Managing Deep Dyspareunia

Dyspareunia is the term used for recurring pain in the genital area or within the pelvis during sexual activity.  This can be very distressing physically and emotionally for the person experiencing these symptoms and their partner.  Dyspareunia can be further defined as superficial or deep.  Superficial dyspareunia is when pain is felt at or close to the entrance of the vagina with penetration.  Deep dyspareunia occurs with deep penetration and is felt in the deep vaginal tissues, cervix, or lower abdomen. It may feel worse in certain positions.  Common underlying causes of deep dyspareunia can include endometriosis/adenomyosis, interstitial cystitis, ovarian cysts/fibroids,  and other conditions that involve increased pelvic floor muscle tension. Scar tissue in the pelvis and lower abdomen from previous surgeries, trauma, or infections can also contribute to deep dyspareunia.  Additionally, experiencing stress or anxiety can contribute to deep dyspareunia. 

Management of deep dyspareunia is multifaceted and needs to address the specific factors involved in an individuals pain.  Typically, it is helpful to learn strategies to improve relaxation of the pelvic floor muscles. This can include things like deep diaphragmatic breathing and pelvic floor awareness exercises.  Certain stretches and yoga poses can also be helpful to improve relaxation of the pelvic floor.  To address muscular tension more directly,  manual therapy and the use of devices like vaginal dilators can help to improve the tissue flexibility and ability to accommodate vaginal penetration without pain. A pelvic floor physiotherapist can assist in implementing all of these strategies to work towards pain free intercourse. Additionally, many people suffering from deep dyspareunia will benefit from addressing any psychosocial factors than may be contributing to their pain. Seeking assistance from a sex therapist can be very helpful in reaching the goal of pain free intercourse. 

As mentioned previously, in many cases the underlying cause for deep dyspareunia can be a chronic condition or something that there isn’t a “cure” for.  For this reason, it can be very beneficial to have a strategy to reduce the depth of penile penetration to improve comfort and minimize deep dyspareunia.  The OhNut is a wearable device that allows for control of the depth of vaginal penetration. It is placed at the base of the penis to create a buffer, which prevents penetration to deeper painful areas.  The size of the buffer can be controlled as there are 4 detachable rings. The OhNut also comes in 2 sizes: ‘Classic/Regular’ Fit and ‘Wide’ Fit.They are comfortable for the wearer and provide a compressive sensation similar to vaginal penetration. This is an excellent option for minimizing pain for those who experience deep dyspareunia, and a pelvic floor physiotherapist can help you integrate it into your treatment plan.  


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