Women’s Health : Common Causes of Pain During Sexual Intercourse

The medical term for painful intercourse is dyspareunia and it is defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. Painful intercourse can occur for reasons that range from structural problems to psychological concerns. Many women have painful intercourse at some point in their lives. Talk to your doctor if you’re having painful intercourse. Treatments focus on the cause, and can help eliminate or lessen this common problem.

Painful intercourse can usually be felt as

  • Pain only at sexual entry (penetration),
  •  Pain with every penetration including putting in a tampon,
  •  Deep pain during thrusting,
  • Burning pain or aching pain, or
  • Throbbing pain, lasting hours after intercourse.

What Are The Causes?

Physical causes of painful intercourse differ, depending on whether the pain occurs at penetration or with deep thrusting. Emotional factors might also be associated with many types of painful intercourse. Initial pain can lead to fear of recurring pain, making it difficult to relax, which can lead to more pain. You might start avoiding sexual intercourse if you associate it with the pain.

1. Penetration Pain

Pain during penetration might be associated with a range of factors, including:

  • Not enough lubrication – This is often the result of not enough foreplay. A drop in estrogen levels after menopause or childbirth or during breast-feeding also can be a cause. Certain medications are known to affect sexual desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills.
  • Injury, trauma or irritation – This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).
  • Inflammation, infection or skin disorder – An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.
  • Vaginismus – These involuntary spasms of the muscles of the vaginal wall can make penetration painful.
  •  Congenital abnormality – A problem present at birth, such as the absence of a fully formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could cause dyspareunia.

2. Deep Pain

Deep pain usually occurs with deep penetration. It might be worse in certain positions. Causes include:

  • Certain illnesses and conditions –The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.
  • Surgeries or medical treatments – Scarring from pelvic surgery, including hysterectomy, can cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful.

3. Emotional factors

Emotions are deeply intertwined with sexual activity, so they might play a role in sexual pain. Emotional factors include:

  •  Psychological issues – Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain.
  •  Stress – Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
  •  History of sexual abuse – Not every woman with dyspareunia has a history of sexual abuse, but if you have been abused, it can play a role.

Treatment

Treatment options vary depending on the cause of the pain. If an infection or medical condition contributes to your pain, treating the cause might resolve your problem. Changing medications known to cause lubrication problems also might eliminate your symptoms.

For many postmenopausal women, dyspareunia is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to the vagina.

The Food and Drug Administration approved the drug ospemifene (Osphena) to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining, but doesn’t seem to have estrogen’s potentially harmful effects on the breasts.

Drawbacks are that the drug might cause hot flashes, and it carries a risk of stroke, blood clots and cancer of the lining of the uterus (endometrium). Another drug to relieve painful intercourse is prasterone (Intrarosa). It’s a capsule you place inside the vagina daily.

Certain non-medication therapies also might help with dyspareunia. You learn vaginal relaxation exercises that can decrease pain. If sex has been painful for some time, you might have a negative emotional response to sexual stimulation even after treatment and so you may need to go for counseling and sex therapy.

If you and your partner have avoided intimacy because of painful intercourse, you might also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues. Cognitive behavioral therapy can also be helpful in changing negative thought patterns and behaviors.

Lifestyle and home remedies

You and your partner might be able to minimize pain with a few changes to your sexual routine:

  • Change positions. If you have sharp pain during thrusting, try different positions, such as being on top. In this position, you might be able to regulate penetration to a depth that feels good to you.
  • Communication is important. Talk about what feels good and what doesn’t. If you need your partner to go slow, say so.
  • Don’t rush. Longer foreplay can help stimulate your natural lubrication. You might reduce pain by delaying penetration until you feel fully aroused.
  •  Use lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one you like.

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