For many years women were told that painful intercourse (dyspareunia) was the result of an emotional problem and healthcare providers did not even look for other causes. Now it has become more acceptable to discuss, not only with friends and partners, but also with professionals. Even so, the vast majority women are not properly evaluated, don't get an appropriate diagnosis, don't have a comprehensive treatment plan, or don't get enough time with their provider to execute a treatment plan adequately.  

Some studies say that up to 53% of women have pain during intercourse at least once in their lives. So when does this become a problem you should discuss with a healthcare professional? When almost every sexual encounter with attempted vaginal penetration is painful for six months or longer.  

Pain can primarily be on the external anatomy (vulva) and at the entrance (vestibule), or deeper in the pelvis with deep pressure against the cervix, often call collisional pain (provoked by collision between the penis and the cervix).  The duration symptoms have been present, location, and nature of the pain are all important in identifying the causes of the pain.

Some women have experienced pain with intercourse from their very first attempt. For other women it starts after an injury or infection, after cancer treatments involving genital surgery or radiation, with breast cancer treatment, and other times the cause is never found.

Visual examination of the vulva may reveal the cause of pain and can include lesions, skin disease, vaginal atrophy or vulvovaginal infections. An internal pelvic exam may also reveal physical reasons for pain including anatomical variations or lesions on the cervix. Often there is an initial cause for the pain which leads to a woman tensing her pelvic floor muscles, which then creates a secondary pain which can last longer than the original cause. 

The experience of painful sex varies from woman to woman, it can be a mild distraction from feeling pleasure, or it can be so intense that she stops trying altogether. This is an isolating experience and often results in the distancing of relationships and can even cause the end of a relationship. Women experience low self esteem and negative self talk related to their inability to have sexual intimacy with a partner.

Some of the potential causes of sexual pain are relatively easily identified and treated, and rarely there can be something more serious. For that reason, it is important that all participants in this program are up to date on well woman exams, have discussed their pain with a healthcare professional and have either found no cause or an inadequate solution.