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It's been said before, and it should be emphasized again for good measure: Sex should not be painful in any way, shape, or form. If you are experiencing significant discomfort or an inability to have penetrative sex with a partner, there may be something going on that needs medical attention.
"The most common misconception about pain with sex is that people have to live with it, but thankfully they don’t have to because there are many different treatment options," says Dorothy Bestoyong, DO, an OB/GYN practicing in Orlando, Florida. "It can be such a taboo topic to bring up, even to your closest friends. But there’s no such thing as TMI when it comes to something like painful sex!"
Still, it can be overwhelming to wade through all the information about possible conditions related to painful sex. Is it vaginismus, dyspareunia, or another potential cause? Keep reading as we break down the differences between vaginismus and dyspareunia and walk you through the diagnosis and treatment options for both. If you’re dealing with either of these conditions, we promise there is help up ahead!
How do I know if I have vaginismus? What about dyspareunia?
First, let’s define vaginismus: It is a condition that occurs when muscles around the vagina contract or spasm involuntarily, which can make inserting anything (even a tampon or menstrual cup) painful or even impossible, explains Marcy Crouch, PT, DPT, WCS and Founder & CEO of The Down There Doc™️. There’s not a designated cause of vaginismus, but some factors can be related to sexual trauma, anxiety, or physical complications from pelvic surgery or childbirth.
Dyspareunia, on the other hand, is the medical term for painful penetrative sex. It is not necessarily a condition, but rather, it could be a symptom of a condition like vaginismus. “Dyspareunia can happen for a bunch of reasons — everything from hormonal changes, infections, or even psychological factors,” say Dr. Crouch. "Both vaginismus and dyspareunia require time and attention from an OB/GYN or pelvic floor specialist to diagnose and treat."
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So, how can you distinguish between vaginismus and dyspareunia?
Vaginismus can involve anxiety and trauma, so it involves your mental health in that regard, but it is not just in your head, Dr. Crouch clarifies. “It’s a physical condition where your pelvic floor muscles are reacting involuntarily,” she says. This is not the same as low libido, either. It’s just that sex can be painful.
“Some signs of vaginismus include painful insertion of tampons, sex toys, or pain during an attempt at penetrative intercourse,” says Dr. Bestoyong. And it’s not just menstrual and sex-related pain: You may also experience pain and difficulty during pelvic exams at your OB/GYN’s office (one more reason why you should talk over your symptoms with your doctor, so that they can approach your annual appointment more sensitively).
While it's true that vaginismus can cause dyspareunia, it is not the only cause. Dyspareunia may vary from person to person, in that it can be experienced as pain upon initial penetration, or it can involve pain with deeper penetration. Like vaginismus, this pain response is not the equivalent to low libido or an absence of desire to have sex.
What are the treatment options for vaginismus?
The process for treating vaginismus might start in your OB/GYN’s office or preferred sexual health clinic. If you’re experiencing painful sex (or painful insertion of tampons, etc.), it’s important to share that with a healthcare provider that you trust. An OB/GYN can pay specific attention to your medical history and will try to rule out certain issues before referring you to a pelvic floor physical therapist.
If your diagnosis is vaginismus, it will involve both mental and physical treatment, according to Dr. Crouch. “The physical side involves exercises to relax and stretch the pelvic floor muscles, like using dilators and pelvic floor physical therapy,” she explains. “On the mental side, therapy is super important to work through any fears, anxiety, beliefs, or trauma that might be contributing to the muscle spasms.” Some specific methods might be Cognitive Behavioral Therapy Cognitive Behavioral Therapy (CBT) or sex therapy to address the thoughts and beliefs around past life events or any pain that may be contributing to your physical condition.
How is dyspareunia diagnosed and treated?
Dyspareunia involves a similar diagnostic process: "An OB/GYN can perform a pelvic exam if that is comfortable for you and will take a pain history to figure out where and when you experience painful sex," explains Dr. Bestoyong. "The doctor can also do an ultrasound to examine causes of dyspareunia," she adds. Your medical provider may then refer you to a pelvic floor physical therapist for further treatment (many states and insurance providers require an OB/GYN referral to get pelvic floor physical therapy, according to the American Physical Therapy Association).
Because dyspareunia can be a symptom of many different conditions, including menopause, a pelvic floor PT will do a thorough assessment that involves taking your medical history, sexual history, and details about your level of pain, explains Dr. Crouch. Note that a pelvic exam does *not* have to be involved. “A physical exam can help rule out infections or skin conditions, but it is important to note that if physical exams are too traumatic for you, you have the option to not consent to this,” says Dr. Crouch. “In pelvic floor physical therapy we are able to assess the tension/spasm in the muscles without the need for an internal assessment on the first visit.”
The next step before setting specific goals for your treatment plan is determining the root cause of the pain: It could be muscular, nerve-related, or skeletal, according to Dr. Crouch. Painful sex due to vaginismus, a muscular issue, is often treated with muscle relaxation, while pain due to vaginal dryness from menopause, a hormonal issue, might be treated by estrogen or other hormonal treatments, she explains.
It is only once you advocate for yourself and the pain you’ve been experiencing that you can get to the bottom of what’s causing your pelvic discomfort or painful penetration. From there, it’s up to your healthcare provider or a pelvic floor therapist to come up with a thoughtful, tailored treatment plan to address the main cause of either vaginismus or dyspareunia, and not just the symptoms you’re experiencing. Here's to more enjoyable sex in your future!
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.