Clinical Review & Disclaimer
- Verified Content: Approved by the Women’s Health Clinic Clinical Team.
- Educational Use: This is not a substitute for professional medical advice, diagnosis, or treatment.
- Clinical Assessment: Individual suitability is determined by a clinician; results may vary.
- MEDICAL EMERGENCY: If you are experiencing a medical emergency, call 911 immediately.
About the Author
Painful Sex Treatment UK Doctor-Led Assessment & Solutions
Quick Answer: Dyspareunia is a symptom, not a diagnosis. Causes range from menopause-related dryness to vaginismus. Successful treatment requires identifying the root cause before selecting options like Laser, RF, PRP, or conservative management.
Painful sex can be isolating, distressing, and genuinely frightening. Whether caused by hormonal changes, tissue conditions, or pelvic floor dysfunction, you don't have to "just live with it." We provide thorough medical assessment to identify your specific pain drivers and create a personalised management plan.
Why Women Choose Our Clinic
Specialist Assessment
Identifying root causes.
Multimodal Care
Medical, physio & support.
Treatment at a Glance
Condition
Dyspareunia (Painful Sex)
Methods
Laser, RF, PRP, or Conservative
Suitability
Menopause, Postpartum, Vaginismus
Approach
Doctor-Led & Personalised
Evidence-Informed
Transparent clinical counselling
Personalised Assessment with
Our GP-Led Team
Every journey begins with understanding. Our comprehensive medical assessment ensures your treatment is perfectly matched to your physiology, whether that means hormonal support, regenerative therapy, or referral for physiotherapy.
What is Dyspareunia?
It is not a single condition, but a symptom pattern. NHS guidance emphasises multiple underlying causes, from hormonal changes and tissue atrophy to pelvic floor dysfunction and anxiety.
Superficial (Entry) Dyspareunia
Most CommonPain experienced at the vaginal entrance or opening, often described as burning, stinging, or feeling like "hitting a wall."
- Genitourinary Syndrome of Menopause
- Vulvodynia / Vestibulodynia
- Post-birth scarring
Deep Dyspareunia
Pelvic PainDiscomfort felt deeper in the pelvis during or after intercourse, often described as aching, cramping, or being "hit."
- Endometriosis / Adenomyosis
- Pelvic Inflammatory Disease
- Ovarian cysts or adhesions
Vaginismus
InvoluntaryThe pelvic floor muscles develop protective "guarding" patterns that cause the vaginal muscles to clench or spasm, making penetration impossible.
*Often develops as a protective response to pain or fear.
The Pain-Fear-Avoidance Cycle
Dyspareunia typically creates a self-perpetuating cycle. Initial pain creates anticipatory anxiety, which triggers physiological muscle tension and reduced lubrication. This tension worsens the pain, reinforcing the avoidance behavior. Breaking this cycle requires accurate diagnosis and a combination of physical and psychological support.
Medical Note: Dyspareunia is a symptom, not a diagnosis. Results vary significantly between individuals. No treatment outcome is guaranteed.
Complex & Structural Causes
Detailed definitions of specific medical conditions that may drive dyspareunia.
Deep Pelvic Pathology (Adenomyosis, IC, Endometriosis)
-
[cite_start]
- Adenomyosis: Endometrial tissue grows within the uterine muscle wall, causing deep pelvic aching during intercourse and a tender, enlarged uterus[cite: 298]. [cite_start]
- Interstitial Cystitis (Painful Bladder Syndrome): A chronic bladder condition causing deep pain/pressure with penetration, often worse with a full bladder[cite: 299]. [cite_start]
- Endometriosis: Tissue similar to the womb lining grows elsewhere (e.g., Pouch of Douglas), causing deep pain often worse in certain positions or cyclically [cite: 297-298].
Structural, Surgical & Congenital Factors
-
[cite_start]
- Congenital Variations: Structural issues present from birth, such as a Septate Hymen (thick band of tissue) or Vaginal Septum, which can physically obstruct comfortable penetration[cite: 297]. [cite_start]
- Post-Surgical Changes: Scarring from episiotomies, perineal tears, or pelvic surgeries that reduces tissue flexibility or narrows the vaginal opening[cite: 297]. [cite_start]
- Pelvic Organ Prolapse: While not always painful, altered vaginal angles and tissue exposure can contribute to friction and discomfort[cite: 297].
Vulval & Skin Conditions
- Lichen Sclerosus: A chronic inflammatory condition causing white, patchy, fragile skin that tears easily. [cite_start]Progressive scarring can narrow the vaginal opening[cite: 295]. [cite_start]
- Lichen Planus: Can cause a raw, red appearance at the entrance with erosions and potential scarring (adhesions) [cite: 295-296]. [cite_start]
- Dermatitis: Reactions to irritants like perfumed soaps, laundry detergents, or latex, causing surface burning and stinging[cite: 296].
Who Benefits from Treatment?
Our dyspareunia clinic sees women across diverse age groups and circumstances. Whether due to life stages, medical history, or personal preference, we provide care that respects your body's natural balance.
Menopause (GSM)
For women aged 45-65+ experiencing vaginal dryness, tissue thinning, and progressive worsening of pain due to declining estrogen.
Postpartum Women
New mothers facing pain related to perineal scarring, breastfeeding-induced atrophy, or pelvic floor dysfunction after delivery.
Cancer Survivors
Women on aromatase inhibitors or following radiotherapy who cannot use hormone-based creams.
Vaginismus
Those who experience complete penetration barriers or involuntary muscle spasm despite conscious relaxation attempts.
Lichen Sclerosus
Women needing adjunct treatments beyond topical steroids for thinning, scarring, and chronic vulval pain.
Younger Women
Addressing primary dyspareunia, hormonal contraceptive effects, endometriosis-related pain, or unexplained pelvic pain.
Unsure Which Option is Right?
You don't need to decide alone. Our GP-led team offers a comprehensive medical assessment to review your symptoms and recommend the safest, most effective treatment plan for your physiology.
Book Assessment CallBreaking the Pain Cycle
Our dyspareunia management aims to interrupt the pain-fear-avoidance cycle at multiple points: targeted physical treatment, rehabilitation, and evidence-based support.
How the Technology Works
Treating Vaginismus
Evidence Transparency
Safety First
Rigorous Clinical Governance
Doctor-Led Assessment
We don't just offer "procedures." We start with a thorough medical evaluation by experienced women's health doctors to identify exactly what is driving your pain.
Multidisciplinary Care
We address physical, hormonal, and psychological factors. Our approach includes medical interventions, physiotherapy referrals, and psychosexual support where beneficial.
Evidence-Based & Transparent
We transparently explain what is clinically established versus emerging. You will receive full counselling on FDA warnings and NICE guidance for any energy-based treatments.
Private & Confidential
We provide sensitive, non-judgemental care in a private environment. We have seen hundreds of women with dyspareunia—nothing you share will shock or embarrass us.
Evidence-Based Results
Many women describe treatment as transformative, but we maintain realistic expectations. While we cannot guarantee specific outcomes, many women achieve significant improvement or complete pain resolution with appropriate intervention.
See Clinical Evidence Managing Symptoms at Home
While professional assessment is vital, practical self-care steps can provide immediate relief and support your overall treatment journey.
Optimising Lubrication
- Generous Application: Use far more lubricant than you think necessary, applied to both yourself and your partner.
- Regular Moisturising: Use vaginal moisturisers 3 times weekly (separate from sex) to maintain tissue hydration.
- Prioritise Arousal: Aim for 15-20 minutes of foreplay to encourage natural lubrication before penetration.
Vulval Care Best Practices
- Avoid Irritants: No perfumed soaps, shower gels, bubble baths, or douching. Wash with warm water only.
- Clothing Choices: Wear cotton underwear or sleep without underwear to allow air circulation.
- Gentle Laundry: Use fragrance-free detergent and avoid fabric softeners on intimate wear.
Relaxation & Mind-Body
- Breathe Deeply: Practice diaphragmatic "belly breathing" to reduce physiological arousal and anxiety.
- Pelvic Drop: Visualize your pelvic floor muscles softening and releasing (like dropping an elevator).
- Warm Baths: Can help promote overall pelvic muscle relaxation.
Communication & Pacing
- No Rush: Plan intimate time when you are relaxed, avoiding time pressure or stress.
- Redefine Success: Focus on pleasure and connection rather than specific acts. Non-penetrative intimacy is valid and important.
- Clear Signals: Establish verbal or non-verbal signals with your partner to communicate discomfort immediately.
When Self-Care Isn't Enough: If you experience persistent pain despite these measures, worsening symptoms, or significant relationship distress, professional assessment is recommended.
Transparent Treatment Costs
Vaginal Laser (Course)
Tissue-focused thermal stimulation for GSM/atrophy related dyspareunia.
Sessions
- Medical assessment included
- 3 Sessions spaced 4-6 weeks apart
- Full clinical governance
Treatment Menu
*Conservative management plans (e.g., physio referral) are discussed during consultation.
Multimodal Care Plans
Combined approaches (e.g., Laser + PRP + Physio referral) for complex cases like post-cancer GSM or persistent Vaginismus.
Custom Quote
Request ConsultationInsurance Coverage?
Some private medical insurance policies may cover initial assessment for diagnostic purposes. Procedural treatments are typically elective. We provide detailed coding for you to check with your provider.
Book Medical Assessment Clinical Safety and Contraindications
Patient safety is our absolute priority. We adhere to strict clinical protocols before any intervention.
Absolute Contraindications
Treatment cannot be performed if any of the following apply:
- Active Infection: Active genital or pelvic infection (e.g., Thrush, BV).
- Undiagnosed Bleeding: Vaginal bleeding between periods or post-coital bleeding.
- Malignancy: Current or recent vaginal, vulval or cervical malignancy.
- Pregnancy: Or attempting to conceive (treatment dependent).
Relative Contraindications
Further assessment is required for the following conditions:
Confidential Medical Review
If you are unsure about your suitability, our medical team can conduct a private assessment. Most conditions do not rule out treatment but may change the choice of technology.
Disclaimer: This list is not exhaustive. A full medical history is taken during your consultation. Information provided on this site is for educational purposes and does not constitute medical advice.
Unsure Which Option is Right For You?
You don't need to decide alone. Our GP-led team offers a comprehensive medical assessment to review your symptoms and recommend the safest plan.
Frequently Asked Questions
Clinical answers regarding symptoms, the procedure, and safety.
Is painful sex "normal"?
Can Laser or RF "cure" painful sex?
Could menopause be causing my pain?
What if it feels like my muscles "clench" involuntarily?
Will I need an internal examination?
Will treatment affect my fertility?
Does the treatment itself hurt?
How many sessions will I need?
Is there any downtime? Can I have sex afterwards?
Can I have this if I am on HRT?
Can this help with Lichen Sclerosus (LS)?
Is it safe with a Coil (IUD)?
Radiofrequency (RF): Safe with plastic (Mirena) coils. [cite_start]However, if you have a Copper Coil, internal RF is contraindicated due to potential heating of the metal[cite: 505].
Have a specific question?
Our medical team is happy to discuss your specific concerns in a private setting.
Ask a Medical ProfessionalDebunking Dyspareunia Myths
Misinformation can delay treatment. Let's clarify the reality.
Myth
"Painful sex is normal and I just have to accept it."
Reality
It is common, but absolutely not "normal." Pain is a symptom requiring assessment. NHS guidance emphasizes that treatable causes exist.
Myth
"It's all in my head."
Reality
Most cases have physical causes (hormonal, tissue, muscular). Psychological factors (anxiety) are usually a result of the pain, not the cause.
Myth
"If the doctor can't see anything, nothing is wrong."
Reality
Many conditions (Vulvodynia, deep Endometriosis, pelvic floor tension) are not visible on a standard speculum exam. "Normal appearance" does not mean no pathology.
Myth
"I'm 'too tight' down there."
Reality
This sensation usually reflects protective muscle guarding (Vaginismus) or dryness, not anatomical size. Muscles can be retrained.
Myth
"Menopause pain is inevitable."
Reality
Genitourinary Syndrome of Menopause (GSM) is highly treatable with local estrogen, moisturisers, or regenerative therapies. You do not have to suffer.
Myth
"Laser is a guaranteed cure."
Reality
No medical treatment is a guaranteed cure. Energy-based treatments are tools for specific tissue conditions, and evidence limitations must be discussed transparently.
More About This Treatment
The Pain-Fear-Avoidance Cycle
Dyspareunia typically creates a self-perpetuating cycle: Initial pain creates anticipatory fear, which triggers muscle tension and reduced lubrication. This tension worsens the pain, reinforcing the cycle.
Our management aims to interrupt this cycle at multiple points: targeted physical treatment for tissue issues, pelvic floor rehabilitation for muscle tension, and psychological support for anxiety.
Why Early Intervention Matters
Evidence suggests that earlier assessment improves outcomes. Shorter pain duration correlates with faster resolution and less severe pelvic floor dysfunction. Prompt treatment prevents pain pathways from becoming sensitized (chronification).
Conservative Management First
Before considering procedural interventions (Laser/RF), we thoroughly evaluate conservative strategies. This includes medical-grade lubricants (water or silicone-based), vaginal moisturisers (used 3x weekly), and vaginal estrogen to restore tissue thickness.
Multimodal Treatment Logic
Dyspareunia is often multi-factorial. A post-cancer patient may need laser for tissue regeneration (GSM), physiotherapy for muscle guarding, and counselling for anxiety. We combine these modalities rather than relying on a single "magic bullet".
Regulatory Position (FDA & NICE)
The FDA warns that energy-based devices are not cleared for "vaginal rejuvenation" and reports adverse events like burns or scarring.
NICE advises that transvaginal laser for urogenital atrophy should only be used in research due to inadequate evidence. We discuss these positions transparently with all patients.
PRP Biological Rationale
Platelets contain growth factors (PDGF, TGF-β, VEGF) that may support tissue regeneration, collagen remodelling, and angiogenesis (new blood vessel formation).
It is positioned as a regenerative adjunct for selected cases, with an emerging evidence base showing high individual variability.
Clinical References
- 1. NICE Clinical Knowledge Summaries. Menopause and Genitourinary Symptoms.
- 2. British Menopause Society. Guidance on Genitourinary Syndrome of Menopause (GSM).
- 3. RCOG. Patient Information Leaflets on Gynaecological Conditions.
- 4. FDA Safety Communication on Energy-Based Devices for Vaginal Rejuvenation.
Patient Support & Resources
- Support Organisations:
Relate, Endometriosis UK, The Vulval Pain Society, The Daisy Network. - Recommended Reading:
"The Vagina Bible" (Dr Jen Gunter), "Come As You Are" (Dr Emily Nagoski). - Apps:
Squeezy App (NHS-endorsed pelvic floor exercises).
About Our Clinical Team
Dr Farzana Khan
BSc (Hons), MD, DFFP, RCGP
Qualifications
- MD, University of Copenhagen (2003)
- MRCGP, CCT (2013)
- Diploma of the Faculty of Sexual & Reproductive Health (2013)
Clinical focus
Sexual function and comfort
Lichen sclerosus
Vulval skin
Volume concerns
How she works
- Listens first. Conservative and medical options discussed before procedures
- Clear, balanced counselling on benefits, limits, risks, and alternatives
- Shared decisions, realistic expectations, written aftercare
Training & teaching
- KOL/Trainer: Neauvia, Asclepion Laser, RegenLab (since 2023)
- Ongoing CPD: IMCAS, CCR, ACE, and intimate HA/PRP/Polynucleotide training
Authored and medically reviewed by Dr Farzana Khan. Last updated: [November 2025]
Katy Pitt Allen
Clinical Director
Katy brings exceptional clinical expertise and international experience to her role as Clinical Director, with specialized knowledge in oncology, gynaecology, and palliative care developed through over a decade of nursing excellence. Her proven leadership skills, demonstrated through her progression from staff nurse to junior ward sister and her current international oncology practice, ensure our clinic maintains the highest clinical standards while delivering compassionate, evidence-based care to all patients.
Dr Kamaljit Singh
Clinical Oversight
Dr. Kamaljit Singh provides medical oversight for our clinical team, bringing over 25 years of comprehensive healthcare experience to ensure the highest standards of patient care. A graduate of Leeds Medical School with distinction, Dr. Singh holds his MRCGP qualification and served as a senior partner at Leicester Medical Group for 16 years. His expertise spans both traditional medicine and aesthetic procedures, with specialized training in cosmetic treatments and 18 years of membership with the British Association of Aesthetic Plastic Surgeons. Dr. Singh's background includes roles as an FY2 trainer and GP assessor, demonstrating his commitment to medical education and professional standards that ensure our clinical team operates with rigorous oversight and excellence.
Jill Crowe
Director of Relationships
Jill brings over two decades of nursing excellence and exceptional relationship-building skills to her role as Relationship Manager at our women's health clinic. With her proven expertise in communication, team leadership, and inter-agency collaboration, she seamlessly coordinates between practitioners, patients, and partners to ensure the highest quality of care and service delivery.
Dyspareunia: Causes, Symptoms & Treatment Options
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Experiences Shared by Women Like You
- Educational and informational only. Individual experiences vary.
- Patient feedback reflects personal experiences, not clinical outcomes.
- Reviews relate to overall care and service experience.
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Free Telephone Consultation —Dyspareunia: Causes, Symptoms & Treatment Options
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Evidence-Based Treatment —Dyspareunia: Causes, Symptoms & Treatment Options
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Immediate Aftercare & Comfort —Dyspareunia: Causes, Symptoms & Treatment Options
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Long-Term Care & Follow-Up —Dyspareunia: Causes, Symptoms & Treatment Options
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