Dyspareunia (Intercourse Pain)

Overview Causes Symptoms Treatment

Causes of dyspareunia (intercourse pain)

Dyspareunia can result from a wide range of physical, hormonal, and emotional factors. Physical causes often include cervical stenosis, vaginal dryness, infections, pelvic floor muscle tightness, endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids, or scar tissue from prior infections, childbirth, or trauma. Hormonal changes—especially low estrogen during breastfeeding, perimenopause, or menopause—can thin vaginal tissues and reduce lubrication, making intercourse painful. Pain may also arise from dermatologic conditions affecting the vulva, such as lichen sclerosus, or from structural issues like cervical stenosis. Emotional factors, including anxiety, stress, or past trauma, can contribute to muscle tension and heightened sensitivity. In many cases, multiple factors overlap, making dyspareunia a complex condition that requires proper medical evaluation to determine the underlying cause.

Here at Clear Passage®, our therapists find that a significant amount of dyspareunia is caused by tiny, powerful collagen cross-links, the building blocks of adhesions. Each time an object enters a woman’s womb, it may introduce bacteria. Designed to promote life, the womb is a perfect place for bacteria to grow. When bacteria attach to vaginal surfaces, your body sends powerful strands of collagen, the building blocks of adhesions, to surround and isolate the bacteria to help your immune system fight them off.

The body creates internal curtains of ‘adhesions’ to isolate the bacteria. After bacteria die, these curtain-like internal bonds tend to remain on vaginal walls like an internal glue. These immobile bonds can cause significant pain during intercourse when they form on vaginal walls. Adhesions at the cervix or coccyx (tailbone) can be severe with deep penetration. They can cause pain at the entrance (introitus) when they form there.

Pain at the Vaginal Entrance

When the body heals from an infection, trauma, or surgery, it forms tiny but powerful collagen cross-links–the building blocks of adhesions. These tiny internal scars act like straitjackets, attaching to the vaginal wall or entrance or other pain-sensitive structures. Robbed of their usual elasticity, the adherent tissues cause pain at initial penetration.

Pain With Deep Penetration

Tiny adhesions that form at the tailbone (coccyx) can pull that structure forward, causing pain during deep penetration. Adhesions can also form between muscle cells deep within the cervix (stenosis of cervix), also known as stenotic cervix, causing a similar deep pain during sexual intercourse.

Adhesions form in response to any of the infections, inflammations, surgeries, or traumas to which the female reproductive tract is subjected. Conditions that cause these adhesions include:

• Endometriosis
• Physical or sexual abuse
• Intercourse when not fully lubricated
• Bladder or vaginal infection or inflammation
• Vaginismus (a spasm of the muscles around the opening of the vagina)
• Surgery (e.g., abortion, episiotomy, C-section, hysterectomy, female circumcision)
• Trauma to the tailbone, pelvis, or nearby structures (hip, low back, etc.), such as a fall or sports injury (e.g., a cheerleading, skating, horseback riding, or bicycle injury)

Symptoms of dyspareunia (intercourse pain)

• Pain at the vaginal opening during penetration
• Deep pelvic pain during thrusting
• Burning, stinging, or sharp pain with intercourse
• Aching or throbbing pain after sexual activity
• Vaginal dryness or tightness
• Involuntary pelvic floor muscle tightening
• Pain that worsens with certain positions
• Persistent pelvic or lower abdominal discomfort after intercourse
• Emotional distress, anxiety, or avoidance of intimacy due to pain

Treatment of dyspareunia (intercourse pain)

In the hundreds of women we have treated for dyspareunia pain, we have a success rate of 90%. We usually find that tiny adhesions, or internal scars, are the direct cause or significantly contribute to their pain.

Physicians often overlook these small, sometimes microscopic structures for several reasons. Adhesions can be so small that they are often difficult or impossible to view, even using advanced medical imaging such as CT, MRI, ultrasound, or X-ray. While our specialty-trained therapists can feel them, adhesions are nearly impossible for doctors to treat when they form on or within the delicate tissues of the vagina.

Our therapists use their hands and a protocol of over 200 manual techniques to detach pelvic and vaginal adhesions, often reducing or eliminating dyspareunia pain permanently. We always work well within the patient’s tolerance level, and the patient is always in control of the pressure we use at each moment during therapy. Most of our therapy is external, as we treat the legs, hips, and other structures that attach to the areas of pain. If we treat internally, we use a gloved hand and work slowly and gently. All therapy is performed with respect and dignity in a private treatment room, following established guidelines for draping and the presence of chaperones. The patient always has the choice to refuse internal therapy, although it is highly recommended for dyspareunia.

We direct therapy to the areas that are causing symptoms. For some women, pain may occur at first penetration as a sharp and specific pain in one or more locations at or near the opening of the vagina. Others experience pain with deep penetration. They generally describe a broader, deeper pain ̶ as if “… my partner is hitting something.” Some women experience pain in both areas.

Women who bring their partner along to therapy are able to test their progress by having intercourse during treatment week, usually starting about halfway through therapy. This feedback can help us determine which areas are being relieved and which areas still need attention during upcoming treatment sessions.

Some women absorb repetitive traumas and stresses to the pelvis without experiencing symptoms or negative side effects. However, some women experience significant, long-lasting symptoms, as tiny but powerful adhesive fibers rob their bodies of the easy mobility and extensibility of normal tissues.

Bound by adhesions, they may also experience other symptoms, such as anorgasmia (inability or difficulty reaching orgasm) and decreased desire or lubrication. When we treat the vaginal tissues, these symptoms tend to resolve or improve dramatically. Our work addresses all of these conditions, with positive results generally lasting years or a lifetime.

Other Treatments for Dyspareunia (Surgery, Drugs)

Intercourse pain is an area that often confounds physicians and their patients. The tiny adhesions we have found to be the cause of pain are microscopic and do not appear in diagnostic tests. In addition, the delicate tissues of the vagina are not generally amenable to surgery, which itself can cause more adhesions. As a result, many gynecologists prescribe palliatives, desensitizing agents, and pain relievers for patients who experience pain during or after sex. Typical gynecologic recommendations would be (in this order):

1. Increase foreplay;
2. Use more lubrication.
3. If the above does not help, the doctor may prescribe either analgesics (pain relievers) or a desensitizing gel (so the patient feels less pain). As a result, the patient is numbed to pain – and to pleasure;
4. If the patient still has complaints of dyspareunia pain, she is generally referred to a psychologist or psychiatrist to help her deal with the pain issues. In some cases, the physician feels the pain is “all in the patient’s head.”

Condition Specific Disclaimer:

The information provided about intercourse pain (dyspareunia) is for educational purposes only and is not intended to diagnose or replace medical advice from a physician. Because intercourse pain can result from a wide range of physical, hormonal, pelvic floor, and psychological causes, we encourage evaluation by a licensed physician or specialist. Our therapy is a non-invasive manual approach that may be considered as a complementary option to your medical care. Patients should consult their healthcare provider to determine the underlying cause of symptoms. Contact Clear Passage® Therapy and fill out a medical history form to determine if therapy is an appropriate part of your overall treatment plan.

Testimonials:

To read Clear Passage® Therapy patient success stories, please visit our Testimonials page.

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