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How to Treat Dyspareunia or Painful Sex

Kim Vopni August 2022

Pelvic Floor: Kim Vopni

Painful sex, before, during or after intercourse (Dyspareunia) can happen for women at some point in their lives.

It is a frequent problem for women in the menopause transition.  

“Dyspareunia is associated with sharp or intense pain in the vagina while having sex.”


20 to 30 percent of postmenopausal women surveyed, not on hormone therapy, report dyspareunia. Dyspareunia is associated with sharp or intense pain in the vagina while having sex. It may cause women to experience severe or acute pain and can happen during intercourse and possibly before or after. For some women, dyspareunia is temporary. For others, it can become chronic.

During menopause, painful sex can be linked to a decrease in estrogen levels. Losing estrogen can cause urinary problems, and changes to the tissues in the wall of the vagina that can contribute to discomfort with sex; however, lack of sexual activity itself also contributes to loss of tissue health and elasticity. The vaginal tissues become less elastic, more fragile, and more susceptible to bleeding, tearing, or pain. There are treatment option so keep reading.

Other Factors:

Other factors are sometimes at play, including injury or trauma, childbirth, pelvic surgery, organ prolapse, or overactive pelvic floor muscles. Skin conditions like eczema, lichen sclerosus, or an infection in your genital area or urinary tract also can cause sex to be painful.

Certain medications, such as antidepressants and high blood pressure drugs, can contribute to vaginal dryness. In addition, stress, fear of intimacy, and concerns about body image or relationship difficulties can make pleasurable sex more challenging.

Pain associated with deep penetration or certain positions may cause inadequate relaxation of pelvic muscles or conditions that affect the pelvic area, such as endometriosis, and uterine fibroids. Scarring from pelvic surgery or treatments such as pelvic radiation can also cause changes that can make sex painful.

“Many women with painful sex do not require medical treatment.”

Painful Sex Treatment:

Many women with painful sex do not require medical treatment. If sex hurts, especially if it hurts to the point that you are avoiding it or want to stop, it’s time to find a pelvic floor physical therapist and get help.

They may ask when your pain began, where it hurts, and if it happens every time, you have sex. They may ask about your history of surgery, childbirth, and sexual relationships. Moreover, they can also help screen for skin conditions and know when to refer you on to medical treatment. Pelvic floor physical therapists help overactive muscles relax to ensure optimal blood flow and circulation. They can also ensure the muscles have balanced tone.

Relieve Discomfort Of Dyspareunia:

Lubricants and Moisturizers:

Vaginal lubricants can help decrease pain during sex and can be applied as often as needed. Vaginal moisturizers that contain hyaluronic acid can help maintain vaginal moisture and even heal already dry irritated tissue. Moisturizers are not to be used in place of a lubricant but rather used at night before bed.  Lubricants are used during intimate activities.

“Pelvic muscle training can also ensure the balance between strength and suppleness remains optimal.”


Vaginal estrogen is considered the gold standard and can relieve discomfort and help improve the condition of the vaginal tissues. There are different forms such as creams, pellets, and a ring that delivers the estrogen over a period of time. Your doctor or naturopath can help you decide which option is best for you. It is also recommended to read the book The Estrogen Fix and Estrogen Matters to help understand the confusion surrounding hormone therapy.

Pelvic Floor Exercises:

Daily exercise to strengthen the pelvic floor muscles can also help with blood flow and circulation. Pelvic muscle training can also ensure the balance between strength and suppleness remains optimal.

Incorporating kegels into whole body movement trains the pelvic floor dynamically and is more functional. You can also incorporate pelvic floor relaxation techniques during the day and before intimate activities to release any stuck tension that may be contributing to pain.

Bottom line, pelvic pain and painful sex are treatable. Get help and end your suffering.

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Kim Vopni

About the Author:

Kim Vopni is a self professed pelvic health evangelist and is known as The Vagina Coach. She has a BA in Psychology and a postgraduate certificate in Health and Fitness. She is a certified fitness professional who became passionate about spreading information on pelvic health when she was pregnant with her first child. 

Kim is the founder of Pelvienne Wellness Inc – a company offering pelvic health programs products and coaching for women in pregnancy, motherhood and menopause. She is also the creator of the Ab System – a revolutionary birth prep and recovery system for pregnant women.  Kim certifies other fitness and movement professionals to work with women with core and pelvic floor challenges through her Core Confidence Specialist Certification and Pre/Postnatal Fitness Specialist Certification. You can find her on-line at www.vaginacoach.com and on social media @vaginacoach