Painful Intercourse (Dyspareunia)

Experiencing pain during sex is common. Sometimes, this pain is due to physical issues, and other times, it's related to emotional or mental factors. The medical term for painful sex is dyspareunia. This means persistent or repeated pain in the genital area, either right before, during, or after sexual activity.

If you're experiencing pain during sex, it's important to talk to your doctor. Treatment options depend on the specific cause of the pain and can be very helpful in resolving or lessening the discomfort. There are many possible reasons for this pain, so discussing it with a healthcare professional is crucial.

Experiencing pain during sex, or dyspareunia, can manifest in several ways. Some women feel pain only when their partner first enters, a sensation often described as pain at penetration. Other times, pain occurs with each attempt at penetration, including inserting a tampon. Some women describe a deep ache or throbbing sensation during the act of sex itself, sometimes continuing for hours afterward. You might also feel a burning or aching pain. All of these are possible symptoms of pain during intercourse.

Experiencing pain during sex repeatedly? It's important to talk to your doctor. Addressing the cause of the pain can improve your sexual experiences, your emotional connection with your partner, and how you feel about yourself.

Painful Intercourse: Understanding the Causes

Experiencing pain during sex, known as dyspareunia, can have various physical and emotional roots. The type of pain—whether it happens at the beginning of sex or deeper in—can point to different underlying issues.

Pain at Entry: Pain when penetration first occurs can stem from several physical factors:

• Physical Injuries or Irritation: Accidents, surgeries (like pelvic surgeries or those involving the vagina), female circumcision, or episiotomies (incisions during childbirth) can lead to injury or irritation, making sex painful.

• Infections or Skin Problems: Genital infections, urinary tract infections, eczema, or other skin conditions in the genital area can cause inflammation and pain during intercourse.

• Vaginismus: Involuntary tightening of the vaginal muscles can make penetration very painful. This is a condition where the muscles around the vagina involuntarily spasm.

• Birth Defects: Sometimes, a person is born with a vaginal opening that isn't fully developed (vaginal agenesis) or with a membrane covering the vaginal opening (imperforate hymen). These conditions can cause pain during intercourse.

• Lack of Lubrication: Not enough foreplay can lead to dryness, making penetration uncomfortable. Changes in hormone levels, such as after menopause, childbirth, or breastfeeding, can also contribute to vaginal dryness.

Deep Pain During Intercourse: Pain that intensifies with deeper penetration often has different causes:

• Health Conditions: Several medical conditions can cause deep pain during sex, including endometriosis (tissue similar to the lining of the uterus growing outside the uterus), pelvic inflammatory disease (infection of the reproductive organs), uterine prolapse (uterus dropping), a retroverted uterus (uterus tilted backwards), uterine fibroids, cystitis (bladder infection), irritable bowel syndrome, pelvic floor dysfunction, adenomyosis (endometrial tissue growing within the uterine wall), hemorrhoids, and ovarian cysts.
• Surgeries and Treatments: Scar tissue from surgeries like hysterectomies (uterus removal) can sometimes cause pain. Cancer treatments like radiation or chemotherapy can also lead to changes that make sex uncomfortable.

Emotional Factors:

Emotions play a significant role in sexual experiences, and they can certainly affect the pain associated with sex.

• Stress: Stress can cause tension in the pelvic floor muscles, making intercourse painful. Even minor stress can contribute to this tension.
• History of Abuse: A history of sexual abuse can significantly impact a person's experience of sex and contribute to pain. This is not true for everyone with pain during sex but can be a factor.

Understanding the Connection: Pain during sex can trigger fear and anxiety, making it difficult to relax. This, in turn, can worsen the pain, leading to avoidance of sexual activity. It's important to remember that emotional factors can be intertwined with physical ones, making it sometimes difficult to isolate the exact cause of the pain.

Several things can make sex uncomfortable. These include medical conditions, operations, other medical procedures, and problems with mental well-being. For example, some illnesses or treatments can affect the tissues around the genitals, making sex painful. Similarly, emotional distress or stress can also impact sexual comfort.

Diagnosing painful sex (dyspareunia) often involves a few steps:

Talking to your doctor: Your doctor will want to know about your pain. This includes when the pain started, where it's located, what it feels like (sharp, burning, etc.), and if it happens with every partner and every position. They'll also ask about your past sexual experiences, any surgeries you've had, and if you've given birth. It's important to be honest, even if it feels embarrassing. These details help pinpoint the cause of the pain.

Physical exam: Your doctor might also need to look inside your vagina. A tool called a speculum is used to gently open the vaginal walls to see the inside. This can sometimes be uncomfortable, and that's okay. Let your doctor know if the exam is too painful, and they can stop.

Other tests: If your doctor suspects a specific problem, such as a physical issue in the pelvic area, a pelvic ultrasound might be needed. This test uses sound waves to create an image of your pelvic organs.

Important Note: Your comfort and honesty are crucial. Don't hesitate to ask questions or express any concerns you have during the evaluation process.

Treating painful intercourse depends on the reason behind the pain. If an infection or another medical issue is causing the pain, treating that problem might solve the issue. Sometimes, changing medications that are contributing to dryness can also help.

Many women going through menopause experience painful intercourse due to vaginal dryness caused by lower estrogen levels. Lower estrogen can often be treated by applying estrogen directly to the vagina. Doctors may prescribe a medicine called ospemifene (Osphena). This medicine works like estrogen in the vagina, but it can cause side effects like hot flashes. It also has a small risk of stroke, blood clots, and uterine lining (endometrium) cancer.

Another option is prasterone (Intrarosa), a capsule placed inside the vagina daily.

There are also non-drug treatments that can help. One is desensitization therapy, which involves learning exercises to relax the vagina and reduce pain. If painful intercourse has been a problem for a while, emotional factors might come into play. You might have negative feelings about sex even after the physical pain is gone. If you and your partner have avoided intimacy because of the pain, you might need help improving communication and getting back to a healthy sex life. Counseling or sex therapy can be very helpful. These therapists can help you manage negative thoughts and behaviors related to sex, which can improve your experience. This could also involve cognitive behavioral therapy, which helps change negative thought patterns and behaviors.

Having pain during sex? Here are some ways to make it more enjoyable for you and your partner:

Experiment with different positions: If you feel sharp pain when you're thrusting, try switching positions. Being on top, for example, can give you more control over the depth of penetration, which might make it more comfortable.

Talk to each other: Open communication is key. Tell your partner what feels good and what doesn't. If you need them to go slower, or adjust the pressure, let them know.

Take your time: Longer foreplay is often helpful. It helps your body produce more natural lubrication, which can make sex more comfortable. Waiting until you're both fully aroused before penetration might reduce any pain.

Use lubricant: Using a personal lubricant can significantly improve comfort during sex. Experiment with different brands and types to find what works best for you.

Find other ways to connect: If vaginal penetration is still painful, there are other ways to be intimate and connect with your partner. Sensual massage, kissing, and mutual masturbation are all great alternatives. They can be just as enjoyable, or even more so, than intercourse, and are a great way to explore intimacy while your bodies are adapting.