Sex is a very pleasurable experience but so many women go through pain during sex, even by the thought of having sex can be very traumatizing for some people. The medical term for painful intercourse is dyspareunia, defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia.
Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a condition called vaginismus. Pain during sex is not the same as vaginismus although women with this condition also experience pain during sex.
Types of Pain during sex
- Superficial Pain: felt just at the entrance of the vulva.
- Deep Pain: felt when the penis or dildo penetrates into the vagina.
Causes of Pain during sex
Varies depending on the type of dyspareunia:
- Superficial Pain may be caused by:
- Dryness, when the vagina feels dry, and lubrication for intercourse is inadequate. It can also be caused when you are breastfeeding or menopausal due to reduced estrogen levels.
- Increased sensitivity of the genital area to pain
- Inflammation or infection in the genital area (including genital herpes), the vagina, or Bartholin glands (the small glands on either side of the vaginal opening)
- Inflammation or infection of the urinary tract
- Injuries in the genital area
- Radiation therapy affecting the vagina, which can make the vagina less elastic and can cause scarring, making the area around the vagina smaller and shorter
- An allergic reaction to contraceptive foams or jellies or to latex condoms
- Involuntary contraction of the vaginal muscles (click vaginismus )
- Rarely, a congenital abnormality (such as an abnormal partition within the vagina) or a hymen that interferes with entry of the penis
- Surgery that narrows the vagina (for example, to repair tissues torn during childbirth or to correct a pelvic floor disorder.
- Deep Pain may be caused by:
- Infection of the cervix, uterus, or fallopian tubes (pelvic inflammatory disease), which may cause collections of pus (abscesses) to form in the pelvis
- Growths in the pelvis (such as tumors and ovarian cysts)
- Bands of scar tissue between organs in the pelvis, which may form after an infection, surgery, or radiation therapy for cancer in a pelvic organ (such as the bladder, uterus, cervix, fallopian tubes, or ovaries)
- Fibroids can cause the uterus to get stuck in a bent-backward direction (retroversion)
- Strong unintended (involuntary) contraction of the muscles in the pelvis (called pelvic muscle hypertonicity) can cause or result from deep pain.
- Emotional Factors
Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain. Emotional factors include:
- Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
- Stress: Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
- History of sexual abuse: Not everyone with dyspareunia has a history of sexual abuse, but if you have been abused, it can play a role.
The diagnosis is based on the woman’s description of the problem, when and where the pain is felt, medical history, sexual history and on the results of a physical and psychological examination.
Distinguishing pain that occurs with touching the genitals or early penetration from pain that occurs with deeper penetration is a clue to the cause of your symptoms. Therefore, your doctor will ask you questions about the exact location, length and timing of your pain. He or she also will ask you:
- If there was ever a time you had painless intercourse, or if you have always had dyspareunia
- If you have enough natural lubrication, and if your symptoms improve if you use commercially available lubricants.
- About your sexual history (to help assess your risk for sexually transmitted infections)
- If you have ever been sexually abused, or had a traumatic injury involving your genitals.
- If you are middle-aged, your doctor will ask whether you are experiencing irregular periods, hot flashes or vaginal dryness, symptoms suggesting that you may have atrophic vaginitis.
- If you are a new mother, your doctor will ask whether you are breastfeeding your baby, because breastfeeding also can lead to vaginal dryness and dyspareunia
During the physical examination, your doctor will check your vaginal wall for signs of dryness, inflammation, infection (especially yeast or herpes infection), genital warts and scarring. Your doctor also will do an internal pelvic examination to look for abnormal pelvic masses, tenderness or signs of endometriosis. If doctors find an abnormal area, they may take a sample to be examined under a microscope (biopsy).
He or she also may suggest that you speak with a counselor to determine whether a history of sexual abuse, trauma or anxiety may be contributing to your symptoms.
- If vaginal dryness is the problem, you can ease penetration and sexual intercourse with increased clitoral stimulation before intercourse or lubrication with an over-the-counter lubricant such as K-Y jelly etc.
- For vaginal yeast infections, you will be given antifungal medication.
- Antibiotics will be prescribed for urinary tract infections or sexually transmitted diseases
- To relieve painful inflammation, try sitz baths, which are warm-water baths in a sitting position.
- For skin diseases affecting the vaginal area, the treatment will vary depending on the disease. For example, lichen sclerosus and lichen planus often improve with steroid creams.
- For vulvar vestibulitis, typical therapies include topical estrogen cream, low-dose pain medications, and physical therapy with biofeedback to lower the muscle tension in the pelvic floor.
- For dryness from menopause, atrophic vaginitis, estrogen therapy will be prescribed, either as a vaginal formulation or as a pill.
- If endometriosis is causing your dyspareunia, you may be prescribed medication or you may need surgical procedures to control or remove abnormal growths of uterine tissue.
- For deep pain, using a different position for intercourse may help. For example, being on top can give women more control of penetration, or another position may limit how deeply the penis can thrust.
- Pelvic muscle relaxation exercises, can help women with tight pelvic muscles learn to consciously relax them.
- For dyspareunia that has no apparent physical cause or has lasted for months or years, you may need psychological counseling to address stress or anxiety regarding sexual intercourse.
Although some causes of dyspareunia, such as a history of sexual abuse or trauma, can’t be avoided, other causes can be prevented:
- To decrease your risk of yeast infection, avoid tight clothing, wear cotton underpants and practice good hygiene. Change your underclothes after prolonged sweating. Bathe or shower daily, and change into dry clothing promptly after swimming.
- To avoid bladder infections, wipe from front to back after using the toilet, and urinate after sexual intercourse.
- To avoid sexually transmitted diseases, avoid sex or practice safe sex by maintaining a relationship with just one person, or using condoms to protect against sexually transmitted diseases.
- To prevent vaginal dryness, use a lubricant, or seek treatment if the dryness is due to atrophic vaginitis.
- If you have endometriosis, avoid very deep penetration, or have sex during the week or two after menstruation (before ovulation), when the condition tends to be less painful.
Pain, including dyspareunia, is greatly affected by emotions. For example, minor discomfort may feel like severe pain after a traumatic sexual experience, such as rape. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. You might start avoiding sexual intercourse if you associate it with the pain. Anger toward a sex partner, fear of intimacy or pregnancy, a negative self-image, or a belief that the pain will never go away may make the pain feel worse.
Sexual intercourse may be uncomfortable the very first time, it should never be painful. If you suddenly begin having pain before, during or after intercourse, see your doctor. It is important to seek care early, before you begin to avoid sexual intercourse or feel anxious in anticipation of your partner. If you don’t know where to start, you can use the Consult a Doctor Platform.
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