Medicines for Painful sex

What it is

Dyspareunia means persistent or recurrent pain during or after sex. It is common, can affect people at any age, and — importantly — usually has a treatable cause, so it is worth seeking help rather than putting up with it. The pain can be felt at the entrance to the vagina (superficial) or deeper inside (deep), and the location can give clues to the cause. There are many possible causes. Superficial pain can result from vaginal dryness (for example around the menopause or while breastfeeding), infections (such as thrush or STIs), skin conditions of the vulva, an involuntary tightening of the vaginal muscles (vaginismus), or after childbirth. Deeper pain can be linked to conditions such as endometriosis, fibroids, pelvic infection, ovarian cysts, or bladder or bowel conditions. Psychological factors — such as anxiety, previous painful experiences, relationship issues, or a history of trauma — can also contribute, often alongside physical factors. It can affect wellbeing and relationships, and a supportive approach helps.

How it is treated

Assessment aims to identify the cause (or causes), which guides treatment — a doctor will ask sensitively about the pain (where, when, how long), and examine and investigate as appropriate. Treatment then addresses the cause: for example, vaginal moisturisers, lubricants, or hormonal treatment for dryness (especially around the menopause); treating any infection or skin condition; managing conditions such as endometriosis for deeper pain; and physiotherapy, relaxation techniques and, where relevant, psychosexual therapy for muscle tightness or where psychological factors are involved. Often a combination of approaches helps. Because physical and emotional factors frequently interact, a holistic, unhurried and non-judgemental approach works best, sometimes involving different specialists. Open communication with a partner can help. The reassuring message is that painful sex is common, usually has a treatable cause, and help is available — so it is worth talking to a health professional.