What is the Pelvic Floor?
The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. The pelvic floor has three openings that run through it, the urethra, the vagina, and the rectum. The functions of the pelvic floor include:
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To support the pelvic organs, specifically the uterus, the bladder, and the rectum
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To help provide sphincter control for the bladder and bowel
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To withstand increases in pressure that occur in the abdomen such as coughing, sneezing, laughing, straining, and lifting
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To enhance the sexual response
What is Dypareunia?
Dyspareunia is pain in the vagina, labia minora or clitoris just before, during or after sexual intercourse.
The vagina is a muscular tube providing a passage between your uterus and the outside of the body. It has three functions: admitting the penis during sexual intercourse, allowing menstrual blood to leave the body, and giving birth. The labia minora are folds of hairless skin containing sweat glands that make up part of your external genitalia. The clitoris is a pea-size sexual organ located in front of the urethra, close to where the labia minora meet. It is highly sensitive with over 8,000 nerve endings and functions for sexual pleasure.
The location and frequency of pain with dyspareunia may vary. Symptoms often include:
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Pain at the entrance of the vagina with initial penetration; even from penetration from a finger or tampon
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Deeper vaginal pain with thrusting of the penis
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Pain may be a sharp and burning, or deep and aching
You may also experience an involuntary tightening of the pelvic floor muscles (vaginismus) during penetration. The tightening can be severe enough that the vagina is unable to be penetrated.
Normal female anatomy

What Causes Dyspareunia?
There are several causes of dyspareunia, these include:
Vaginal dryness
Side effects of medications
Infection
Inflammation or skin problems
Vulvar vestibulitis
Vaginismus
Allergic reaction
STDs
Uterine and other pelvic conditions
Inadequate lubrication can be due to a lack of sexual arousal, or a decrease in estrogen, which occurs after menopause, during and after pregnancy, and while breast feeding.
Certain medications can decrease sexual arousal and result in inadequate lubrication. These medications include antihistamines, antidepressants, birth control pills, breast cancer medication, high blood pressure medication, and some sedatives.
A bacterial or fungal infection of the vagina, genital area or urinary tract can cause painful intercourse.
Inflammation or severely dry skin such as eczema can lead to painful initial penetration. Skin diseases such as lichen sclerosis or lichen planus can affect the vaginal area and lead to painful intercourse
A condition that can result in severe pain when the area around the vagina is touched or with initial penetration.
An involuntary tightening of your pelvic floor muscles during initial penetration.
An allergic reaction to clothing, spermicides or douches can cause painful intercourse.
Sexually transmitted diseases can cause blisters and sores that make intercourse painful.
Certain conditions of the uterus can lead to painful intercourse. These conditions include retroverted uterus, endometriosis, pelvic inflammatory disease, fibroids, ovarian cysts, and interstitial cystitis.
Prolapses
Scarring
A prolapse of the bladder (cystocele), uterus (uterine prolapse), rectum
(rectocele), or intestine (enterocele) can cause a deep pain during intercourse.
Previous surgeries to the pelvic area can cause scarring that leads to painful intercourse.
Childbirth
Treatments for cancer
Tearing or an episiotomy during vaginal delivery can lead to painful intercourse.
Chemotherapy and radiation to the pelvic area can lead to painful intercourse.
Other trauma Trauma from accidents and injuries to the pelvic area can lead to painful intercourse.
Emotional factors can also contribute to painful intercourse. Emotions and stress are important for sexual arousal and greatly affect the amount of lubrication and the tightness of the pelvic floor. Psychological issues such as anxiety, depression, and fear of intimacy can be a factor with dyspareunia. Additionally, any history of sexual abuse can lead to problems with dyspareunia.

How is Dyspareunia Treated?
The treatment of dyspareunia depends on the underlying cause. A combination of the following treatments may be used:
Increased lubrication When vaginal dryness is the cause for pain, clitoral stimulation or oral sex prior to intercourse can increase the amount of natural lubricant. However, both you and your partner must be comfortable with this type of stimulation or the anxiety can cause problems. Additionally, abundant amounts of overthe-counter, water-based lubricants such as Slippery Stuff, Wet, K-Y Jelly or
Astroglide can help. Placing a towel underneath the bottom partner can prevent spillage of the lubricant onto bedclothes.
Medication Medication to treat a bacterial or fungal infection will help decrease pain caused by infection. If prescribed medications are causing decreased lubrication, then changing medications may help. In some cases your doctor may prescribe injections of pain-relieving medication into a sight of increased pain and tenderness.
Hygienic changes
Steroid creams
Sitz baths
Estrogen therapy
Pelvic floor muscle reeducation using biofeedback
Manual physical therapy
Correction of prolapses
Treatment for endometriosis
Changing sexual positions
Avoiding irritating spermicides, skipping douches, and avoiding drying soaps, such as scented bath gels, can decrease allergenic problems that lead to dyspareunia.
If skin disorders such as lichen sclerosis or lichen planus are the cause of dyspareunia, then a steroid cream may be prescribed.
Warm sitz baths can help decrease inflammation that causes dyspareunia.
A cream-based estrogen therapy can be prescribed to help increase the natural lubricant made in your vagina.
Biofeedback uses special computer equipment that measures muscle activity. You can use this feedback while you are doing exercises to learn to properly contract and relax the pelvic floor muscles.
Releasing adhesions and massaging tight pelvic floor muscles can help decrease painful intercourse. Desensitization techniques may also be performed to help treat dyspareunia.
If a prolapse is the cause for dyspareunia, then correction of the prolapse can help.
If endometriosis is the cause for dyspareunia, then medication or surgery to remove abnormal growths of uterine tissue may be prescribed.
Switching positions can help relieve pain felt during intercourse. If you are on top, then you will usually have more control in the depth of penetration.
Additionally, if you guide the penis in with your hand on initial penetration this can provide more comfort for you.

Coping with Dyspareunia
Having dyspareunia for a prolonged time can lead to negative feelings about sex. Avoiding intimacy can lead to communication difficulties between you and your partner. Seeking help with a sex therapist or counselor can resolve these issues and restore intimacy with your partner.
Some tips on coping with dyspareunia include:
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Having good communication. Be sure you talk with your partner about what feels good and what does not.
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Use a lot of foreplay. Having sufficient foreplay will increase the amount of lubricant made in the vagina, easing penetration.
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Learn about your own body. Explore your own body and learn about how you like to be touched and what turns you on.
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Have intimate but non-intercourse related activities with your partner. Bathing together, massaging each other, sensual caressing, mutual masturbation, looking at sexual books can all provide intimate activities without intercourse.