Painful Intercourse
What causes pain during sexual intercourse?
The quality of your sex life is important at every age. One problem that can be hard to talk about is painful sex. The pain can be at the opening of the vagina and vulva, inside the vagina, or deeper in the pelvic area. Sex should never be painful. When it is, it means that something is wrong. In many cases, simple things such as a lack of natural lubrication in the vagina or an awkward position can be the cause. There are many physical and emotional factors that can cause painful intercourse.
You may feel pain at the opening of your vagina or in the vulva, which is the area around the vaginal opening. Even a gentle touch in this area may cause pain. The pain can be caused by:
- infection
- irritation from soaps, spermicides, or other chemicals
- a problem called vulvar dystrophy, which is a thinning or thickening of the skin of the vulva.
Pain during sex can be caused by vaginal dryness. Possible causes of vaginal dryness are:
- a lack of natural moisture resulting from not enough foreplay
- hormonal changes such as those that happen during breast-feeding or during or after menopause
- psychological factors that affect your level of sexual arousal.
Examples of other problems that can cause pain in the vaginal or vulvar area are:
- Bartholin's gland cyst, a swelling of a gland near the opening of the vagina
- scarring of tissues from a pelvic infection, childbirth, or vaginal or pelvic surgery
- injury to the vaginal area.
Sometimes the muscles at the opening of the vagina tighten because of spasms. The muscle tightening can make the vaginal opening smaller. It may even close the opening. This condition is called vaginismus. It causes pain and the penis may not be able to enter the vagina. Psychological factors such as a fear of intercourse, fear of getting pregnant, or fear of being hurt may cause the vaginal muscles to tighten.
You may feel pain deep inside your vagina during sexual intercourse. This can be caused by problems such as:
- movements that are too forceful
- bladder that is too full
- infection of the bladder, vagina, or pelvis
- growths in the uterus called fibroids
- ovarian cysts (fluid-filled sacs in or on an ovary)
- endometriosis, an abnormal growth of uterine tissue outside the uterus
- prolapsed (fallen) uterus, meaning the uterus has moved from its normal position down into your vagina
- tipped uterus (the uterus is tipped backward and downward)
- scarring of tissues from a pelvic infection
- injury to the vagina from childbirth, rape, or sexual abuse.
The medical term for painful intercourse is dyspareunia.
How is it diagnosed?
Your healthcare provider will ask about the pain. You may have a pelvic exam and tests to look for infection or other problems. Tests may include:
- cultures for infection
- blood tests
- urine tests
- ultrasound
- laparoscopy (surgery to look at your pelvic organs).
How is it treated?
Your treatment depends on the cause of the pain.
- If you have an infection, your provider will prescribe medicine for it.
- If vaginal dryness is the cause, your provider may recommend using a water-based lubricant every day or every time you have sex to decrease pain or discomfort. Lubricants can be purchased at a drugstore.
- During or after menopause, an estrogen cream put on the vaginal area may help.
- Kegel exercises and dilators of the vagina can help vaginismus.
Depending on the cause, other possible treatments include counseling or surgery.
How can I take care of myself?
- If you have itching, burning, pain, or other symptoms of irritation or infection, see your healthcare provider. Follow the treatment prescribed or recommended by your provider.
- Use a water-based vaginal lubricant when you have sex.
- Avoid using soaps, spermicides, or other chemicals that can irritate the skin of your genital area.
- Talk to your partner about what might help to increase your readiness for sex.
- If psychological or emotional problems appear to be contributing to the problem, see a therapist or marriage counselor.
