You Need to Know These 4 Facts if Your Partner Has Dyspareunia

Many people experience painful intercourse at some point in their lives. Whether you needed more lubricant or you just weren't in the mood—the reason doesn't matter—it's not unusual to occasionally feel pain during sex.

When that pain is chronic, however, it might be a condition called dyspareunia.

Dyspareunia is the medical term for genital pain that occurs consistently before, during or after sex. This recurrent pain can make having sex nearly impossible for some sufferers.

Dyspareunia affects approximately 10 percent to 20 percent of all women in the United States. You may have a female partner with the condition, now or in the future, so understanding what it means to have dyspareunia and how you can best support your partner is important.

What is dyspareunia?

The first detail you should understand about dyspareunia is that a doctor arrives at a diagnosis after a series of exams intended to rule out potential causes. This process helps the doctor determine the best course of treatment. If your partner is experiencing painful sex often, it may be time to encourage them to see a physician.

"Dyspareunia is pain in the vulva, vagina and pelvic area that can be experienced during sexual intercourse," said Lisa Lawless, Ph.D., a clinical psychotherapist and CEO of Holistic Wisdom in Bend, Oregon. "It is diagnosed through a physical examination and diagnostic tests, such as labs and imaging, to determine the underlying cause."

There are two different types of dyspareunia, according to Heather Jeffcoat, D.P.T., a physical therapist at Femina Physical Therapy in Los Angeles and author of "Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve."

"Dyspareunia is categorized as deep or superficial," Jeffcoat explained. "Deep dyspareunia is pain near the cervix. Superficial—sometimes referred to as introital dyspareunia—is pain with initial penetration. Pain with initial penetration may be determined to be vestibulodynia or vaginismus. Pain with deeper thrusting located closer to the cervix may be due to endometriosis, for example."

Being examined by a qualified doctor is a crucial first step in healing from dyspareunia. The causes are many, and only a doctor can determine the best treatment plan.

While your partner seeks treatment, you can take the emphasis off penetrative sex, which can go a long way toward strengthening your relationship.

Educating yourself about the condition can also indicate your willingness to be supportive. We talked to experts about the facts you should understand about dyspareunia in order to be a supportive and understanding partner.

Fact #1

Dyspareunia has several root causes

Many medical conditions are a direct result of a specific factor, but dyspareunia is different. There are many reasons a woman may be suffering from chronic painful sex.

The good news is that determining the cause means a doctor can prescribe the correct treatment.

"Dyspareunia is not a lifetime disorder in the vast majority of cases. Once the root cause is determined, a treatment plan can be put in place to help support your partner," Jeffcoat said.

The potential causes vary by type of dyspareunia, deep or superficial. The causes of superficial dyspareunia may include the following:

• Genital infections, such as urinary tract infections (UTIs) or sexually transmitted infections (STIs)
• Skin conditions, such as eczema
• A lack of lubricant
• Vaginismus
• A physiological difference, such as a vagina that never fully formed or an imperforate hymen

Causes of deep pain can come from medical conditions such as endometriosis, pelvic inflammatory disease (PID), ovarian cysts, uterine issues and more. Scarring from past surgeries, such as hysterectomy, can cause painful intercourse.

Certain medical treatments, such as radiation therapy and chemotherapy, can also cause dyspareunia.

Emotional factors can also contribute to painful sex, and these may fluctuate depending on your partner's emotional state at that time. Anxiety, stress, self-esteem issues and other psychological distress may cause dyspareunia.

Understanding your partner's triggers can be an important part of your support.

"Depending on if the underlying cause of the dyspareunia is emotional, there may be triggers that relate to internal conflicts or past abuse," said Monte Swarup, M.D., an OB-GYN in the Phoenix area and the founder of HPV Hub.

Fact #2

Dyspareunia is often a side effect of endometriosis

Endometriosis is a common uterine disorder that affects more than 200,000 women in the United States and occurs when endometrium-like tissue—similar to the tissue that lines the uterus—grows outside of the uterus, typically on the ovaries, fallopian tubes or intestines.

Deep dyspareunia occurs in half of the women with endometriosis, causing negative effects on their sexual quality of life, according to a 2018 study published in the journal Sexual Medicine.

"Dyspareunia is a common side effect of endometriosis because the penis can repeatedly hit areas with endometriosis implants, worsening the inflammation in the area," Swarup explained.

The 2018 study suggested that women with endometriosis and deep dyspareunia experience lower levels of sexual function and satisfaction. For women with endometriosis-caused dyspareunia, penetrative sex can feel painful during or after intercourse, or it can flare up during certain times in their menstrual cycle.

Possible solutions include using positions that allow for more shallow penetration, such as spooning or modified doggy style. You can also try nonpenetrative sexual intimacy: oral stimulation, massage, kissing and sex toys.

"Explore ways to have sexual intimacy with her that does not involve vaginal penetration; relax her and provide her with nurturing," Lawless said. "After all, you would appreciate the same support if you struggled with erectile dysfunction, because that is what a loving partner does."

Endometriosis is often diagnosed through surgery, and during that diagnostic surgery, physicians can also remove the endometrium-like tissue causing painful intercourse and any other symptoms.

"If deep dyspareunia is due to endometriosis, the gold standard to determine if this is present is laparoscopic surgery, as there is no single test, nor any combination of tests, that will rule out all types of endometriosis," Jeffcoat said.

Even after laparoscopic surgery, however, it's important to know that endometriosis can return, and with it your partner's dyspareunia.

Fact #3

Dyspareunia may not happen every time the woman has sex

As discussed above, dyspareunia can be the result of many different root factors, and because of this, the condition tends to flare up depending on those factors.

"Vaginal lubrication can fluctuate, and with this, the dyspareunia may occur occasionally," Swarup said. "In the case of endometriosis-related deep pain, there would likely be more pain at certain times of the cycle and with certain positions."

If your partner's dyspareunia fluctuates with their cycle, ask them about it. Understand what times of the month are OK for penetrative sex and when you'll need to be a little more creative.

If your partner's dyspareunia is triggered by emotional issues, then it's up to you to be supportive of their mental health and understand when her emotional state is not conducive to sex.

"The most important thing to understand about dyspareunia is that it is not a woman's fault that she is experiencing pain, nor is it because she is simply uninterested in sex or her partner," Lawless said. "It is essential to be aware of pain during intercourse, as well as the stress and anxiety anticipating the pain can cause. While a physical condition may cause it, it encompasses mental and emotional aspects that should also be addressed."

Fact #4

The condition is usually treatable

Depending on the cause of your partner's dyspareunia, the symptoms are often treatable. It can take time to find the best course of treatment, and those treatments may fluctuate in effectiveness.

"It can take time to determine a cause and treat dyspareunia, so both partners need to be patient and supportive of one another to maintain intimacy," Lawless said.

Discovering the root cause of the condition and treating it effectively may be a lengthy process. Your patience is paramount during this time.

"Treatments include practicing patience and being open to trying treatment solutions," Swarup said.

These treatments include the following:

• Water-based lubricants, because dryness can occur when there is anxiety about intercourse, causing deep pain and, therefore, less natural lubrication
• Medications for dryness due to menopause
• Sexual therapy
• Pelvic floor therapy
• Treatments for suppressing the endometriosis implants, such as progesterone, birth control pills, certain intrauterine devices (IUDs) or medications that can alter or suppress ovulation

If your partner is open to it, go to appointments with them and continue to educate yourself about the condition and the various treatments. This level of support can make them feel less pressured to constantly explain the pain they are experiencing.

"This treatment plan should include a great deal of ongoing education regarding why specific treatments are chosen to be a part of recovery or why certain providers are recommended to be a part of [the] care team," Jeffcoat said.

Supporting your partner

No matter the cause of your partner's dyspareunia, being supportive and taking the pressure off of penetrative sex can make a big difference in her self-esteem and stress level.

"It is vital to listen to one another without judgment and show one another compassion, as both partners may worry that this is a negative reflection of how their partner feels about them and make them feel incredibly vulnerable," Lawless said. "As a male, remember that it is not just her problem."

If your partner doesn't have a regular physician or is looking for a new one for any reason, Giddy telehealth takes the difficulty out of such a search. It provides access to hundreds of healthcare professionals who offer video visits as a regular part of their practices. An easy-to-use online portal, Giddy telehealth's physicians, therapists and others have expertise across the full scope of medical care, including women's issues, and many have same-day appointments.