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Painful intercourse or dyspareunia occurs in many women at some point in their lives.
It is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Talk to your doctor if you’re experiencing painful intercourse. Treatments focus on the underlying cause which can be physical or psychological

Do you experience Painful Intercourse and/ or other Pelvic Pain that causes significant distress?

You have two options:

*See your GP for a check- up.
**Then depending on the outcome, ask your GP for a Referral Letter to Dr Miller for a more thorough review that could involve more comprehensive blood tests and ultrasound scans.

Possible Causes

  • Insufficient lubrication
  • Not enough foreplay
  • Drop in oestrogen levels after menopause, after childbirth or during breast-feeding
  • Certain medications inhibit desire or arousal such as antidepressants, high blood pressure
  • medications, sedatives, antihistamines and certain birth control pills.
  • Injury, trauma or irritation.
  • Injury or irritation from an accident, pelvic surgery, female circumcision, episiotomy or a congenital
  • abnormality.
  • Inflammation, infection or skin disorder can cause a superficial pain at the beginning of the
  • intercourse
  • Vaginismus
  • Involuntary spasms of the muscles of the vaginal wall which often can be a protective measure to
  • avoid pain
  • Deep pain
  • Occurs with deep penetration and may be more pronounced with certain positions.
  • Pathological causes
  • Such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, cystitis,
  • irritable bowel syndrome and ovarian cysts.
  • Surgeries or medical treatments.
  • Scarring from surgeries that involve your pelvic area, including hysterectomy, can sometimes
  • cause painful intercourse. In addition, medical treatments for cancer, such as radiation and
  • chemotherapy, can cause changes that make sex painful.
  • Emotional factors, sexual abuse and psychological problems.
  • Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship
  • problems can contribute to a low level of arousal and a resulting discomfort or pain.
  • Stress
  • Pelvic floor muscles tend to tighten in response to stress in life. This can contribute to pain.

Tests and diagnosis

A thorough Medical history, pelvic examination, vaginal swabs, pap smear and pelvic ultrasound +/- colposcopy will enable us to identify possible cause.



  • Medications: Oestrogen cream, ordinary vegetable oil is the best lubricant (most other lubricants have alcohol/preservatives which may act as an irritant)
  • Therapy: Desensitization therapy + counselling or sex therapy
  • Drugs:Depending on the underlying problem antibiotics, oral endep, Amitriptilin 2% cream vaginally or some anti-epileptic drugs may be used.
  • LASER: a non-invasive treatment for reshaping and revitalizing of scar tissue and atrophic mucosa of the vagina.
  • Platelet Rich Plasma (PRP): a non-invasive treatment for reshaping and revitalizing of scar tissue and atrophic mucosa of the vagina.
  • Combination of LASER and PRP.


  • Reversal of the scar
  • Laparoscopy: excision of endometriosis, removal of ovarian cyst, adhesiolysis, removal of the fibroids, etc.

Some tips and home remedies

  • Switch positions: changing positions may help. Being on top of your partner during intercourse may regulate penetration to a depth that feels good to you.
  • Communicate: what feels good and what doesn’t? If you need your partner to go slow, say so.
  • Don’t rush: longer foreplay stimulates your natural lubrication delaying penetration until you are aroused.
  • Use lubricants: olive oil and vegetable oil are most effective, cheap and readily available (plus, they have the added benefit of being common household products)

Some common causes of Dyspeurunia are:

  • Hormonal factors associated with Perimenopause and Menopause.
  • Stress factors, including work or relationship issues.
  • Previous traumatic birth or pelvic injury.
  • Various infections including urinary tract and yeast/ fungal.

Some key Period problems are:

  • Irregular cycles.
  • Painful cramps for first days or even in a daze just prior to the start of the menstrual bleed.
  • Pain in pelvic area restricting the use of tampons.
  • Heavy bleeding with or without Anaemia.
  • Excessive and / or prolonged bleeding, possibly involving many (large) clots.
  • Migraines.
  • Spotting in between periods.