Painful sex, also known as dyspareunia, is a condition experienced by some women that causes discomfort or pain during sexual intercourse. It can have various causes, including physical, psychological, or a combination. Physical factors contributing to painful sex may include vaginal dryness, infections, hormonal imbalances, pelvic floor muscle dysfunction, or certain medical conditions.
Psychological factors such as anxiety, stress, past traumatic experiences, or relationship issues can also play a role in the development of dyspareunia. Seeking medical attention is crucial for diagnosing the underlying cause and developing an appropriate treatment plan. Treatment options may include addressing any physical issues, counseling or therapy to address psychological factors, incorporating changes in sexual practices, or using lubricants to improve comfort and reduce pain. It is important for individuals experiencing painful sex to openly communicate with their healthcare provider to receive proper care and support.
Types of dyspareunia
Dyspareunia refers to persistent or recurrent pain during sexual intercourse. There are various types of dyspareunia, categorized based on the location and underlying causes of the pain.
Superficial dyspareunia
This type of dyspareunia involves pain near the entrance of the vagina or external genitalia. It may be caused by vaginal dryness, vaginal infections, skin conditions, trauma or injury to the area, or a condition called vulvodynia.
Deep dyspareunia
Deep dyspareunia refers to pain felt deeper within the pelvis during intercourse. It is often associated with conditions like endometriosis, pelvic inflammatory disease (infection of the female reproductive organs), uterine fibroids, or adhesions (scar tissue) in the pelvic region.
Vaginismus
Vaginismus is characterized by involuntary spasms or contractions of the muscles around the vaginal opening, which can cause pain or discomfort during attempted penetration. It is often related to anxiety, fear, or psychological factors.
Psychological or emotional dyspareunia
Emotional or psychological factors, such as anxiety, stress, a history of trauma or abuse, relationship problems, or negative sexual experiences, can contribute to pain during intercourse. These factors can affect arousal and lead to muscle tension or difficulty relaxing, resulting in pain.
Mixed or unspecified dyspareunia
Dyspareunia can sometimes involve a combination of factors, making it difficult to categorize into a specific type. This may occur when physical and psychological factors contribute to the pain experienced during sexual activity.
Symptoms
If you have painful intercourse, you may feel:
- Deep pain during thrusting
- Burning pain or aching pain
- Pain only at sexual entry
- Pain with every penetration, including putting in a tampon
- Throbbing pain lasting hours after intercourse
Causes
In many cases, if vaginal lubrication is insufficient, a woman may experience painful intercourse. When this happens, the pain can be relieved if the amount of foreplay is increased or if the couple uses a sex lubricant. Sometimes, a woman may experience painful intercourse if the following conditions exist.
Vaginismus
Vaginismus is the body’s automatic response to the fear of some or all types of vaginal penetration. The vaginal muscles tighten by themselves whenever penetration is done, and there is no control over it.
Vaginal infections
Vaginal infections and vaginitis, or inflammation of the vagina, are so common that most women will experience one or the other, possibly both, in their lifetime. Symptoms of vaginal infection or vaginitis may include vaginal discharge, burning, itching, pain, and a strong odor. While sexually transmitted infections cause some vaginal infections, other very common infections are not.
Problems with the cervix
In this case, the penis can reach the cervix with maximum penetration. Therefore, cervical problems can cause pain during deep penetration.
Problems with the uterus
These problems may include fibroids, which can cause deep pain during intercourse.
Endometriosis
Endometriosis is an often-painful uterine disorder in which tissue similar to the lining of the uterus begins to grow outside the uterus. For this reason, it may involve the ovaries, fallopian tubes, and tissue lining the pelvis. Doctors believe that it is rare for endometrial-like tissue to be found outside of the area where the pelvic organs are located.
Pelvic inflammatory disease (PID)
In pelvic inflammatory disease, the deep tissues inside are severely inflamed, and the pressure of intercourse causes deep pain.
Ectopic pregnancy
An ectopic pregnancy occurs when the fertilized egg implants outside the uterus. An ectopic pregnancy often occurs in the fallopian tube that carries eggs from the ovaries to the uterus.
Menopause
With menopause, the vaginal lining can lose its natural moisture and become dry.
Intercourse too soon after surgery or childbirth
After giving birth, the woman’s body enters the healing phase when the bleeding stops and the cervix closes. Having intercourse too soon, especially in the first two weeks, increases the risk of postpartum bleeding, pain during intercourse, and uterine infection.
Sexually transmitted diseases
Sexually transmitted diseases (STDs) are usually spread through sexual contact. Bacteria, viruses, or parasites that cause sexually transmitted diseases may be transmitted from person to person in blood, semen, vaginal fluid, and other body fluids. These may include genital warts, herpes sores, or other Sexually transmitted diseases.
Injury to the vulva or vagina
These injuries may include a tear from childbirth or a cut (episiotomy) in the area of the skin between the vagina and anus during childbirth.
Vulvodynia
It refers to chronic pain that affects the female external genitalia, collectively called the vulva, including the labia, clitoris, and vaginal opening. It may occur only in one spot, or it may affect different areas from time to time. Doctors do not know what causes it, and there is no known cure. But self-care along with medical treatments can provide relief.
What tests are done to diagnose dyspareunia?
To find the source of the pain and diagnose any medical conditions, healthcare providers may do the following:
- Physical examination: This examination can include a pelvic examination, a rectal examination, and a Pap test. The healthcare provider may also collect a sample of vaginal fluid and urine to test for signs of infection.
- Ultrasound: transvaginal ultrasound can give a better view of the female reproductive system.
- Laparoscopy: In rare cases, laparoscopy is used for other inconclusive tests.
Who is at risk for dyspareunia?
Both women and men can experience dyspareunia, but it is more common in women. Dyspareunia is one of the most common problems of menopausal women.
According to the American College of Obstetricians and Gynecologists, about 75% of women experience painful intercourse at some point. People are more at risk who:
- They use drugs that cause vaginal dryness
- They have a viral or bacterial infection
- They are after menopause
How to treat painful intercourse in women?
Some painful sexual problems in women do not require medical treatment. For example, painful intercourse after pregnancy can be alleviated by waiting at least six weeks after delivery before having intercourse. In cases of vaginal dryness or lack of lubrication, use water-based lubricants.
Some treatments for female genital pain require a doctor’s care. If vaginal dryness is due to menopause, ask a healthcare professional about estrogen creams or other prescription medications. Other causes of painful intercourse may also require prescription medication.
For cases of sexual pain for which there is no underlying medical reason, sex therapy may be helpful. Some people may need to resolve issues such as guilt, internal conflicts about sex, or feelings related to past abuse.
Call Dr.Naim, the best ob-gyn in Los Angeles, 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 other concerns need to be addressed.
Prevention
There is no specific prevention for dyspareunia. But to reduce the risk of pain during intercourse, you can do the following:
- After giving birth, wait at least six weeks before resuming sex.
- Use water-soluble lubricants when you have vaginal dryness.
- Use proper hygiene.
- Get appropriate routine medical care.
- Avoid sexually transmitted diseases (STDs) by using condoms or other barriers.
- Encourage natural vaginal lubrication with plenty of time for foreplay and stimulation.
The bottom line
In conclusion, addressing and finding solutions for painful sex in women is crucial to promote their overall well-being and sexual health.
It is essential for women experiencing painful sex to seek medical attention and discuss their symptoms with a healthcare professional. A thorough evaluation can help identify any underlying medical conditions such as infections, hormonal imbalances, vaginal dryness, pelvic floor dysfunction, or certain anatomical abnormalities. Psychological factors such as stress, anxiety, trauma, or relationship issues may also contribute to the pain experienced during intercourse.
Treatment options for painful sex depend on the underlying cause and may include a combination of medical, psychological, and lifestyle interventions. These can range from medication, hormonal therapy, physical therapy, counseling, or sexual therapy to address the condition’s physical and emotional aspects. Open communication with a healthcare provider and a partner’s support can greatly assist in finding the most appropriate treatment approach.
Additionally, self-care practices can play a significant role in managing and preventing painful sex. Engaging in activities that promote relaxation, using lubricants during intercourse, practicing gentle stretching exercises, and exploring alternative sexual activities can help alleviate discomfort and enhance sexual pleasure.
Remember, every individual is unique, and the experience of painful sex can vary. Therefore, personalized care and a comprehensive approach are key to addressing this issue effectively. By prioritizing sexual health and fostering a supportive environment, we can work towards ensuring that all women have fulfilling and pain-free sexual experiences.
Additional questions
- Can vaginismus be treated?
This occurs due to tightening of the pelvic floor muscles. It is possible to treat vaginismus. However, treatment depends on the underlying cause, whether physical, psychological, or a combination.
- How common is painful sex?
Pain during intercourse is widespread. Approximately 3 out of 4 women experience pain during intercourse during their lifetime. For some women, the pain is only a temporary problem. For others, it’s a long-term problem.
- What can cause pelvic inflammatory disease?
Most cases of PID are caused by a bacterial infection that spreads from the vagina or cervix to the upper reproductive organs. Several types of bacteria can cause PID. It is often caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhea.
- What are the four types of infection?
- Bacterial
- Viral
- Fungal
- Parasitic
- Why is sex painful with endometriosis?
Pain during sex is one of the common symptoms of endometriosis. Penetration and other intercourse-related movements can stretch the endometrial tissue, especially if it has grown at the back of the vagina or the bottom of the uterus. Vaginal dryness can also cause this pain.
References
https://www.webmd.com/sexual-conditions/female-pain-during-sex
https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
https://my.clevelandclinic.org/health/diseases/12325-dyspareunia-painful-intercourse
https://www.princetongyn.com/blog/causes-and-solutions-for-painful-intercourse
https://familydoctor.org/condition/dyspareunia/
https://www.healthdirect.gov.au/painful-sex-for-women
https://www.jeanhailes.org.au/health-a-z/sex-sexual-health/painful-sex-dyspareunia