Pain with sexual intercourse 

Pain with sex (dyspareunia) is very common affecting around 7.5% of women in the UK. Before the menopause common causes include endometriosis, pelvic inflammatory disease (PID) and adhesions, a condition where structures in the pelvis are 'stuck down' usually secondary to PID, endometriosis or previous surgery. These conditions are usually diagnosed using a combination of vaginal swabs, ultrasound scans and laparoscopy, the latter of which can also be used to treat the problem. After the menopause the most common cause is genitourinary syndrome of menopause, also known as vaginal atrophy. This causes vaginal dryness, itching, burning and painful intercourse due to lack of lubrication. This is usually treated by vaginal oestrogen creams / pessaries but in ladies in whom this is ineffective or not acceptable, can be managed with vaginal laser treatment.

A more uncommon cause, and one of significant debate among gynaecologists, is pain with sex due to a retroverted uterus. This is where the uterus hangs backwards rather than forwards and is in fact normal in around 15% of ladies. In a small number of ladies who have no other disease but do have pain with sex, operating to stitch the uterus into a forward position (anteverted) relieves their pain. This is called a ventrosuspension and can be done by key hole surgery. Details of such a procedure can be found on the Embarrassing Bodies website which follows a patient treated by Mr Carpenter