What are the Causes of Pain During Sex?
The medical term for painful intercourse is dyspareunia, which is defined as persistent or recurrent genital pain that occurs just before, during, or after sex. If you’re having painful intercourse, speak to your healthcare professional— treatments will focus on the cause, and can help eliminate or lessen this common problem.
Many women experience painful intercourse at some point in their lives. You might feel pain upon penetration, deep pain during thrusting, burning or aching pain, or even throbbing pain that persists hours after intercourse.
If the problem is consistent or recurrent however, it may be the result of anything from structural problems to psychological concerns. If you have recurrent pain with sex, talk to your healthcare provider— treating the problem can help your emotional and mental health, your self-image, and the pain itself. The causes of pain with sex can differ depending on whether the pain occurs only at entry, or with deep penetration.
Pain at Entry
This can be associated with many factors, including:
- A lack of lubrication. This might be the result of insufficient foreplay, or nervousness surrounding sex. A drop in oestrogen levels following menopause or childbirth might also cause a lack of lubrication. Certain medications are known to affect sexual arousal or the mucous membranes of the vagina, and can contribute to vaginal dryness and discomfort. These might include antidepressants, high blood pressure medication, antihistamines and certain birth control pills which affect hormone levels.
- Injury, trauma, or irritation. This can include injury or irritation from an accident, surgery in the pelvic region, female circumcision, or incisions made during childbirth to enlarge the birth canal.
- Inflammation, infection, or a skin disorder. An infection in your genital area or urinary tract can contribute to painful intercourse, as can skin problems like Eczema.
- Vaginismus. These are involuntary spasms of the muscles of the vagina wall that can make penetration painful.
- Problems present at birth. Not having a fully formed vagina, or the development of a membrane that blocks the vaginal opening (imperforate hymen) could cause dyspareunia.
Pain During Deep Penetration
Causes for consistent pain during intercourse or deep thrusting might include:
- Certain illnesses and conditions. These can be anything from fibroids and ovarian cysts to endometriosis and pelvic inflammatory disease. Painful sex is often a symptom of a number of more serious conditions, so you might ask your health professional about testing for these.
- Past surgeries or medical treatments. This can include scarring from pelvic surgery, such as a hysterectomy, or medical treatments such as radiation or chemotherapy. Both of these can cause changes to the body that make sex uncomfortable, or consistently painful.
- Emotional factors. Emotions are often deeply intertwined with sexual activity, and might play a role in your pain. These can include psychological issues such as anxiety, depression, a poor self-image or a fear of intimacy. They might also be linked to stress in your daily life. It can be difficult to tell whether emotional factors are associated with dyspareunia; initial pain can lead to fear of recurring pain, which can contribute to stress and further pain. You may start avoiding sex altogether if you associate it with the pain.
- A history of sexual abuse. Not everyone with dyspareunia has a history of sexual abuse, but if you have been abused, it can easily play a role.
How Can Painful Intercourse be Diagnosed?
To diagnose whether your discomfort is recurrent, or persistent, you might be subject to a medical evaluation from your healthcare provider. This will usually begin with your medical history, such as asking when your pain began, where it is located, how it feels and if it happens with every partner or sexual position. It is normal to be a little uncomfortable or embarrassed, but don’t let this stop you from answering truthfully. You are not the only person to experience discomfort during intercourse, and by being open with your doctor, they can more accurately discover the cause of your pain.
The next step is usually a pelvic exam, where your doctor will check for signs of irritation, infection, or obvious anatomical complications such as an imperforate hymen. They might also try to locate your pain by applying gentle pressure to your genitals or pelvic muscles. The examination might include the use of a speculum as well, like the kind used during cervical screening or a Pap smear. The vaginal walls will be gently separated to provide a closer look inside. If this becomes painful as well, you can always ask to stop the exam, and there are other options.
For example, your doctor might suspect certain things to be the cause of painful intercourse and recommend a pelvic ultrasound. This will most likely be transvaginal, consisting of a small transducer wand inserted into the vagina to produce sound waves and capture the reflections as images on a video screen. This can help your health provider discover if you are suffering from something like ovarian cysts, or endometriosis.
How Can Pain During Sex be Treated?
Once your doctor has determined the cause and severity of your pain, you will be recommended a treatment. This will usually take the form of medication, or therapy. In some cases, if your pain during sex is revealed as a symptom of a larger problem, you may be recommended surgery— in this way, treating the larger problem will help resolve your painful symptom.
For many women, especially post-menopause, painful intercourse can be caused by inadequate lubrication caused by low levels of oestrogen. Often, this can be treated with:
- Local Oestrogen. Vaginal dryness can respond well to local oestrogen treatments that help balance the hormone levels in your body. These can also help greatly with discomfort and pain, as well as regulate bacteria. Local oestrogen treatments might take the form of small tablets inserted into the vagina with an applicator, gels and creams, or vaginal rings which are replaced every few months.
- Pessaries. A once-daily pessary, or a soluble medicine inserted into the vagina can help to regulate hormone levels through the release of Dehydroepiandrosterone (or DHEA).
- Ospemifene. A table treatment that has an oestrogen-like effect in the vagina, which is suitable for some women who are not candidates for vaginal oestrogen.
If your pain is diagnosed as a symptom of endometriosis, chronic pelvic pain, or ovarian cysts, you will likely be recommended medical treatments more specifically suited to resolving those conditions. Find out more through the linked articles.
Sometimes, if the cause of your painful intercourse is psychological, tied to your emotions or stress, the best course of treatment might be non-medical. This might take the form of counselling or sex therapy. If sex has been painful for you for some time, you might have developed a negative emotional response to sexual stimulation— even after medical treatment. If you and your partner have avoided intimacy because of this, you may need help improving communication with your partner to combat your condition together and restore intimacy. Consider seeking out a counsellor or a sex therapist.
Another option is found in desensitisation therapy. Learning simple psychological techniques to change your mindset and reduce pain perception can be a potent tool. Consult a psychologist to receive help preparing yourself to tackle this problem. This can be used in conjunction with physical therapy, aimed at identifying other issues that can arise because of your pain. Together, these can provide a framework of mental and physical exercises to help you cope with your dyspareunia.
If you are experiencing pain during sex, make an appointment with Dr.Nicole Stamatopoulos here.