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Nurturing Intimacy: Overcoming Challenges for a Pleasurable Sex Life

Nurturing Intimacy: Overcoming Challenges for a Pleasurable Sex Life

Do I have to do something?

Dyspareunia – a word little known to people but unfortunately it is an affliction which affects more and more of us. It is a sexual dysfunction manifested in pain during intercourse without accompanying contraction of the vulva and vagina. Pain may be felt during intercourse or just after penetration.

A woman who has such symptoms often does not know who to turn to for help, and can often ignore her health for a long time, as many young patients are convinced that the pain will pass over time. There are erroneous stereotypes and beliefs that maybe sex should be like this and you have to “suffer”. Due to the re-occurring ailments, she withdraws from relationships that may lead to  intercourse and the patient often does not know what to do next to improve her sexual comfort. A qualified physiotherapist is able to help her. What we need is more awareness among women about what is the norm, and what should be worked on to improve their sex life.

What is it?

Based on where the pain occurs, there are three types of dyspareunia which can be classified:

  • shallow dyspareunia – This is where the pain is localized at the entrance of the vaginal entrance
  • deep dyspareunia – This is where the pain is within the vagina.
  • generalized dyspareunia – pain when the whole vagina and pelvic region is sore.

Pain may occur in women from their first sexual experience (primary dyspareunia), or may appear in the later stages of sexual life (secondary dyspareunia). Secondary dysplasia may appear postnatally, when a partner changes or because of other medical conditions such as endometriosis. The division also takes into account whether the symptoms appeared intercourse has started, then resolved once stopped and whether the pain lasts for up to several hours. If the occurrence of pain depends on the woman’s menstrual cycle which usually occurs in the bleeding phase of the menstrual cycle. Dyspareunia may also depend on the position in which sexual intercourse takes place and whether a position change alleviate symptoms. This gives further information to the physiotherapist, where the cause of the discomfort may be and what structures should be worked with.

What does the examination look like?

An examination by a physiotherapist may include an assessment of the anterior abdominal cavity, lumbar spine, as well as transvaginal or rectal palpation. An Abdominal examination will allow them to see if there are scars that can cause intra-tissue adhesions and problems at deeper stages. The physiotherapist can also see stretch marks, bumps, hernias, rectus abdominis or a shift in the white border.

Any tenderness of some areas in the lower abdomen can be felt in the examination. During transvaginal examination, the vaginal walls, color, hardness, presence of nodules, and edema are examined. It should be remembered that in a female patient who has a dyspareunia problem, pain may significantly impede the performance of the examination or prevent it from being completed time. However you will still be able to help the patient.

Or maybe answer is much simpler learning how to properly relax the pelvic floor muscles is enough to help?


  1. Szostek, N, Wiedza, postawa oraz rola fizjoterapeuty w terapii kobiet z dyspareunią, 2019
  2. Avellanet, Y.R., et al., Dyspareunia in Puerto Rican middle-aged women. Menopause (New York, N.Y.), 2009. 16(4): p. 742-747.
  3. Basta, A., et al., The statement of Polish Society’s Experts Group concerning diagnostics and methods of endometriosis treatment. Ginekol Pol, 2012. 83(11): p. 871-6.
  4. Kao, A., et al., Dyspareunia in postmenopausal women: a critical review. Pain Res Manag, 2008. 13(3): p. 243-54.
  5. Wurn, B.F., et al., Decreasing Dyspareunia and Dysmenorrhea in Women with Endometriosis via a Manual Physical Therapy: Results from Two Independent Studies. Journal of Endometriosis and Pelvic Pain Disorders, 2011. 3(4): p. 188-196.
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