Dyspareunia (Pain During Intercourse)

What it is

Dyspareunia is pain during or after intercourse, which can occur at the vaginal entrance, during penetration, or deep in the pelvis. It affects women of all ages and has varied causes: vaginal dryness and atrophy at menopause or during breastfeeding, infections, vulvodynia, involuntary tension of the pelvic-floor muscles, endometriosis, childbirth scars, and emotional factors. The pain tends to create a cycle of fear and avoidance that affects desire and the relationship. It's not a condition to tolerate in silence: it can be investigated and treated. The gynecology team at Femi Saúde assesses the source of the pain and proposes an individualized plan, in partnership with pelvic-floor physiotherapy and psychology when needed.

Most common symptoms

• Pain or burning at the vaginal entrance during penetration
• Deep pain, at the back of the pelvis, during intercourse
• Pain that lingers for hours afterward
• Dryness and a feeling of friction
• Involuntary contraction that makes penetration difficult or impossible
• Fear, anxiety and loss of desire from anticipating pain

Causes and risk factors

• Vaginal dryness and atrophy at menopause or during breastfeeding
• Vaginal and urinary tract infections
• Vulvodynia and vaginismus
• Endometriosis, ovarian cysts and pelvic inflammatory disease
• Scars from episiotomy, tearing or surgery
• Emotional factors, stress and traumatic experiences

How it is diagnosed

The visit begins with a careful conversation about where the pain occurs, when it started, whether it happens at the entrance or deep inside, whether there's pain at other times, and how it affects desire and the relationship. The gynecological exam is done calmly and at the patient's pace: the gynecologist inspects the vulva and vaginal entrance, touches sensitive points with a cotton swab, and assesses lubrication, pelvic-floor muscle tone, and the mobility of the uterus and ovaries. Depending on the suspicion, she orders infection screening, transvaginal ultrasound, and, for deep pain, tests directed at endometriosis.

How we treat it at Femi Saúde

Treatment targets the cause and usually combines more than one approach. For dryness and atrophy, vaginal lubricants, moisturizers, and local estrogen are used; infections receive specific treatment. For pelvic-floor tension and vaginismus, pelvic-floor physiotherapy, with desensitization and dilators, gives good results. The gynecology team at Femi Saúde treats endometriosis and other causes of deep pain with medication or surgery, depending on the case, and may recommend vaginal laser for atrophy. Follow-up with psychology or sex therapy is offered when fear and anxiety keep the pain going. The plan is individualized and reviewed throughout treatment.

What we offer