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Painful sex in women

Painful sex is a common problem

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The medical term for painful sex is ‘dyspareunia’. Dyspareunia is a pain disorder described as recurrent or persistent pain during sexual intercourse. Sometimes women are also likely to report pain with other forms of penetration such as finger insertion, tampons, and gynaecological examinations.  The pain can be superficial or deep. Superficial pain is located near the vaginal entrance on penetration and is often described as stinging, sharp or burning. Deep pain, on the other hand, is associated with deep vaginal penetration, and therefore often felt within the pelvis. Painful sex is a common problem that typically - but not exclusively - affects women aged 16-24 and 55-64. Although it is common, dyspareunia is still a poorly understood and neglected female health problem. For this reason, it is important to know that this condition can have an important impact on women’s quality of life, mental well-being and self-esteem. On top of the physical pain, it can lead women to feel lonely, anxious, depressed, frustrated, disappointed, isolated, discouraged, and/or out of place. It is therefore important for women to find a tactful and sensitive practitioner in whom they can confide in all honesty and comfort for the best possible outcome. 

 

Causes

Painful sex can be caused by many different, and sometimes overlapping causes. Some causes are physical, some are psychological, and sometimes they can be both. If the symptoms arise suddenly, the problem might be physiological. If they arise gradually, the problem might be physical. Because pain during sex is a physical symptom, it is important to first and foremost rule out any potential physical factors at the origin of the pain. Here are the most common physical causes associated with painful sex in women: 

  • Inadequate lubrication: may be caused by a sexual arousal disorder or chronic vaginal dryness. 
  • Vaginismus: involuntary contractions of the vaginal wall.
  • Vulvodynia: a condition causing chronic pain around the vulvar area without an identifiable cause.
  • Vestibulodynia: sensitivity to pain at the opening of the vagina that is triggered when the penis enters the vagina or moves. Gentle touch or stimulation can also be painful. 
  • Vaginal atrophy: drying and inflammation of the vaginal walls caused by a decrease of oestrogen during menopause.
  • Chronic Pelvic Inflammatory diseases (PID): infections of the upper genital tract usually caused by sexually transmitted infections. 
  • Bartholin’s abscess or cyst: infection of one of the Bartholin glands on either side of the vaginal opening. 
  • Post-partum dyspareunia: when you have intercourse too soon after childbirth.
  • Acute or chronic diseases: recurrent candida, herpes, urinary tract infections, yeast infections, skin conditions.
  • Genital surgical damage 

There are some rarer factors than can result in pain during intercourse which must be ruled out too. These include: 

  • Endometriosis: a condition where the tissue lining the uterus (endometrium) grows outside the uterus and starts growing in other places such as the fallopian tubes and the ovaries.
  • Malformations e.g. a deviated vaginal septum
  • Once physical factors have been ruled out or diagnosed, potential psychological factors must be assessed that might cause and/or worsen painful sex. Generally speaking, psychological causes for dyspareunia involve any situations and/or experiences that cause mental distress in the patient.

Common psychological causes include:

  • Depression
  • Anxiety
  • Unresolved or present feelings of grief
  • Traumatic childhood memories (e.g. sexual, mental, physical abuse)
  • Loss
  • Fear
  • Dissatisfaction or unhappiness in a relationship
  • Domestic abuse

Whether physical and/or mental, it is important to point out that the anticipation of a situation of pain during intercourse can create anxiety and further complicate the interaction. 

What can you do?

If you experience recurrent or persistent pain during sex, talk to your GP or healthcare professional. Because there are many potential causes to dyspareunia, there are also many different ways of approaching the problem and different treatments that can be proposed. These can range from antibiotics to treat infections, to surgery to correct malformations or remove cysts, to the prescription of oestrogen in case of thinning and drying of the vagina, to therapy and pelvic muscle relaxation exercises. A collaboration of sex therapy, gynaecology, and physical therapy can be beneficial for an optimal assessment of the problem. It is important that you feel comfortable undergoing a physical examination and talking about your sexual history. It is, therefore, useful to find a professional who is sensitive and tactful in order to achieve optimal care. 

Sources: 

Cassis, Charlotte, Mukhopadhyay, Sambit, Morris, Edward, ‘Dyspareunia: a difficult symptom in gynaecological practice’, in Obstetrics, Gynaecology and Reproductive Medicine, 28:1 (2017), pp. 1-6
Kimberly A. Payne, Elke D. Reissing, Marie-Andrée Lahaie, Yitzchak M. Binik, Rhonda Amsel, Samir Khalifé, ‘What Is Sexual Pain? A Critique of DSM's Classification of Dyspareunia and Vaginismus’, in Journal of Psychology & Human Sexuality, 17:3-4 (2006), pp. 141-154 
Lee, Likki M W, Jakes Adam D, Lloyd Jillian, Frodsham Leila C G., ‘Dyspareunia’, in BMJ (2018) https://www.bmj.com/content/361/bmj.k2341 [last accessed 18.02.2019]
Meana, Marta, ‘Painful Intercourse: Dyspareunia and Vaginismus’, in Journal of Family Psychotherapy, 20:2-3 (2009), pp. 198-220
Seehusen, Dean A., Baird, Drew C., Bode, David V., ‘Dyspareunia in Women’, in American Family Physician, 90:7 (2014), pp. 465-470 

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