Painful Sex (Dyspareunia): Causes and Integrative Treatment
Clinical content by Trevor Wing MBRCP FRCHM MBAcC BSc (Hons) MSc (Dist) DMed (Img). Last reviewed October 2026.
Key facts
- Pain during or after sex affects around 1 in 10 women in the UK at some point.
- Pain at the entrance and deep pain usually have different causes.
- Common causes include vaginal dryness, infection, vaginismus, endometriosis and menopause-related changes.
- Almost all causes can be treated or improved.
- Assessment at our clinic can include a pelvic ultrasound to check for conditions such as endometriosis or fibroids.
What is dyspareunia?
Dyspareunia is pain during or after sex. It is common, can happen at any age and is often hard to talk about. It is not something you have to put up with, and finding the cause is the first step to effective treatment.
What causes painful sex?
Pain at the vaginal entrance (superficial dyspareunia) may be caused by:
- Vaginal dryness, from low oestrogen after childbirth, during breastfeeding or around the menopause, or from some medicines
- Infections such as thrush or sexually transmitted infections
- Skin conditions of the vulva, such as lichen sclerosus or eczema
- Vulvodynia, ongoing vulval pain without an obvious cause
- Vaginismus, an involuntary tightening of the pelvic floor muscles
- Healing tissue after childbirth or surgery
Deep pain with penetration (deep dyspareunia) may be caused by:
- Endometriosis or adenomyosis
- Fibroids or ovarian cysts
- Pelvic inflammatory disease
- Bowel or bladder conditions such as irritable bowel syndrome or bladder pain syndrome
Emotional factors such as anxiety, past painful experiences or relationship stress can contribute to pain and are often part of the picture alongside a physical cause.
How is the cause found?
A sensitive consultation about when and where the pain happens, followed where appropriate by an examination, swabs for infection and a pelvic ultrasound. At our clinic, ultrasound on the GE Voluson S10 can look for endometriomas, fibroids, adenomyosis and ovarian cysts.
What are the conventional treatment options?
- Treating infection with the right medicine
- Vaginal moisturisers and lubricants, and vaginal oestrogen for menopause-related dryness
- Pelvic floor physiotherapy and vaginal dilators for vaginismus and muscle tension
- Treatments for skin conditions of the vulva
- Medication for nerve pain, such as amitriptyline, for vulvodynia
- Treatment of underlying conditions such as endometriosis, sometimes including surgery
- Psychosexual therapy, alone or with a partner
How do we treat painful sex at the Women’s Natural Health Clinic?
Once structural causes have been ruled out or treated, we combine approaches that address both body and mind. Your plan may include:
- Acupuncture and Chinese herbal medicine, tailored to your pattern, to ease pain and support healing.
- Gentle vaginal dilator and relaxation exercises to help muscles and mind become more comfortable with penetration.
- Topical vaginal moisturisers and gels suited to sensitive tissue.
We find that combining these approaches tends to give the best results, and we will review progress with you regularly.
Frequently asked questions
Is it normal for sex to hurt?
Occasional mild discomfort can happen, but sex that is regularly painful is not normal and is worth getting checked. Most causes can be treated.
Can the menopause cause painful sex?
Yes. Falling oestrogen makes the vaginal tissues thinner and drier. Vaginal moisturisers, lubricants and low-dose vaginal oestrogen can help a great deal.
Could painful sex be endometriosis?
Deep pain during sex is a common symptom of endometriosis, especially if you also have painful periods. A transvaginal ultrasound is a good first step.
What is vaginismus?
Vaginismus is an involuntary tightening of the muscles around the vagina that makes penetration painful or impossible. It responds well to pelvic floor therapy, dilators and psychosexual support.
Book a consultation
To book, book an appointment online or call 020 3811 8778. Initial consultations last up to one hour at our clinic at 16 Bridle Lane, St Margaret’s, Twickenham TW1 3EE.