Overview of sexual pain in females
This topic describes treatment of sexual pain in individuals presumed female at birth, other than those undergoing (or who have had) gender-affirming hormones or surgery; see resources on sexual health relating to gender-affirming treatment on the TransHub website.
Healthcare providers are encouraged to use a sensitive approach that avoids assumptions about gender identity, sexual orientation or sexual practices.
For guidance on healthcare issues specific to individuals of diverse sexual orientation, see A guide to sensitive care for lesbian-gay-and bisexual people attending general practice at the Rainbow Health Victoria website.
Painful sex is common; in a study of females in Australia, 20% of those surveyed experienced at least 1 month of symptoms in the previous year1 . Inadequate arousal, vulvovaginal atrophy related to menopause or provoked vulvodynia may cause pain with penetration. Vulvodynia is a chronic vulvar pain syndrome; provoked vestibulodynia (the local form of vulvodynia affecting the vaginal entrance), the most common subtype, causes a burning, stabbing or itching sensation at the vaginal entrance2 . Vaginismus, tightness in the pelvic floor surrounding the vagina, is commonly associated with vulvodynia. It is a very common cause of painful sex. The current consensus definition of vaginismus is persistent or recurrent difficulties of the female to allow vaginal entry of a penis, a finger or any object, despite the female’s expressed wish to do so3. Vaginismus may be present from an individual’s first attempts at penetrative sex or develop as a result of sexual pain. It can lead to fear of sex, involuntary pelvic floor spasm and avoidance of sex. Vaginismus can also occur independently of vulvodynia as a result of abnormal patterns of urination and defecation (eg voluntary holding because of lifestyle, occupation or habit).
Other causes of deep pain during intercourse include endometriosis, pelvic inflammatory disease, fibroids and uterine prolapse.
See Screening and assessment for sexual difficulties for advice on how to broach sexual issues and a general approach to assessing sexual difficulties.