Painful Intercourse: dyspareunia

Painful intercourse is described as pain with initial penetration, deep penetration, thrusting, and lack of lubrication. This may be due to muscle tenderness, scarring/adhesions in and around vagina or skin irritation.

It is common following vaginal child birth with tearing/cutting of tissue along the vaginal vault, which may heal with adhesions/scarring. Women expect pain immediately following childbirth, however often pain persists for many weeks, months, or years after delivery. Often times, patients who have been in pain for a number of weeks begin unconsciously holding parts of their body in a tense position to protect themselves from further pain. Maintaining these positions contribute to weakness and painful muscles, strained joints and compressed nerves that further add to the condition.


The Physical Therapists at Midwest Physical Therapy Services are experienced in dealing with intercourse pain and will provide a thorough evaluation, followed by treatments which may consist of some of the following

  • Manual therapy techniques for tight or tense muscles
  • Scar massage to adhesions that may be located around or inside vagina following surgery or vaginal childbirth with tearing/episiotomy
  • Electrical stimulation, TENS (Transcutaneous electrical nerve stimulation), heat, cold laser or ultrasound for pain relief to tissues
  • Exercises designed specifically to address involved muscles
  • Instruction in use of a dilator for stretching and motor retraining
  • Teaching patients to change poor habits such as muscle holding patterns in a tense position
  • Suggestions for positioning during intercourse to minimize stress to tissues involved
  • RUSI (rehabilitative ultrasound imaging)
  • Relaxation techniques