strengthening

Not everyone with dyspareunia has strong or tight pelvic floor muscles. Once overactivity is addressed, some individuals benefit from:

• Gentle strengthening exercises

• Core and hip stability training

• Functional movement retraining

If you or someone you know is struggling with dyspareunia, please consider booking in with one of our women’s health physiotherapists and let us help YOU to be able to achieve pain free intercourse.