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Pain during sex

What causes pain during and after sex?

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Dyspareunia is the medical term for painful sexual intercourse: the pain can be recurrent or continuous and is in the genital or pelvic areas of the body.  The pain is felt during or after sex.

It is a quite common condition that can be experienced by both men and women; it can be caused by a number of different things including infection, physical and psychological problems

Painful sex is perhaps an issue that is not spoken about openly but it can have a profound effect on peoples lives. It is believed that as many as a thirds of younger people and half of older people have experienced the problem.  The effects of painful sex can be far-reaching, leading to relationship problems, loss of intimacy and even depression.

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Causes of dyspareunia

In women

Women may experience pain either in the vagina or deeper inside the pelvis

Causes of pain in the vagina include:

  • A number of different infections can cause pain in the vagina, amongst these, are thrush, sexually transmitted infections which can include genital herpes, chlamydia, gonorrhoea and trichomoniasis
  • Sex may be painful during the menopause as the changes in hormone levels may lead to a dry vagina which in turn may be painful as the penis penetrates a vagina that is not lubricated.  The conditions that cause a woman to not be aroused may be  as a result of psychological or emotional factors such as stress, guilt, history of rape or relationship problems
  • Sexual arousal will lead to a woman producing her own lubrication in the vagina in preparation for sexual intercourse.  If the arousal has not occurred then lubrication will not be produced
  • Skin problems in the area may cause pain; lichen sclerosis is a condition which affects the genital area causing itchiness and thinning of the skin which may split during intercourse
  • There is a condition called vaginismus that causes the muscles of the vagina to tighten which makes sex painful or even impossible
  • Another condition that affects the female external genitalia is vulvodynia; this involves having chronic pain or labia, clitoris and vaginal entrance.  The pain may occur in just one spot or the position where the pain is felt may change.  The medical profession does not know its cause and there is no definitive cure for the condition; self-care combined with some medication can help to relieve the condition
  • Any injury to the vulva or vagina may cause pain; the injury may have been sustained during childbirth either as a tear or from an episiotomy (surgical cut)
  • In some cases, the penis, during deep penetration, may be able to touch the cervix (neck of the uterus).  If there are any problems with the cervix such as infection this may cause pain
  • Any allergy to spermicide, latex condoms, artificial lubricant or soap and shampoo may cause the vaginal area to become sore and inflamed;  the action of the penis penetrating the vagina is likely to be painful in these circumstances

 

Causes of pain deep inside the pelvis can include:

  • Pelvic inflammatory disease (PID)
  • Endometriosis
  • Fibroids
  • Ovarian cysts
  • The presence of an ectopic pregnancy (pregnancy which has implanted inside the fallopian tube) may cause deep pelvic pain during sex
  • Irritable bowel syndrome (IBS)
  • Constipation

 

In men

Some conditions which may cause sex to be painful for men include:

  • Any infections which cause soreness and itching of the penis such as thrush and sexually transmitted infections such as genital herpes
  • If a man’s foreskin is tight then sex may be painful as the foreskin is pushed back during intercourse
  • There may be small tears in the foreskin that cause the area to be sore and cause sharp or stinging pain.  The action of penetrative sex is likely to be very painful in these circumstances
  • Inflammation of the prostate gland
  • Swelling and pain in the testicles; this may be as a result of being sexually aroused but not ejaculating.  It may also be a sign of infection such as chlamydia

 

Treatment for Dyspareunia

It is important that you consult your GP if you experience pain during sexual intercourse.  They are in the best position to determine the cause of the pain and so to advise on any treatment that may be required

Examples are:

  • If you suffer from a dry vagina then your GP may advise using a proprietary lubricant.  It is important to remember that if you use condoms as a protective barrier or form of contraception, the lubricant must be water-based as oil-based lubricants can damage condoms and so make then ineffective
  • If the dry vagina is as a result of the menopause, your GP may prescribe vaginal pessaries or cream which contains oestrogen
  • If sex is painful after pregnancy then wait for at least six weeks before resuming sexual intercourse
  • If you suffer from allergic reaction around your genitals from using some products it is advisable that you stop using them
  • If there is pain or discharge in the genital area it may be advisable to be tested for thrush and other sexually transmitted infections.  Treatment can then be recommended by your healthcare professional
  • If the dyspareunia is being caused by psychological or emotional issues your GP or sexual health clinic will be able to recommend the correct sort of counselling and refer you to the appropriate therapist

 

Sources

  1. Why does sex hurt? https://www.nhs.uk/common-health-questions/sexual-health/why-does-sex-hurt/#:~:text=Women%20can%20experience%20pain%20during,can%20make%20your%20vagina%20dry
  2. Painful sex in women (dyspareunia) https://www.webmd.com/sexual-conditions/guide/female-pain-during-sex#1
  3. The most likely causes of pain during sex https://patient.info/news-and-features/reasons-sex-may-be-painful-for-you
  4. What you need to know about dyspareunia (painful intercourse  https://www.healthline.com/health/dyspareunia

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