Utilizing reduced depth of penetration during intercourse may reduce sex-related pain dramatically or barely at all, depending on the individual, but while other treatments are being considered or pursued, it is one manner in which sexual activities can be maintained while minimizing dyspareunia-related pain.

An example of a position that results in maximum (deepest) penetration is when a woman lies on her back (in the missionary position) with her legs pulled up to her torso. In this position, a male partner will be penetrating as deeply as possible (and therefore making contact with the most tissue on the inside of the vagina). In some cases, this may result in maximized dyspareunia-related pain.

An example of a position that would result in reduced or minimal penetration would be a woman still lying on her back, but with the man’s legs straddling hers on the outside (her legs are therefore quite close together). In this position, a greater proportion of the penis will remain outside the vagina and less inner vaginal tissue will experience intercourse-related contact. In some cases, this is an effective way of managing dyspareunia.

As well, if dyspareunia is affecting your sex life and/or relationship, and you are finding that pain is in fact reduced when the depth of penetration is reduced, it may also be a good idea to experiment with positions that work for you and result in a manageable degree of penetration.

This condition arises when nerves send a signal for vulvar pain, but then the signal does not stop when it should. As a result, vulvar pain becomes the norm, or certainly more frequent and prevalent than it should be, with pain signals being sent in the absence of stimuli that would normally be required for such a negative sensation.

Vulvar Vestibulitis (known sometimes as “V.V.”) can exist concurrently with vulvodynia and/or vaginismus, and can also be a cause of the latter condition.

Indeed, Vulvar Vestibulitis is sometimes considered a highly specific form of the vulvar pain syndrome vulvodynia.

This is a term that is sometimes (erroneously) used interchangeably with vaginismus, dyspareunia, and vulvar vestibulitis – sometimes even by medical professionals!

Vulvodynia specifically refers to pain around the vulva (the highly innervated external female genital organs). Roughly speaking, it’s what you are able to see from the outside. Vulvar Vestibulitis, on the other hand, refers specifically to chronic pain at the vestibule (entrance) of the vagina.

It may not come as a surprise that vulvodynia can cause vaginismus. The pain associated with having the vagina entered can cause the body to develop a tightening reflex that creates a vicious cycle.

Dyspareunia can result in reduced frequency of sexual activity, and this can result in other problems arising in the relationship.

Especially since dyspareunia and sexual issues can be difficult to talk about, even between romantic partners, one partner may not know or understand precisely why the sexual relationship is the way it is. Even if a partner is aware that the other suffers from dyspareunia, it may be difficult to empathize or fully understand the other’s position.

The self-esteem or sexual confidence of one or both partners may be affected. As such, it is important to find a forum in which these issues can be discussed and where each partner’s point of view can be presented, understood and respected. Ultimately, it should be the goal of both partners to help the other work through the emotional and physiological issues involved so that not only the sexual aspects, but the relationship as a whole, can bring the most joy possible.

One problem that may result from these cells being misplaced is pelvic pain, and this can have implications for and contribute to dyspareunia (painful intercourse).

Endometriosis does tend to occur frequently in correlation with infertility, though the two are by no means certain to coincide.

The frequency and severity of pain in women with endometriosis can vary. There may be no pain involved despite fairly significant cell displacement, and in some women, even minor cell displacement can lead to constant and debilitating pain.

Endometriosis-related pain can also occur in conjunction with dysmenorrhea (menstrual cramps of varying severity), dyschezia (pain during bowel movements), dysuria (abnormalities in frequency and urgency of urination) and adenomyosis (tumors at the endometrial opening).

Naturally, due to the anatomical differences, it tends to manifest itself differently, though it will have the potential to be just as damaging in terms of quality of life and relationship implications.

One typical pattern in men involved pain in the genitalia shortly after ejaculation. This may be caused by infections in areas such as the bladder, prostate or seminal vesicles.

Pain may also be experienced at the moment of ejaculation, rather than immediately after, and this may indicate different physical causes of the pain. Interstitial cystitis may be a cause of this pain concurrent with ejaculation. Gonorrhea can also produce this symptom.

Persistent pain in the genitals during or immediately after ejaculation can be characterized as postejaculatory pain syndrome. This can involve painful muscle spasms similar to a male version of vaginismus and can be intertwined with psychological factors such as beliefs about sex or negative / painful past experiences.

Stimulation of the genitals may itself be a painful experience in some cases. This may result from prostatitis or urethritis.

As well, in some cases men may have abnormally shaped genitals, which can make intercourse challenging or painful. In the case of Peyronie’s Disease, for example, a connective tissue disorder results in exaggerated curvature in the penis.

Brin MF and Vapnek JM presented Treatment of Vaginismus with Botulinum Toxin Injections in 1997 (Lancet 349: 252-253).

Since this publication, there has been a significant amount of promising research and practical application of the technique.

Shirin Ghazizadeh MD and Masoomeh Nikzad MD outlined one such study in Botulinum Toxin in the Treatment of Refractory Vaginismus, found in Obstetrics and Gynecology 104, 922-925. The results in the sample size were quite positive with respect to the efficacy of Botox treatment (in this case, the sub-type Dysport).

Furthermore, Botox was found to be effective when tested against a placebo (salt water believed by the patient to be Botox) in a 2000 study by Shafik A.

Likewise, approaches to treatment can also be roughly categorized in this manner, based either on an approach to curing or minimizing the symptoms through treating the body or the mind.

A psychological approach to treatment will often approach one or more of three factors in a woman’s perceptions that may be contributing to the problem:

- A belief that the act of sex is either wrong or shameful
- Fear of painful sex
- Traumatic experiences in early childhood

Medical and psychological professionals will often be particularly attentive to the psychological aspects and possible causes of the condition when primary vaginismus is involved (the patient has never experienced vaginal penetration without pain).

It can also be important to examine some psychological conditions that may co-exist with, be correlated with, or made more severe by vaginismus. These can include depression and self-esteem issues.

A physiological or physical approach to treatment will focus specifically on the physical muscular spasms that are creating the pain.

Examples of treatment techniques include sensate focus exercises and desensitization. Botox has also been used in the treatment of vaginismus, with some success.

This word refers specifically to pain experienced during the act of intercourse. Needless to say, the consequences of this condition for a healthy and enjoyable sex life can be profound, with the possibility for spillover into other aspects of romantic relationships.

Intercourse can be experienced as painful for a variety of reasons, and these can be either physiological or psychological. In both cases, it is categorized as dyspareunia.

A diagnosis of the condition will be given when there is recurrent or persistent genital pain before, during or after sexual intercourse, and this pain is not caused exclusively by vaginismus or by lack of lubrication.

Vaginismus can exist in a patient concurrently with dyspareunia, and vaginismus can develop in a patient who has shown a history of dyspareunia. As a result, even expert medical professionals can run into some difficulty isolating the issues at first.

This word refers to a condition where the muscles in the vagina (pubococcygeus) tense reflexively, with the result that vaginal penetration becomes painful and, in some cases, impossible. This condition clearly can have a profound effect on a woman’s sex life, and can also affect normal activities such as the use of tampons and gynecological examinations.

Vaginismus can be classified as “primary” or “secondary.”

In the case of Primary Vaginismus, a woman has never been able to experience any sort of vaginal penetration without the onset of pain.

With Secondary Vaginismus, a woman, who has historically been able to experience penetration without pain, later develops the pain symptoms associated with vaginismus.