Dyspareunia Definition and Timing of Pain
Yes, dyspareunia includes pelvic pain experienced after sexual intercourse, not just pain during penetration or intercourse itself. 1, 2
Clinical Definition
Dyspareunia is defined as recurrent or persistent genital pain associated with sexual intercourse that causes distress, affecting approximately 10-20% of U.S. women. 1 The condition encompasses pain at multiple timepoints:
- During attempted vaginal insertion (entry dyspareunia) 1, 2
- During intercourse itself (superficial or deep dyspareunia) 1, 2
- After sexual activity (post-coital pain) 3
Temporal Classification
The pain can be classified based on when it occurs:
- Entry dyspareunia: Pain with attempted vaginal insertion, commonly associated with vulvodynia, vaginal atrophy, inadequate lubrication, or vaginismus 1, 2
- Deep dyspareunia: Pain during deep penetration, associated with endometriosis, pelvic congestion, adhesions, infections, or adnexal pathology 2, 4
- Post-coital pain: Pelvic pain experienced after intercourse has concluded 3
Prevalence Data Supporting Post-Coital Pain
A high-quality systematic review found that 35% of postpartum women experience dyspareunia, with timing varying significantly: 43% at 2-6 months postpartum, 22% at 6-12 months, and 40% at 12-24 months. 3 This temporal variation demonstrates that pain associated with sexual activity extends beyond the immediate act of intercourse itself.
Clinical Implications
The NCCN Guidelines specifically address "symptoms of pain with sexual activity" rather than limiting the definition to pain only during intercourse, recommending treatments including ospemifene, pelvic physical therapy, topical anesthetics, yoga, and meditation. 3 This broader terminology acknowledges that sexual pain encompasses the entire sexual experience, including post-coital discomfort.
Common Pitfall
Clinicians should not limit their assessment to pain occurring only during penetration or active intercourse. A comprehensive sexual history must include questions about pain timing: before, during, and after sexual activity. 1 Women may experience pain exclusively after intercourse due to pelvic floor dysfunction, endometriosis, or pelvic congestion that manifests following the mechanical stimulation of intercourse. 2, 4