Painful Sex

Painful Sexual Intercourse (Dyspareunia)

Pain during sexual intercourse (dyspareunia) is very common. A recent Swedish survey suggested that it occurs in 9.3 per cent of females, with the incidence being higher among the young and inexperienced and relatively low among the over-50s. There are two type of painful sex:

Supercial Dyspareunia – pain occurs on superficial vaginal penetration.

Deep Dyspareiunia – pain occurs with deep vaginal penetration.

Causes of Superficial Pain

  • Lack of lubrication
  • Vaginismus
  • Menopausal or post-menopausal dryness
  • Vaginal or urinary tract infections
  • Injury - Injury is more commonly caused by a childbirth tear or the episiotomy cut that is often made during labour. Badly healed stitching can also cause pain. Injury to vulva or vagina can occur during rape or sexual assault and later cause superficial pain or vaginismus
  • Genital Herpes and other sexually transmitted infections
  • Vulvitis - This means inflammation of the vulva (the opening to the vagina). It can be due to all sorts of causes, including chemicals in bubble-baths or soaps or irritation from condom latex.
  • Urethral caruncle - This is a tender small swelling patch that develops at the urinary opening.
  • Foreign body in the vagina may cause pain. The usual culprit is a forgotten tampon.
  • Vulvodynia – Pain due to increased sensitivity of the outside part of the sex organs (the vulva)

Causes of Deep Pain

  • Womb trouble: retroverted uterus and other various womb problems, including fibroids, can cause deep intercourse pain.
  • Endometriosis: this very common disorder often affects the womb and surrounding tissues. It makes them very tender, particularly near period times.
  • Ovary problems: cysts on the ovary can cause deep pain. Pain may also be caused if the tip of the penis hits an unusually positioned ovary.
  • Pelvic inflammatory disease (PID):this is caused by infection. In PID, the tissues deep inside become badly inflamed and so the pressure of intercourse causes deep pain.
  • Problems with the cervix: the man's penis hits the cervix at the farthest extent of his thrust. So infections of the cervix and tender places on it can cause pain during deep penetration. This is called 'collision dyspareunia'.
  • Ectopic pregnancy: This may be the first awareness of likelihood of preganancy. It is means a pregnancy outside the womb, usually in the Fallopian tube. Pressure on it can be very painful during sex.
  • Others – irritable bowel syndrome, constipation and other inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease can be associated with deeply painful sex.

Treatment of Painful Sex

For painful intercourse in women after pregnancy:

  • Wait at least 6 weeks after childbirth before resuming sexual relations.
  • Be gentle and patient.
  • Use lubrication as needed

For vaginal dryness/inadequate lubrication:

  • Try water-based lubricants.
  • If you are going through menopause and lubricants don't work, talk to your doctor about estrogen creams or other prescription medications.

Other causes of painful intercourse may require prescription medications or, rarely, surgery.

Sex therapy may be helpful, especially if no underlying medical cause is identified. Guilt, inner conflict, or unresolved feelings about past abuse may be involved which need to be worked through in therapy. It may be best for your partner to see the therapist with you.

Antibiotics, painkillers, or hormones are amongst the treatment options that may be considered.

Prevention

  • Good hygiene and routine medical care will help to some degree.
  • Adequate foreplay and stimulation will help to ensure proper lubrication of the vagina.
  • The use of a water-soluble lubricant like K-Y Jelly may also help. Vaseline should not be used as a sexual lubricant because it is not compatible with latex condoms (it causes them to break), it is not water soluble, and it may encourage vaginal infections.
  • Practicing safe sex can help prevent sexually transmitted infections.