Pain during sex, or dyspareunia, is persistent or recurring pain just before, during or after sex. The pain is felt in the genital region. Women can have pain externally in the vulvar region — to the labia (lips of the vagina) or at the opening to the vagina. Some feel the pain internally—in the cervix, uterus or lower abdomen. Some women have pain in the vaginal lining itself. The pain also can commonly involve the muscles and nerves in the pelvis.
It’s a common condition that can have negative emotional and psychological effects. In addition to the physical pain, couples may suffer from loss of intimacy or experience strain in their relationship.
This is condition is hard to discuss and is often ignored by your doctor. Dr. Guerette and the IWI team specialize in treating pain with sex and recognize how important it is to your quality of life. We will listen you, make you comfortable to be open and put the effort required in to get a diagnosis and successful treatment plan.
Pain during sex is more common in women. It can affect both men (male dyspareunia) and women (female dyspareunia) of all ages. The pain is usually due to physical factors or medical conditions, but it can also have a psychological component.
Pain during sex is one of the more common gynecologic problems. It affects up to 30% of premenopausal women and over 50% of postmenopausal women.
The location of the pain can help determine what type of dyspareunia you are experiencing:
Entry pain (superficial dyspareunia): This pain is felt at the entrance to the vagina during initial penetration. Some factors associated with entry pain can be lack of lubrication, hormone changes, skin conditions such as lichen sclerosis, injury or infection.
Vaginismus (high tone pelvic floor disorder): This is a condition in which the muscles of the pelvis don’t relax or contract more during penetration. This is discussed further in it’s own section.
Deep pain (collision dyspareunia): This is pain that occurs in deep penetration and can feel worse in certain sexual positions. You will feel this pain in the cervix or lower abdomen. A medical condition or prior surgery usually causes sexual pain that occurs deeper. A very common condition that causes this type of pain is pelvic organ prolapse.
Pain during intercourse can also be described as primary, secondary, complete or situational:
In many cases, you can experience pain during sex if there is not sufficient vaginal lubrication. In these cases, the pain can be resolved if you become more relaxed, increase foreplay or if you use a sexual lubricant.
In some cases, you have painful intercourse if one of the following conditions is present:
Vaginal atrophy: The vaginal lining can lose its normal moisture and thickness and become dry, thin and inflamed. This can be caused by medication, menopause or other hormonal changes.
Vaginismus: The fear of being hurt or prior trauma causes a spasm of the vaginal muscles.
Vaginal infections: These conditions are common and include yeast infections.
Problems with the cervix (opening to the uterus): The penis can reach the cervix at maximum penetration. Therefore, problems with the cervix (such as infections) can cause pain during deep penetration.
Problems with the uterus: These may include fibroids that can cause deep intercourse pain.
Endometriosis: A condition in which the endometrium (tissue lining the uterus) grows outside the uterus.
Problems with the ovaries: Such problems might include ovarian cysts.
Pelvic inflammatory disease: The tissues deep inside become badly inflamed, and the pressure of intercourse causes deep pain.
Ectopic pregnancy: A pregnancy in which a fertilized egg develops outside of the uterus.
Intercourse too soon after surgery or childbirth.
Sexually transmitted infections (STIs): These may include genital warts, herpes sores or other STIs.
Vulvodynia: Causes chronic pain in the vulvar area.
Injury to the vulva or vagina: These injuries may include a tear from childbirth or from a cut (episiotomy) in the perineum (area of skin between the vagina and the anus) that is made during labor. They can also be the consequence of sexual trauma to pelvic surgery.
Skin disorders affecting the genitalia: The most common skin condition is Lichen Sclerosis. The chronic inflammation causes dryness and burning made worse with penetration. The inflammation can also cause the opening of the vagina to fuse partially closed causing superficial pain and excessive tightness.
Psychological issues: Anxiety, depression and low self-esteem can prevent sexual arousal. If you have been a victim of sexual abuse, it can also contribute to your pain during sex.
If you have pain during sex, you may feel:
The most common symptom is pain with intercourse that occurs at the vaginal opening or deep in the pelvis. It can be a distinct pain in one area or it may affect the entire genital region. There can be feelings of discomfort, burning or throbbing.
Dyspareunia doesn’t necessarily cause bleeding. Any bleeding that occurs during sexual intercourse is likely caused by the underlying medical issue. The bleeding could be caused by the same issue that is causing the painful sex.
Talk openly with us about any pain during sexual intercourse. We are here to help you and make you feel heard. Some common questions we may ask are:
Dr. Guerette and the IWI team will diagnose the underlying cause of pain during sex with a thorough, specialized health history and physical examination.
To locate the source of the pain and diagnose any medical conditions, we may perform the following:
The key is a correct diagnosis. Dr. Guerette and the IWI team will provide a diagnosis and design a treatment plan that specifically addresses your issue.
Applying a water-based lubricant to your vagina, vulva and labia is helpful to some women when dryness is the main cause. Those who have pain during sex often stop using vaginal perfumes, bubble baths or scented sanitary pads or toilet paper.
Yes, there is a medicine available to treat pain during sex. If vaginal dryness due to low estrogen is the cause of your painful sex, topical estrogens can be applied to the vagina. The Food and Drug Administration (FDA) approved a drug called ospemifene for dyspareunia due to menopause. It can be taken orally. Medication can also be prescribed to treat pain due to infection or underlying medical conditions.
There are some things you can do on your own to manage the pain you feel during or after sex:
Painful sexual intercourse can be physically and emotionally difficult. We understand. Some questions you may want to ask are:
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