Pain during intercourse is a topic that still rarely breaks into the public debate on health. As shown in the latest analyses published in the Journal of Clinical Medicine, dyspareunia affects up to 1 in 5 women. It is a medical problem, but also a social one, associated with shame and insufficient systemic support. In practice, this means that one of the most common sexual dysfunctions remains at the same time one of the least frequently diagnosed.
Pain experienced during intercourse
Dyspareunia, or pain experienced during intercourse, is a complex condition that is difficult to reduce to a single cause. It may result from somatic diseases such as endometriosis, pelvic inflammatory conditions, or hormonal deficiencies, but psychological and social factors are equally important.
As emphasized by Dr. hab. Marek Murawski from the Department of Operative Gynecology and Oncology at the Wroclaw Medical University:
This condition is a complex state involving biological, psychological, and social factors.
It is precisely this multidimensionality that makes dyspareunia often escape simple diagnostic frameworks.
Shame as a diagnostic barrier
The scale of the problem is greater than it might seem. It is estimated that symptoms of dyspareunia may be experienced by around 20% of women, yet only some of them report this issue to a doctor.
Despite the fact that dyspareunia can have a significant impact on women’s intimate relationships, it is still, in many cases, treated as a taboo subject.
It is shame and the lack of open communication that become one of the main causes of delayed diagnosis. As a result, many patients function for years with pain that, although real and burdensome, remains invisible to the healthcare system.
One of the key problems is the way dyspareunia is diagnosed. In clinical practice, a biomedical approach often dominates, focused on the body and possible physical causes. Meanwhile, as noted by Dr. hab. Marek Murawski:
It is not uncommon to observe doctors focusing exclusively on the biomedical approach, completely overlooking the functional and psychological aspects.
This limitation may lead to situations in which a diagnosis is formally made, but the actual cause of the problem remains unidentified.
The key role of the doctor–patient relationship
In the case of dyspareunia, something that is often treated as obvious in medicine becomes particularly important: conversation.
A detailed medical history, including psychological and sexological aspects, seems to be a key element enabling correct diagnosis, emphasizes Dr. hab. Marek Murawski
It is precisely the quality of the doctor–patient relationship that determines whether a patient will decide to talk about her symptoms at all, and thus whether it will be possible to begin treatment.
Since the causes are multidimensional, the treatment must be as well. In practice, this means the need for cooperation among specialists from various fields—from gynecologists to urogynecological physiotherapists, and from psychologists to sexologists.
Comprehensive therapy includes pharmacotherapy, physiotherapy, sexual education, and psychotherapy, summarizes Dr. hab. Marek Murawski
Increasing evidence suggests that, for example, pelvic floor physiotherapy may be effective as a first-line treatment, and cognitive-behavioral therapy helps reduce anxiety associated with pain. The problem, however, lies in the availability of these forms of support, especially within the public healthcare system.
Visibility as the first step
The greatest challenge in the case of dyspareunia today is not the lack of medical knowledge, but the lack of its application in practice. The condition is described, the mechanisms are partially understood, and treatment methods are available. The problem is that they still reach too few of those who need them. Therefore, the first step toward change remains something seemingly simple: recognizing that pain during intercourse is not “normal” – and that it deserves attention, diagnosis, and treatment.
Material based on the article:
Exploring the Diagnostic and Therapeutic Pathways of Women with Dyspareunia: A Mixed-Methods Study
https://www.mdpi.com/2077-0383/15/2/787
Authors: Joanna Wojtas, Zofia Sotomska, Marek Murawski, Magdalena Emilia Grzybowska