London School of Hygiene & Tropical Medicine

Nearly one in 10 British women are experiencing painful sex (dyspareunia), according to a new study published in BJOG: An International Journal of Obstetrics and Gynaecology.

The findings come from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) - the largest scientific study of sexual health lifestyles in Britain - carried out by the London School of Hygiene & Tropical Medicine, UCL and NatCen Social Research.

The national survey included 8,869 women aged between 16-74, interviewed between 2010 and 2012. Among the 6,669 women who had been sexually active in the past year, 7.5% reported having painful sex; of those, 1.9% experienced morbid pain (symptoms lasting at least six months, occurring very often or always and leaving the woman feeling distressed).

The proportion who reported painful sex was highest among women aged 55-64 (10.4%) and those aged 16-24 (9.5%). Of the 1,708 women in the study who were not sexually active, 2.05% said they avoided intercourse due to painful sex or a fear of feeling pain.

The study found that painful sex was strongly associated with other sexual function problems, in particular vaginal dryness, feeling anxious during sex, and lack of enjoyment in sex. It was also linked to poor physical and mental health including depression, sexual relationship factors, such as not sharing the same level of interest in sex, and adverse experiences, such as an STI diagnosis and non-volitional sex.

Of those women who reported painful sex, 30.9% said they were dissatisfied with their sex life compared to 10.1% of women who didn't report painful sex, while those experiencing pain were more likely to say they had avoided sex in the past year because of sexually difficulties (44.9% versus 10.7%).

The study's lead author is Dr Kirstin Mitchell, who began the research at the London School of Hygiene & Tropical Medicine and is now based at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. She said: "While dyspareunia is a common problem, sexual pain disorders are often overlooked because underlying conditions are often difficult to diagnose and treat, and causes can be complex and poorly understood.

"This data demonstrates the importance of taking a holistic approach to medical care which takes into account the sexual, relationship and health context of symptoms. Healthcare professionals should be supported in taking a detailed history during a patient's clinical assessment; thoroughly investigating symptoms, asking about enjoyment and satisfaction, and considering the relationship context.

"There is also a need for resources to support clinicians who feel uncomfortable broaching the topic of sexual function and pleasure with patients, including advice on language and on when to refer patients to specialists in sexual health."

Edward Morris, Vice President of the Royal College of Obstetricians and Gynaecologists (RCOG), said: "This study raises the need for increased awareness that sex is more likely to be painful at the extremes of reproductive life (ie. in young women and those who have gone through the menopause). It also reveals an association between painful sex and women wanting to have known more at first sexual experience. Given that painful sex is common in younger women, and that half of young women report their first experience of intercourse as painful, it would be beneficial to ensure that the possibility of pain is discussed openly in sex education and in consultations between young people and health professionals.

"It is important that women who experience recurrent painful sex speak to their doctor or healthcare professional."

The study was funded by the Medical Research Council (MRC) and the Wellcome Trust with additional funding from the Economic and Social Research Council and the Department of Health. The MRC/Chief Scientist Office (CSO) Social and Public Health Sciences Unit at the University of Glasgow is funded by the MRC and the Scottish Government CSO.

Publication:

• Mitchell KR, Geary R, Graham CA, Datta J, Wellings K, Sonnenberg P, Field N, Nunns D, Bancroft J, Jones KG, and Mercer CH. Painful sex (dyspareunia) in women: Prevalence and associated factors in a British population probability survey. BJOG 2017: DOI: 10.1111/1471-0528.14518