Intercourse or sex is a natural and pleasurable act for humans. It is also the means through which the human race continues the lineage. Sex isn’t supposed to hurt or cause too much discomfort; however, women may feel painful intercourse. As per the American College of Obstetricians and Gynaecologists, around 75% of women will feel pain during intercourse at some point in their lives.

For some, it may be rare, but for others, it could be persistent. Just because a woman feels pain, she shouldn’t accept it as normal and get on with it. One shouldn’t have to deal with chronic pain. This phenomenon of pain during intercourse has a medical term for it – dyspareunia. This is defined as recurrent or persistent genital pain that can occur, before, during or after intercourse.

When to see your healthcare provider?

If a woman is experiencing the following problems, it is best to consult a doctor.

  • Pain with penetration and even with using a tampon
  • Pain at sexual entry
  • Aching or burning pain
  • Deep pain with thrusting
  • Throbbing pain that lasts hours after intercourse

Recurrent pain during sex is a problem and women must speak to the doctor about it. It may seem like a small issue, but it can impact your emotional well-being, self-image, and intimate life. The good thing, this is recognized in the medical field, and hence there are ways to treat this issue for a better life. Women may feel pain in the vulva or the area surrounding the vaginal opening known as vestibule or inside the vagina. The perineum is a commonplace where the pain is experienced. Bladder, uterus, pelvic region and lower back are also areas where someone may experience pain.

Facts

  • Dyspareunia is the pain felt during sexual intercourse and is mostly experienced by women.
  • Reasons for this could range from psychological to physical and could be related to menopause as well.
  • Pain can be moderate to severe.
  • Solutions for this could be through therapy, counseling or medication.

Diagnosis

When talking to a physician, the patient will need to agree to a pelvic exam in order to identify the cause of the pain. The doctor will also look at the patient’s medical history. The patient needs to explain the timing, length of duration and the exact location of the pain. There may also be a discussion on reproductive history and previous sexual experiences.

In a pelvic exam, the doctor will look for signs of structural abnormalities or signs of an infection. A device – speculum may be used to check the vagina visually, but it may also cause some discomfort to the women experiencing dyspareunia. When a woman tells the doctor when and where the pain occurs, this can be used to determine the cause. The doctor may press pelvic muscle and the genital area for diagnosis. A pelvic ultrasound can detect endometriosis, structural abnormalities, cysts or fibroids.

Sexual Response Issues

Dyspareunia can be caused by problems in sexual responsiveness. The following can be the most common causes.

  • Partner – there may be a situation where the partner has a sexual problem, and it may cause anxiety in women. A common scenario is that the male partner is on medication for erectile dysfunction; hence the women have a delayed orgasm. This may lead to longer sex and pain.
  • Surgical and medical conditions – Certain medical conditions can indirectly affect a person’s sexual response. Such conditions include diabetes, cancer, thyroid, and arthritis. Women who have gone through surgery can feel issues with body image and a reduced desire for sex. This means no arousal and then painful intercourse.
  • State of mind – Certain emotions like embarrassment, awkwardness, shame, fear, and guilt about having sex can make relaxation difficult. Women need to be in a relaxed state to enjoy comfortable sex. Fatigue and stress can also affect the desire for intercourse.
  • Relationship – Problems with the partner can interfere with good sex. A mismatch between the two partner’s level of desire for sex can be a common reason.
  • Medicine – Some types of pain medication and birth control medication can affect the desire to have sex.

Conditions causing Painful Intercourse

There can be certain causes that lead to dyspareunia.

  1. Deep Pain – This kind of pain occurs with penetration and may be more pronounced with certain positions. The causes for this may be:
  2. Medical treatment or surgery – pelvic surgery scarring from instances like hysterectomy can lead to painful sex. Medical treatment for cancer like chemotherapy and radiation can bring changes to the body and can make sex painful.
  3. Illness – Conditions such as ovarian cysts, haemorrhoids, uterine fibroids, cystitis, irritable bowel syndrome, retroverted uterus, uterine prolapse, pelvic inflammatory disease or endometriosis. 
  4. Vulvodynia – This means chronic pain that impacts a woman’s external sexual organs or the vulva. The vulva includes the vaginal opening, labia, and clitoris. The pain may affect one spot or different areas at different points of time. There isn’t much information on what causes it, and hence self-care is the best way to manage it.
  5. Ectopic pregnancy – If a woman has an ectopic pregnancy, then too, she can experience pain. Here the fertilized egg develops outside the uterus.
  6. Emotional Pain – Emotions and sexual activities are closely linked. Hence any emotional issues may impact intercourse.
  7. Sexual abuse – Not all women going through dyspareunia have been through this. However, sexual abuse is a factor that can cause pain during intercourse.
  8. Stress – If there is stress in your life, then the pelvic floor muscles in the body will tighten. Because of this, penetration can be painful and lead to painful intercourse.
  9. Psychology – Depression, anxiety, body image concerns, or fear of intimacy can lead to lower levels of arousal and result in pain or discomfort.
  10. Entry Pain – Pain caused by penetration is known as entry pain. This can be due to multiple factors such as Irritation, trauma or injury: Irritation or injury from pelvic surgeries, accidents, cut during childbirth or female circumcision can cause painful intercourse later on for women.
  11. Lack of lubrication – A dry channel causes friction during penetration and may lead to pain. That is why foreplay is very important. Menopause, childbirth or breastfeeding can lead to a drop in menopause, causing pain during sex. Medications can affect arousal, or sexual desire can reduce lubrication leading to painful sex. Antihistamines, sedatives, birth control pills, blood pressure medication, and antidepressants can lead to dyspareunia.
  12. Vaginismus – Involuntary muscle spasms of the vaginal wall can also cause this.
  13. Infection, skin disorder or inflammation – Issues such as urinary tract infection, an infection on the genital area or eczema in that part can contribute to painful sex.
  14. Congenital abnormality – A problem from birth, such as the development of a membrane that causes the blockage of the vaginal opening or absence of a fully developed and formed vagina are also valid causes for dyspareunia.

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Treatment for Painful Intercourse

Some treatments for painful sex doesn’t require medical treatments. Like painful sex post-pregnancy can be managed by waiting at least six weeks for sex after childbirth. Following are the treatment options.

  • Medication

If there is an infection or medical condition, then medicines can be used to treat it. When existing medicines cause dryness, then doctors can advise on alternatives. Vaginal dryness due to low levels of estrogen can be treated through topical estrogen. In 2013, the FDA approved ospemifene – a drug for treating dyspareunia at a dosage of 60 mg in a day. There are certain side effects like hot flashes.

  • Counseling

If the woman has experienced trauma, sexual abuse or some emotional issues, then counseling may help. Women who don’t have emotional issues may also choose to attend counseling to deal with dyspareunia caused by other factors. Couples too can attend such sessions to battle intimacy issues due to dyspareunia.

  • Lifestyle

Certain lifestyle changes can address dyspareunia.

  • Sexual health

Safe sex and genital hygiene, along with regular medical check-ups, can prevent the chances of infection. This can reduce dyspareunia.

  • Changes in sexual behavior

Pain can be reduced by using water-based lubricants, enhanced communication, longer foreplay for better lubrication and comfortable sex positions for better pleasure and comfort.

  • Kegel:

Women with vaginismus can benefit from exercises that strengthen pelvic floor muscles. To find these muscles, try to stop urination midway. If you are successful, then you have found the muscles.

Recommended blog: Top 5 Common Causes of Painful Sex for Women

Conclusion

Intercourse needs to be enjoyable for both parties. If the woman or even the man is experiencing pain, then the act becomes unpleasant and forceful. The important thing is to talk to your doctor and counselor to determine the best ways to deal with it and have a healthy sex life.

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