What is Collision Dyspareunia?

[Leslie Turner, WHNP, CNM]

Occasionally women may experience pain with intercouse felt deep inside the vaginal canal; some women describe it as feeling a stabbing pain in their abdomen or bladder. It usually occurs with deeper penetration and sometimes is relieved with position change or their partner not thrusting quite as deeply. For some women, however, this pain occurs consistently with penetrative intercourse.

What could be the cause of this discomfort?

There are several possible reasons for pelvic pain with deep penetration. If you are experiencing this type of discomfort, your health care provider will want to rule out any infections or gynecologic concerns such as endometriosis.

However, if this is something you are experiencing for the first time with a new partner or with a new position, it is likely something known as ‘collision dyspareunia.’

Collision dyspareunia is pain that occurs during intercourse when your partner’s penis collides into your cervix, causing painful sex (the medical term for painful sex is dyspareunia). This ‘collision’ moves the uterus, which then collides into the highly sensitive nerve plexus of the sacrum (aka tail bone), rich in nerves from the spinal cord. In other words, OUCH!

While women with a retroverted uterus (Uterus tips back a little. Totally normal anatomically.) may be more likely to experience this discomfort, it can also occur in other women just in certain positions.

Or it can occur in women who have a partner with a penis that is longer than comfortably fits in the vaginal canal.

The average erect penis length is 4.7- 6.3 inches (12-16cm).
The average vaginal length of women who have never been pregnant is about 2.75-3.25 inches. However, when women are aroused, their vaginas lengthen significantly, up to an average of 4.25-4.75 inches or more. (Many women aren’t aware that this occurs, but this is important information, especially if you’re experiencing regular collision dyspareunia. Make sure that you’re adequately aroused prior to penetration and see if that makes a difference.)

Obviously, there are outliers in both categories. If a man with a longer penis and a woman with a shorter vaginal canal and retroverted uterus pair up, there may be some discomfort with deeper penetration, despite adequate arousal.

Some solutions- couples can try positions that allow for less depth of penetration, such as facing each other, side by side.

Or there is a creative and comfortable (for both partners) new product on the market called the ‘Oh-nut.’ The Oh-nut allows the man to have the sensation of full penetration, without the worry that he is hurting his partner. And the woman can relax and enjoy intercourse, knowing that there is a little buffer, which prevents her cervix from being crashed into. Win Win.

https://ohnut.co

Back in the day, they used to do a surgery on women called a sacrocolpohysteropexy to try to fix collision dyspareunia by trying to suspend the uterus away from the sacrum with sutures and mesh, but surgery is also a risk factor for developing this condition, so best to be avoided if at all possible.

The Oh-nut seems to solve the problem for many women.

If you suffer from collision dyspareunia and have had the alternate causes of pain ruled out by a health professional, what have you tried that has been helpful?

We welcome your comments and suggestions!

[Helen Leff, LCSW]

Thanks so much for this post Leslie! It’s so important to be specific when discussing painful intercourse and figuring out if the pain is at entry, with thrusting, with external touch …. Woman have told me that they have been broken up with over “collision dyspareunia” as the couple had no idea what it is. Of course there was more to the break up story than that, but had they known that there’s an easy fix who knows what the outcome may have been.
We need to continue to seek real, scientific, and helpful information regarding sexual health.