One of the commonest problems faced by women is pain during sexual
intercourse. Intercourse pain or dyspareunia, can cause problems in a couple's
sexual relationship. In addition to the physically painful sex, there is also
the possibility of negative emotional effects. So the problem should be
addressed as soon as it arises.
In many cases, a woman can experience painful sex if there is not sufficient
vaginal lubrication. When this occurs, the pain can be resolved if the female
becomes more relaxed, if the amount of foreplay is increased, or if the couple
uses a sexual lubricant.
Painful intercourse, described medically as dyspareunia, is not uncommon. An
estimated 20 to 50 percent of women experience some form of sexual dysfunction,
including pain during sex. "The term 'dyspareunia' means pain during sex, and it
covers a huge category of symptoms, with a huge range of possible causes," says
Edwin Huang, MD, a gynecologist at Massachusetts General Hospital in Boston.
Those causes commonly range from, easily remedied issues such as allergic
reactions or infections, to more complex, psychological issues.
For women, the symptoms of dyspareunia include pain in the vagina during sexual
activity, either at the entrance of the vagina or further inside. Some women
experience vaginismus, which means that their vaginal muscles involuntarily
contract during penetration, making the experience painful. Dr. Huang says that
some women with vaginismus not only have pain during sex, but they may also feel
pain during routine gynecological exams.
You may feel pain in your vulva, in the area surrounding the opening of your
vagina (called the vestibule), or within your vagina. The perineum is a common
site of pain during sex. You also may feel pain in your lower back, pelvic
region, uterus, or bladder.
In some cases, a woman can experience painful sex if one of the following
conditions is present:
Vaginismus. This is a common condition. It involves an involuntary spasm
in the vaginal muscles, mainly caused by fear of being hurt.
Vaginal infections. These conditions are common and include yeast
Problems with the cervix (opening to the uterus). In this case, the
penis can reach the cervix at maximum penetration. So problems with the
cervix (such as infections) can cause pain during deep penetration.
Problems with the uterus. These problems may include fibroids that can
cause deep intercourse pain.
Endometriosis. This is a condition in which the tissue that lines the
uterus grows outside the uterus.
Problems with the ovaries. Problems might include cysts on the ovaries.
Pelvic inflammatory disease (PID). With PID, the tissues deep inside
become badly inflamed and the pressure of intercourse causes deep pain.
Ectopic pregnancy. This is a pregnancy in which a fertilized egg
develops outside the uterus.
Menopause. With menopause, the vaginal lining can lose its normal
moisture and become dry.
Intercourse too soon after surgery or childbirth.
Sexually transmitted diseases. These may include genital warts, herpes
sores, or other STDs.
Injury to the vulva or vagina. These injuries may include a tear from
childbirth or from a cut (episiotomy) made in the area of skin between the
vagina and anus during labor.
Some treatments for painful sex in women do not require medical treatment. For
example, painful sex after pregnancy can be addressed by waiting at least six
weeks after childbirth before having intercourse. Make sure to practice
gentleness and patience. In cases in which there is vaginal dryness or a lack of
lubrication, try water-based lubricants.
Some treatments for female sexual pain do require a doctor's care. If vaginal
dryness is due to menopause, ask a health care professional about estrogen
creams or other prescription medications. Other causes of painful intercourse
may also require prescription drugs.
For cases of sexual pain in which there is no underlying medical cause, sexual
therapy might be helpful. Some individuals may need to resolve issues such as
guilt, inner conflicts regarding sex, or feelings regarding past abuse.
Call a doctor if there are symptoms such as bleeding, genital lesions, irregular
periods, vaginal discharge, or involuntary vaginal muscle contractions. Ask for
a referral to a certified sex counselor if there are other concerns that need to
Because there are so many possible causes of dyspareunia and vaginismus, Huang
says, it is difficult to talk generally about treatment options. But, he says,
"finding the source of the issues is more than half the battle." Huang says the
first step for a doctor in treating dyspareunia is to compile a thorough and
complete medical and sexual history of the patient, to identify possible causes.
These could include:
Allergic reactions. The skin in the vagina can be irritated if you have an
allergic reactions to a soap, detergent, a douche product, or perfumed tampons
or maxi pads. Switch to unscented products with fewer ingredients if you suspect
allergies may be involved Huang does not recommend douching because it can
irritate the skin in the vagina.
Vaginal itching. Yeast infections, urinary tract infections (UTIs), and some
sexual transmitted diseases cause itching and burning sensations in the vagina.
Having sex while you are suffering from one of these conditions can be
unpleasant and can cause dyspareunia. UTIs and yeast infections are treatable,
and most sexually transmitted diseases can be treated or managed.
Vaginal dryness. As many as 20 percent of women report lubrication difficulties,
which can lead to pain during sex. The hormonal changes that accompany menopause
can also lead to vaginal dryness. Huang says that using water-based lubricants
and engaging in more foreplay before sexual intercourse can help with vaginal
Vaginismus. The involuntary contraction of vaginal muscles during penetration,
or vaginismus, can be caused by physical and psychological factors, Huang says.
Identifying the cause of vaginismus is essential for developing a treatment
Though dyspareunia is often caused by easily treatable conditions, sometimes it
can be a sign of more serious issues.
Health conditions. Sometimes, dyspareunia is a sign of other health conditions,
including hemorrhoids or endometriosis, a condition in which the tissue that
lines the uterus starts growing in other places in the body. All of these
conditions are treatable.
Psychological causes. Psychological factors, such as anxiety and depression, can
adversely affect sexuality and bring on dyspareunia. Women who have been
sexually abused may find that their relationship to sex has changed
dramatically. A sex therapist or counselor can help you address these root
psychological causes and work with you to cultivate a healthy and positive
Bottom line on sexual pain: Recognize your symptoms and seek advice. If you
experience pain during intercourse, talk to your gynecologist. Sexual pain does
not have to be part of your life.
Physical causes of painful intercourse differ, depending on whether the pain
occurs at entry or with deep thrusting. Emotional factors can be associated with
many types of painful intercourse.
Pain during penetration may be associated with a range of factors, including:
Insufficient lubrication. This is often the result of not enough foreplay.
Insufficient lubrication is also commonly caused by a drop in estrogen levels
after menopause, after childbirth or during breast-feeding.
Certain medications are known to inhibit desire or arousal, which can decrease
lubrication and make sex painful. These include antidepressants, high blood
pressure medications, sedatives, antihistamines and certain birth control pills.
Injury, trauma or irritation. This includes injury or irritation from an
accident, pelvic surgery, female circumcision or a cut made during childbirth to
enlarge the birth canal (episiotomy).
Inflammation, infection or skin disorder. An infection in your genital area or
urinary tract can cause painful intercourse. Eczema or other skin problems in
your genital area also can be the problem.
Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make
attempts at penetration very painful.
Congenital abnormality. A problem present at birth, such as the absence of a
fully-formed vagina (vaginal agenesis) or development of a membrane that blocks
the vaginal opening (imperforate hymen), could be the underlying cause of
Deep pain usually occurs with deep penetration and may be more pronounced with
Certain illnesses and conditions. The list includes endometriosis, pelvic
inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids,
cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.
Surgeries or medical treatments. Scarring from pelvic surgery, including
hysterectomy, can sometimes cause painful intercourse. Medical treatments for
cancer, such as radiation and chemotherapy, can cause changes that make sex
Emotions are deeply intertwined with sexual activity and may play a role in any
type of sexual pain.
Emotional factors include:
Psychological problems. 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. Most women with dyspareunia don't have a history of
sexual abuse, but if you have been abused, it may play a role.
Sometimes, it can be difficult to tell whether psychological factors are
associated with dyspareunia. Initial pain can lead to fear of recurring pain,
making it difficult to relax, which can lead to more pain. As with any pain in
your body, you might start avoiding the activities that you associate with the
Sexual response problems: The following reasons are among the most common:
Your state of mindóEmotions such as fear, guilt, shame, embarrassment, or
awkwardness about having sex may make it hard to relax. When you cannot relax,
arousal is difficult, and pain may result. Stress and fatigue can affect your
desire to have sex.
Relationship problemsóProblems with your partner may interfere with your
sexual response. A common relationship issue is a mismatch between partners in
their level of desire for sex.
MedicationsóMany medications can reduce sexual desire, including some birth
control methods. Many pain medications also can reduce sexual desire.
Medical and surgical conditionsóSome medical conditions can indirectly
affect sexual response. These conditions include arthritis, diabetes, cancer,
and thyroid conditions. Some women who have had surgery find that it affects
their body image, which may decrease their desire for sex.
bIf your partner has a sexual problem, it can make you anxious about sex. If
your partner is taking a drug for erectile dysfunction, he may have delayed
orgasm, which can cause long, painful intercourse.
Gynecologic conditions can cause pain during sex
Pain during sexual intercourse can be a warning sign of many gynecologic
conditions. Some of these conditions can lead to other problems if not treated:
Skin disordersóSome skin disorders may result in ulcers or cracks in the
skin of the vulva. Contact dermatitis is a common skin disorder that affects the
vulva. It is a reaction to an irritating substance, such as perfumed soaps,
douches, or lubricants. It may cause itching, burning, and pain. Treatment of
skin disorders depends on the type of disorder.
VulvodyniaóThis is a pain disorder that affects the vulva. When pain is
confined to the vestibule (the area around the opening of the vagina), it is
known as vulvar vestibulitis syndrome (VVS). There are many treatments available
for vulvodynia, including self-care measures. Medication or surgery may be
needed in some cases. For more information about this condition, see the FAQ
Hormonal changesóDuring perimenopause and menopause, decreasing levels of
the female hormone estrogen may cause vaginal dryness. Hormone therapy is one
treatment option. Using a lubricant during sex or a vaginal moisturizer also may
VaginitisóVaginitis, or inflammation of the vagina, can be caused by a yeast
or bacterial infection. Symptoms are discharge and itching and burning of the
vagina and vulva. Vaginitis can be treated with medication (see the FAQ
VaginismusóVaginismus is a reflex contraction (tightening) of the muscles at
the opening of your vagina. Vaginismus may cause pain when you try to have
Vaginismus can be treated with different forms of therapy.
ChildbirthóWomen who have had an episiotomy or tears in the perineum during
childbirth may have pain during sex that may last for several months. Treatments
include physical therapy, medications, or surgery.
Other causesóPelvic inflammatory disease, endometriosis, and adhesions are
all associated with pain during sex.
Your medical and sexual history, signs and symptoms, and findings from a
physical exam are important factors in determining the cause of your pain.
Sometimes, tests are needed to find the cause. A pelvic exam or ultrasound exam
often gives clues about the causes of some kinds of pain. Further evaluation,
sometimes involving a procedure called a laparoscopy, may be needed.
You also may be asked about medications that you are taking, whether you have
any medical conditions, and past events that may affect how you feel about sex,
such as sexual abuse. Other health care providers may be consulted for further
evaluation and treatment, such as a physical therapist or a dermatologist (a
specialist in diseases of the skin).
Things a woman can do on her own to help with pain during sex
If you have pain during sex, see a health care provider. However, there are some
self-help measures you can try to relieve pain during sex:
Use a lubricant. Water-soluble lubricants are a good choice if you
experience vaginal irritation or sensitivity. Silicone-based lubricants last
longer and tend to be more slippery than water-soluble lubricants. Do not
use petroleum jelly, baby oil, or mineral oil with condoms. They can
dissolve the latex and cause the condom to break.
Make time for sex. Set aside a time when neither you nor your partner is
tired or anxious.
Talk to your partner. Tell your partner where and when you feel pain, as
well as what activities you find pleasurable.
Try sexual activities that do not cause pain. For example, if
intercourse is painful, you and your partner may want to focus on oral sex
or mutual masturbation.
Try nonsexual, but sensual, activities like massage.
Take pain-relieving steps before sex: empty your bladder, take a warm
bath, or take an over-the-counter pain reliever before intercourse.
To relieve burning after intercourse, apply ice or a frozen gel pack
wrapped in a small towel to the vulva.
If you have frequent or severe pain during sex, you should see a health care
provider. It is important to rule out gynecologic conditions that may be causing
your pain. Your health care provider also can help you address problems with
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