Dyspareunia (Painful Sex) Physiotherapy in Clapham

Dyspareunia feels different for everyone. You might notice:

• Pain at the entrance to the vagina when trying to have sex or insert a tampon
• Burning, stinging or rawness during or after sex
• A deep ache in the pelvis or lower tummy during penetration
• Pain or soreness that lasts after sex
• Reduced sensation, or difficulty becoming aroused or reaching orgasm
• Tensing up in anticipation of pain

Pain during sex is common, but it isn’t something you have to put up with.

Superficial dyspareunia

Pain at or near the entrance to the vagina, often felt as burning, stinging or tightness on penetration. It’s commonly linked to a tight pelvic floor, vaginal dryness, skin sensitivity, scar tissue after birth or vaginismus. Ongoing burning pain at the entrance can also be a sign of vulvodynia (provoked vestibulodynia).

Deep dyspareunia

Pain felt deeper in the pelvis with deeper penetration. It can be linked to pelvic floor tension, endometriosis, adenomyosis, pelvic infection or other pelvic conditions, so it’s important to have it properly assessed.

Primary and secondary dyspareunia

Some women have always found sex painful (primary), while for others pain starts after a time without problems (secondary), for example after childbirth, surgery or menopause.

There’s often more than one cause, and physical and emotional factors can feed into each other.

A tight pelvic floor

An overactive pelvic floor that struggles to relax is one of the most common causes, and one physiotherapy can treat directly. Tension can also irritate nearby nerves and affect sensation.

After childbirth

Perineal tears, stitches, scar tissue and lower oestrogen while breastfeeding can all make sex painful after birth. Postnatal physiotherapy can help when you’re ready.

Perimenopause and menopause

Falling oestrogen can make the vaginal tissues thinner and drier, known as genitourinary syndrome of menopause (GSM). Find out about menopause physiotherapy.

After surgery

Scar tissue or changes to the vagina after surgery, such as a hysterectomy, can cause discomfort.

Infections and skin conditions

Thrush, sexually transmitted infections and vulval skin conditions can all cause pain, so it’s worth ruling these out with your GP or a sexual health clinic.

Anxiety and past experiences

Expecting pain makes the pelvic floor tense up, which in turn causes more pain. Breaking this cycle is a key part of treatment.

Physiotherapy focuses on the muscles, tissues and nerves involved in painful sex, and on helping your body feel safe with touch again. Everything happens at your pace. Your plan may include:

• Pelvic floor relaxation: breathing and down-training techniques to help the pelvic floor let go
• Manual therapy: gentle myofascial release and scar tissue work, only with your consent
• Desensitisation: graded techniques, sometimes using vaginal dilators, to reduce sensitivity
• Practical advice: lubricants, positions and pacing to make sex more comfortable while you recover
• Understanding your pain: how pain and the pelvic floor interact, which often eases anxiety on its own

Many women find sex uncomfortable at first after having a baby, whether they had a vaginal birth or a caesarean.

When can I have sex again?

There’s no set time. Many women wait until after their six-week check, and it’s fine to wait longer until you feel physically and emotionally ready.

Why it can hurt

Healing tears or stitches, scar tissue, a tight or weak pelvic floor and vaginal dryness from lower oestrogen, especially while breastfeeding, are all common causes.

What helps

Plenty of lubricant, taking things slowly and positions where you control depth and pace can all help. If pain continues beyond the first few weeks of trying, a pelvic floor assessment is worthwhile.

Talking about painful sex can feel difficult, so we keep things relaxed and private. Your first appointment lasts 60 minutes at our Clapham clinic. Olivia will:

• Talk through your symptoms, history and goals, sharing only what you’re comfortable with
• Explain how the pelvic floor can contribute to pain
• Discuss whether an examination would be helpful. An internal examination is always optional, and it’s your choice whether and when to have one
• Agree a plan with you, so you know what to expect next

You’re in control throughout, and you can pause or stop at any time.

Many women notice less pain and tension within the first few weeks. Longstanding pain, or pain with several contributing causes, can take a few months to settle, and Olivia will review your progress at each appointment.

See your GP or a sexual health clinic if you have unusual discharge, bleeding after sex or between periods, itching or sores, pelvic pain with a fever, or if you might have a sexually transmitted infection. Deep pain during sex can also be a sign of conditions such as endometriosis that need medical assessment. Olivia will refer you on if anything in your assessment needs review.