Painful intercourse affects intimacy more than we admit.
Intimacy is a state of warmth and closeness that is both emotional and physical. Painful intercourse, known clinically as dyspareunia, can affect this on both fronts, and while it can occur in men, it is most common in women. When it persists, it often leads to relationship strain, loss of intimacy, distress, and poor body image. In a culture saturated with images and social media, many women hesitate to acknowledge or discuss the problem at all, either blaming themselves or simply ignoring it.
What causes painful intercourse.
Dyspareunia can stem from physical causes, psychological causes, or a combination of both, and physical causes are the most common. Where the pain is located often points to whether the problem is structural, inflammatory, hormonal, or some mix of the three. Examples include pain with penetration (vaginismus, vaginal dryness, genital injuries, or after pelvic floor surgery), inflammation or infection (vulvodynia, yeast infections, urinary tract infections, or STIs), and hormonal changes that cause skin thinning or lacerations. Certain medical conditions can also cause painful intercourse and need to be addressed directly, including interstitial cystitis, endometriosis, fibroids, irritable bowel syndrome, uterine prolapse, and ovarian cysts.
The mind and body are connected.
Psychological causes can be just as significant, particularly when there is a lack of understanding or communication between partners. These can include a history of sexual abuse or trauma, elevated stress, anxiety, and depression. Stress and anxiety can affect the pelvic floor directly by tightening its muscles and disrupting the natural breathing-pelvic floor pattern. Painful intercourse is often accompanied by other pelvic floor symptoms, including urinary issues, low back or hip pain, painful periods, or GI problems, and many people do not realize these separate-seeming issues share the same underlying cause.
Steps toward improving intimacy.
Improving intimacy starts with both partners being open to treatment, ideally guided by medical professionals trained to properly diagnose and treat these issues. Once any underlying medical conditions are addressed, a few strategies can help: pelvic floor exercises (with dyspareunia, Kegels should focus on relaxing and lengthening the pelvic floor as much as contracting it), squats and bridges to build the hip, back, and pelvic floor strength and mobility needed for pain-free intimacy, diaphragmatic breathing coordinated with pelvic floor contraction and relaxation to increase blood flow, a water-based lubricant for dryness, longer foreplay to help the body and mind get in tune, open communication between partners, and choosing positions that minimize pain.