Pain during sex is still being pushed to the margins of public health discussion, despite affecting a substantial number of women and often reshaping intimate, emotional and daily life.

New analysis published in the Journal of Clinical Medicine suggests that dyspareunia, the medical term for pain experienced during intercourse, may affect up to one in five women.

That figure alone makes the condition impossible to dismiss as rare. Yet many women continue to live with it in silence, with little support, delayed diagnosis and too little recognition from health professionals.

This is more than a private discomfort. It is a common sexual dysfunction with medical, psychological and social consequences. It can strain relationships, reduce quality of life, increase anxiety about intimacy and leave patients feeling isolated.

The latest findings underline a simple but uncomfortable truth, a problem can be common, serious and still remain under-discussed.

Dyspareunia is not a single-condition diagnosis. It is a broad clinical problem with many possible causes. Some are physical. Others are hormonal. Some are rooted in mental health or past experience.

In many patients, several factors overlap. Endometriosis, pelvic inflammatory disease and hormonal deficiency are among the recognised somatic causes. Pelvic floor dysfunction, vulvovaginal changes, prior surgery and irritation may also contribute. In other cases, fear of pain, anxiety, low sexual confidence or relationship strain may intensify the experience.

“The latest study reinforces the need for a more complete response to dyspareunia. It is not enough to recognise the condition in theory. The health system must respond in practice, with better screening, less stigma, more open conversations and integrated care”

Experts involved in the new analysis stress that this complexity is exactly why dyspareunia is often missed or misunderstood. If a clinician looks only for a simple physical explanation, important clues can be overlooked. If the psychological dimension is ignored, treatment may fail. The result is a fragmented approach to a condition that rarely behaves in a fragmented way.

The scale of under-reporting is striking. Although symptoms may affect around 20% of women, only a small proportion seek medical help. Many never mention it at all. Shame is a major factor. So is the belief that pain during intercourse is normal, inevitable, or something that must simply be endured. That idea is deeply harmful. Pain is not a standard part of sex. When it appears repeatedly, it deserves assessment.

There is also the problem of communication. Patients may find it difficult to raise the issue with a doctor. Appointments are often short. Questions may feel awkward. Some women fear dismissal, embarrassment or being told that the problem is “in their head”. When that happens, silence becomes a survival strategy. Unfortunately, silence also delays treatment.

The new analysis highlights another concern, diagnosis in routine practice often remains heavily biomedical. In other words, the focus is frequently on the body alone. That can be useful, but it is not enough.

A narrow approach may lead to tests, prescriptions or procedures that do not address the real source of pain. A formal diagnosis may be recorded, yet the underlying cause still goes unidentified. In practical terms, that means the patient continues to suffer.

A better model starts with conversation. Experts say a detailed medical history is central to understanding dyspareunia. That history should not be limited to gynaecological symptoms alone. It should include pain pattern, menstrual history, sexual function, psychological health, relationship factors, prior trauma where relevant, and any symptoms linked to bladder, bowel or pelvic floor problems. This broader assessment is not a luxury. It is often the only way to reach the right diagnosis.

The doctor–patient relationship matters greatly here. Trust changes what patients disclose. A supportive consultation can make it possible for someone to describe pain they have hidden for months or years. A rushed, dismissive or uncomfortable interaction can shut that down immediately. In a condition so closely tied to intimacy and self-image, the quality of the conversation can shape the entire pathway to care.

Treatment also needs to be broad. Because the causes are multidimensional, the response should be multidisciplinary. Experts point to the role of gynaecologists, urogynecological physiotherapists, psychologists and sexologists, depending on the patient’s needs. That is an important shift away from the idea that one specialist alone can solve everything.

Available approaches may include pharmacotherapy, pelvic floor physiotherapy, sexual education and psychotherapy. The exact combination depends on the cause. Hormonal therapy may help in some cases. Treatment for infection or endometriosis may be necessary in others. Always talk to your healthcare providers for medical advice.

When pelvic floor muscle tension is part of the picture, physiotherapy can play a major role. When fear and avoidance have built up around sex, psychological support can help reduce anxiety and pain anticipation. Education is also vital, because misunderstandings about anatomy, arousal and lubrication can worsen the problem.

Evidence is growing for pelvic floor physiotherapy as a first-line treatment in some patients. Cognitive-behavioural therapy has also shown promise in reducing pain-related anxiety. These are practical interventions with real-world value.

Yet access remains uneven, particularly in public health systems, where waiting lists, staffing shortages and limited specialist services can reduce availability. That gap between evidence and access is one of the most important issues raised by the new report.

The public health implications are larger than they might first appear. Dyspareunia affects not only sexual activity, but wellbeing, partnership dynamics and mental health. It can influence fertility-related decision-making, prevent patients from engaging comfortably in relationships, and contribute to distress long after the original physical trigger has resolved.

For some women, the pain becomes self-reinforcing. Anticipation of pain leads to tension. Tension increases discomfort. Discomfort increases fear. The cycle can be difficult to break without proper support.

What makes the condition especially frustrating is that it is not obscure. The medical literature already describes it. The possible mechanisms are known in broad terms. The treatment options exist. The challenge lies in implementation. Too often, the women who need care most are least likely to be referred, screened or offered a comprehensive plan.

That is why visibility matters. Public discussion can reduce shame. Clinical awareness can shorten the time to diagnosis. Better training can help doctors ask the right questions. Wider access to physiotherapy and psychological care can turn knowledge into treatment. Simple acknowledgement can also be powerful.

Telling patients that pain during intercourse is not normal may sound obvious, yet it can be life-changing for someone who has been told, directly or indirectly, to put up with it.

The latest study reinforces the need for a more complete response to dyspareunia. It is not enough to recognise the condition in theory. The health system must respond in practice, with better screening, less stigma, more open conversations and integrated care.

That is the newsworthy message here. Pain during sex is common enough to demand attention, serious enough to require action and complex enough to rule out one-size-fits-all care.

Women should not have to wait years to be heard. They should not have to normalise pain that can often be treated. The first step is simple, though not always easy, treat the symptom as real, ask about it directly and make sure the pathway to care is actually there.