Dyspareunia: Symptoms and Associated Conditions

In Endometriosis, Female Pelvic Pain, pelvic floor physical therapy, Pelvic Pain, Vulvodynia by Stephanie Prendergast1 Comment

By Stephanie A. Prendergast, MPT, Cofounder, PHRC Los Angeles


What is dyspareunia? A high number of people with a vagina suffer from painful versus pleasurable sex, including before, during or after sexual encounters.

Superficial dyspareunia refers to pain at the opening of the vagina, whereas deep dyspareunia refers to feelings like something is being ‘hot’ or painful, deeper inside. 

Symptoms are classified as primary when they occur before the first attempt at sexual activity, a gynecologic examination, or tampon insertion. 

Symptoms are secondary when they occur after a period of pain-free contact, with the activity in question becoming painful when it was not before. 

There is always a reason for dyspareunia, and help is available! If you are suffering from any of these symptoms a pelvic floor physical therapy examination is warranted and we are here to help. 


Conditions Associated w Dyspareunia Part 1

Vestibulodynia is a common subset of vulvodynia. Both vestibulodynia and vulvodynia can cause what is called ‘superficial’ dyspareunia, which refers to pain/burning at the opening of the vagina during attempted penetration.

Many people with vestibulodynia also have irritative bladder symptoms. The urethra is part of the vestibule and can also be painful during sex,.ometimes people feel an increase in vulvar pain and/or bladder symptoms after sexual activity.

Many people with biopsy-confirmed endometriosis report symptoms of ‘deep dyspareunia,’ which means they feel deep pelvic pain during certain or all positions, as if something is being hit. Studies show that endometrial implants can form in the rectovaginal septum which can be one reason why people feel deep dyspareunia.

People with endometriosis may also have symptoms of vestibulodynia/vulvodynia and or Interstitial cystitis/Painful bladder syndrome and may experience superficial and deep dyspareunia.

People with IC/PBS often have superficial dyspareunia but may also feel deeper pain if the bladder itself is sensitive.

Pudendal neuralgia is a condition in which burning, stabbing pain occurs in the sensory distribution of the nerve. This nerve innervates the vulva, including the clitoris, part of the urethra, the perineum, anus and the majority of the pelvic floor muscles. People will often feel pain in one or more of the territories during sexual activity, there can be superficial and deep dyspareunia.

In order to treat dyspareunia, we need to help identify the underlying causes. Pelvic floor dysfunction is common in all of these diagnoses!


Pelvic floor physical therapists are well positioned to help people find out why sex hurts and to develop a solution! 


Conditions Associated w Dyspareunia Part 2


Vulvar lichen sclerosus can result in reduced vulvar tissue integrity which can lead to pain, tearing and bleeding with sexual activity. A vulvar biopsy is required to confirm this diagnosis, medical management is required for effective treatment.

PGAD is defined as unprovoked feelings of arousal and /or pain.

The hormonal deficiencies that occur with untreated GSM will eventually cause painful sex.

Painful sex can also be a symptom of vaginal infections, it is important to get tested and treat infections if they are present.

Many disorders can cause dyspareunia, all of these conditions are treatable with the right care which almost always should include medical management and pelvic floor physical therapy!



We are excited to announce Molly will be helping PHRC open their 11th location in Columbus, OH in September of 2023. Join the waitlist and be the first to be contacted!

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

Do you enjoy or blog and want more content from PHRC? Please head over to social media!


 YouTube Channel

Twitter, Instagram, Tik Tok


Leave a Comment