Painful Intercourse

Vulvar Vestibulodynia/Vaginismus/Vulvar Vestibulitis/Penetration Dyspareunia (painful intercourse)

It is not normal to have pain with sexual intercourse. Research shows that approximately 16% of women have experienced vaginal pain at some point in their lives.1 These statistics only represent cases that were properly diagnosed and reported. Many more women struggle in silence. Some may have tried to seek help but were misdiagnosed. Others may believe that experiencing pain is a normal outcome after having a baby. Women can be dismissed when medical testing for infections (urinary, yeast, sexually transmitted) come back negative. Unfortunately, some women are told that the pain is psychological, which usually increases the distress to the woman and increases the pain experienced.

Dynia” as a medical suffix means pain. Vestibulodynia is a pain condition where the nervous system has become sensitized. The cause for the sensitization can often be pinpointed, but sometimes the reason for the onset is unclear. Sometimes the condition has been present since first vaginal awareness (primary), sometimes the onset comes after a period of pain-free penetration (secondary). Some women only experience pain with contact, but some women experience unprovoked pain as well as provoked pain.

Vestibule” means passage between the entrance and the interior of a structure. The medical community typically diagnoses the condition with a Q-tip test – touching different parts of the vulvar vestibule (the area within labia minora including the openings of urethra and vagina, bartholin’s glands and Skene’s ducts). Sensitivity is found in the area where the skin transitions from perineal skin to vaginal mucosa, and there is a cessation of sensitivity once within the vaginal canal.

Vestibulodynia is very common – it is amazing how often it is uncovered with careful, specific questioning and/or proper screening for it during a vaginal exam. Symptoms can range from pain on penetration with sexual contact, medical exams and tampon use, to pain with clothing contact, sitting, pant seam pressure, and with cycling. The intensity of pain can fluctuate due to many factors including estrogen levels, arousal level and pelvic floor tension. Common descriptions of the pain can vary from burning, stinging, raw, sharp, scratchy, and knife-like. Pelvic floor muscles spasm as a result of the pain experienced (and/or anticipated) in a protective response. The medical term for this muscle spasm is vaginismus. This muscle spasm increases the pain, and can sometimes result in a complete closure of the vaginal canal, rendering it impenetrable with most women describing it as “hitting a wall”. Loss of interest in sex as well as loss of arousal is commonly experienced. Fear and anxiety is a natural response and adds to the cycle of pain, spasm and distress. Vestibulodynia can affect a woman’s sexuality as well as the relationship she is in, or can be a barrier to begin a new relationship.

Help is available! I can help you understand the condition, all the factors involved and give you real tools to help decrease and/or eliminate your pain with vaginal penetration. My approach includes the use of surface EMG biofeedback and graduated vaginal inserts and is the same as the Multidisciplinary Vulvodynia Program at Vancouver General Hospital. It is based on the current model of pain pathophysiology and follows a progression of treatment that has been proven to help with other pain sensitization conditions. We will discuss and identify together if we think you could benefit from another health care professional that is knowledgeable about vestibulodynia.

1. Harlow BL, Stewart EG. A population-based assessment of chronic unexplained vulvar pain: Have we underestimated the prevalence of vulvodynia? Journal of the American Medical Women’s Association 2003;58:82-8.