What is painful intercourse?
Painful intercourse (Dyspareunia) is a recurrent or persistent genital pain occurring before, during or after sexual intercourse. Dyspareunia occurs as a result of structural or psychological problems in women. Women may have painful sexual intercourse at some point in their lives.
Therefore, speak to your doctor if you have painful intercourse. Your doctor will explore treatment options based on the cause of your dyspareunia.
What are the causes of painful intercourse?
There are physical and emotional causes of dyspareunia. Physical causes vary as they depend on whether the pain occurs during penetration or with deep thrusting.
Here are the physical causes of dyspareunia:
Pain during penetration
Entry pain may occur as a result of the following factors:
- Insufficient lubrication which may be due to inadequate foreplay. Also, childbirth, breastfeeding or menopause may lead to a drop in estrogen levels, causing poor lubrication. In addition, drugs such as sedatives, antihistamines, antihypertensive drugs, certain control pills, and antidepressants may affect arousal or sexual desire. They decrease lubrication and cause painful intercourse as a result.
- Skin disorders like eczema, infection, inflammation and other skin problems may occur in your genital and urinary tracts, making sex painful.
- Congenital abnormalities such as imperforate hymen (a membrane blocking the vaginal opening) and vaginal agenesis (the absence of a fully formed vagina) can make sex painful.
- Irritation, trauma or injury from an accident, female circumcision, episiotomy (a cut to enlarge the birth canal during childbirth) or pelvic surgery could cause painful intercourse.
- Involuntary vaginal wall muscle spasms (vaginismus) can cause painful penetration of the phallus.
Deep thrusting pain
Deep penetration and thrusting during sexual intercourse could cause deep pain, worse in certain positions. Causes of deep pain include:
- Endometriosis
- Pelvic inflammatory disease
- Uterine prolapse
- Uterine fibroids
- Irritable bowel syndrome
- Ovarian cysts
- Hemorrhoids
- Retroverted uterus
- Cystitis
- Scarring from pelvic surgery like hysterectomy
- Medical treatments like radiation and chemotherapy for cancer
Emotional causes
Emotions affect the sexual activity and therefore play a role in the occurrence of painful sex. These emotional factors lead to a low level of arousal and discomfort or pain during sex.
Here are the emotional causes of dyspareunia:
- Anxiety
- Depression
- Concerns about physical appearance
- Fear of intimacy
- Fear of relationship problems
- Stress which causes tightening of the pelvic floor muscles and pain during sex
- History of sexual abuse can play a role in dyspareunia
It is important to note that the association between dyspareunia and emotional factors is not clear-cut. For example, initial pain during sexual intercourse can instill fear of recurring pain. This makes it difficult to relax, thereby causing more pain. As a result of this, you may start avoiding sexual intercourse, having associated it with pain.
What are the symptoms of painful sexual intercourse?
Painful intercourse comes with the following symptoms:
- Pain during sexual penetration
- Pain during every penetration like with tampon use
- Deep thrusting pain
- After sex throbbing pain
- Aching or burning pain
So if you experience recurrent painful sexual intercourse, go see your doctor. Your doctor will treat the condition and help you improve your sexual life, emotional intimacy, and self-image.
How is painful intercourse diagnosed?
Your doctor will evaluate for dyspareunia by taking a detailed medical history, doing a pelvic exam and other tests. They will ask when, where and how you feel the pain; whether it occurs with every sexual partner and every sexual position.
Also, describe your sexual history, surgical history, and previous childbirth experiences, when asked. Do not be embarrassed or ashamed to give candid answers. In fact, your answers are clues to the cause of your painful sex experience.
Pelvic Exam
Your doctor does a pelvic exam to check for signs of anatomical problems, infection or skin irritation. They may also check for the location of your pain by placing gentle pressure on your pelvic muscles and genitals.
Your doctor may use a speculum to visualize your vagina. Some women with painful intercourse experience discomfort or pain during a pelvic exam. So, if you feel severe pain as your doctor exams you, ask him/her to stop the exam. Finally, your doctor may ask that you do a pelvic ultrasound to check for other possible causes.
How is painful intercourse treated?
The cause of your painful intercourse determines the treatment options to follow.
Here are the effective treatment options for dyspareunia:
Medications
It is important to treat the cause of pain which may be due to an infection or medical condition. Also, there may be a need to change medications known to cause problems of lubrication. All of this might resolve or eliminate your symptoms.
Many postmenopausal women experience dyspareunia due to poor lubrication resulting from low levels of estrogen. Your doctor may recommend you apply topical estrogen to your vagina to improve lubrication.
Your doctor may prescribe ospemifene for moderate to severe painful intercourse in women with lubrication problems. Acting like estrogen, ospemifene works on vagina lining with no harmful effects on the breasts. Estrogen is known for its potentially harmful effects on the breasts.
However, ospemifene may cause hot flashes. Also, it increases the risk of stroke, blood clots and endometrial cancer (cancer of the uterine lining).
Also, prasterone is a drug that can relieve dyspareunia. It is a pessary inserted inside the vagina daily.
Non-medication therapies for painful intercourse
The following treatment options might help with painful sexual intercourse:
- Vaginal relaxation exercises that help reduce pain. This is known as desensitization therapy.
- Sex/counseling therapy. The counselor or sex therapist helps women resolve emotional issues arising from their sexual life experience. For example, even after treatment, women with painful intercourse may still have a negative emotional response to sexual stimulation. As a result, they try to avoid sexual intimacy.
- Cognitive-behavioral therapy helps to change negative behaviors and thought patterns.
Home and lifestyle remedies
You and your partner may need to change your sexual routine as follows:
- Do not rush into penetration and thrusting. Take time during foreplay to stimulate natural lubrication and full arousal. Delay in penetration can reduce pain.
- Change your positioning such as being on top if you have pain during thrusting. It is easier to regulate penetration to a comfortable depth in this position.
- Communicate to your partner how you feel during sexual intercourse. For example, talk about what feels good. Also, tell your partner to slow down if necessary.
- Use lubricants to make sex more comfortable.
How to cope with painful intercourse
You and your partner should find other ways of sexual intimacy until pain during vaginal penetration reduces. In the meantime, kissing and sensual massage may be better alternatives than painful intercourse.
How to prepare for your appointment
Speak with your doctor if you have painful sexual intercourse. Your doctor may diagnose and treat you or refer you to a specialist.
Discuss your sexual problems with your doctor. Let them know when these problems began, under what conditions and how often they occur. Provide your key medical information to your doctor, all the medications, doses of drugs, vitamins and other supplements that you take.
Ask your doctor the following questions if you have painful intercourse:
- What could cause my problem?
- What changes in lifestyle can I make to help improve my condition?
- What treatment options are effective?
- What websites or resource materials can I read for more information?
Expect these questions from your doctor:
- How long have you been having painful intercourse?
- Where exactly is the pain?
- Does the pain occur only in certain cases or every time you have sex?
- How do you relate to your partner?
- How have you discussed this issue with your partner?
- Do you feel pain from any nonsexual activities?
- How much distress do your sexual concerns cause you?
- Do you experience vaginal itching, burning or irritation or burning?
- Have you ever had gynecological surgery?
- Has your doctor ever diagnosed you with a gynecological problem?
Try to answer these questions honestly to enable your doctor to help you effectively resolve the problem.
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