Sexual intercourse while supposed to be a pleasurable experience may be associated with considerable pain or discomfort for some. This condition of painful intercourse is called dyspareunia, and can be due to many medical or psychological causes.
It affects women much more commonly than men, globally 8-12% of women have experienced dyspareunia at some point in their lives. However, it is mostly treatable with the right approach and you will be able to lead a healthy sexual life.
Try to describe the pain: –
The duration, location and nature of pain may provide important clues to the underlying cause.
- You may experience one or more of the following patterns
- Superficial: – when penetration is attempted
- Deep seated: -not associated with penetration but is felt only after this has occurred and is felt in the depth of the vagina on deep penetration.
- After intercourse: – Main complaint is feeling of an aching soreness that may last for hours after completing the act. May sometimes be associated with the deep seated variety.
- Superficial type of pain suggests that the problem lies at or near the introitus (which is the area surrounding the opening of the vagina.), whereas deep seated or post-coital pain may mean involvement of structures deeper in the pelvis.
- Pain could affect a small area of vulva or vagina or could be felt all over the surface.
- Some women have always experienced pain for others it may be a recent problem after injury or infection. Some experience it after menopause only.
- It may increase over time or occur cyclically with menstruation.
What could cause it: –
If the couple is inexperienced chances are it is due to improper technique or inadequate lubrication. if not this, there are many causes of discomfort during sex that could point towards an underlying problem.
- Painful lesions in the area of introitus. This causes superficial pain. It could be due to infection of vagina(vulvitis) or urinary tract possibly an STD.
- Many skin lesions in the genital area may also produce pain like boils, fungal infections etc.
- It could also be due to a tender scar from obstetric trauma during previous child birth such as applying instruments like forceps or ventouse (vacuum) or else a cut given to enlarge the vaginal opening. Other surgeries such as if you had your uterus removed or repair of prolapsed uterus could later lead to dyspareunia.
- If the woman has always experienced pain during sex it most likely would be a defect since birth in the structure of vagina which has to be corrected like thickened hymen, small contracted vaginal opening, or vaginal canal defects.
- Menopausal women commonly experience dyspareunia as they have dry vagina and estrogen deficiency.
- Disorders of cervix(cervicitis). The penis hits the cervix during deep penetration and if it is inflamed will cause pain it’s called ‘collision dyspareunia’
- Uterus, ovaries and fallopian tube lesions and pelvic inflammatory disease (PID) which is infection of these structures can also cause discomfort during sex and deep seated pain. PID can occur if an STD ascends up the vagina or during previous invasive procedures like IUD insertion for contraception, medical abortions, biopsy of uterine lining etc.
- Presence of lesions that take up space in the pelvis like ovarian cysts, tumors or fibroids in the uterus.
- Hormonal problems like growth of uterine lining in abnormal areas (called endometriosis)
- Even problems of anal canal can cause pain during intercourse.
Men – though less common, men too may experience painful intercourse due to similar problems.
- Infections of genital area may lead to burning or itching following ejaculation. Gonorrhea can cause similar symptoms.
- Bladder infection can lead to intense pain just before ejaculation.
- Anatomical deformities
Psychological aspect of dyspareunia:
Sometimes there is nothing physically wrong in the patient but she may associate a negative character to the act of sex that makes it painful. The vaginal muscles actually go into spasm at any attempt of entry something that is called vaginismus.
History of abuse, disharmony with the partner, childhood beliefs thinking sex is sinful or dirty or any previous painful experience during sex can cause it in anticipation of pain.
Proper counseling and seeking professional may help.
A single episode or isolated occasional soreness can be ignored as such is normal. However persistent distressing pain must be promptly examined by a gynecologist.
Meanwhile, certain changes on your part can help too although a consult is a must
- change in position to avoid deeper penetration
- prolonging foreplay to help in natural lubrication
- using artificial lubricants.
Treatment centers around treating the underlying cause
- antibiotics for infections picked up on urine culture, blood tests or vaginal swabs
- surgical for any structural abnormality or Ovarian and uterine cysts, fibroid etc. seen on local per speculum exam or ultrasound.
- Estrogen treatment for menopausal vaginal dryness.
- Counseling for psychological cause.