When sex is painful
Painful sex or dyspareunia is a problem that many women are embarrassed, ashamed or just downright uncomfortable discussing. It’s natural to stress about something so personal – but in most cases, effective treatments are available. Painful sex can affect your happiness, your self-esteem and your relationship. It’s not something that you have to tolerate.
Sex can be uncomfortable for many reasons, both physical and emotional. With specialist help, problems can be identified and discomfort can be soothed so that you can enjoy intimacy again.
What sort of pain?
Learning about the pain can help pinpoint the cause. You can play detective and note down the problems you’re experiencing. Consider whether the pain is on the surface or deep, if inserting a tampon hurts, if you’ve ever had pain-free sex and how the pain feels.
Differing types of pain can be down to different causes. The right way of treating and managing each will vary, so be honest and open and you’ll soon be on the road to recovery.
What causes painful sex?
Pain on penetration (superficial dyspareunia)
Pain on vaginal entry can be caused by:
Too little lubrication: Your natural discharge helps the penis slip into the vagina. Too little and sex can be uncomfortable. This may be because of insufficient foreplay, decreased desire due to relationship problems or medications like antidepressants. Discharge is driven by your hormones, so the drop in levels after childbirth, during breastfeeding or after the menopause can have an impact.
Injury, infection and irritation: An accident, tear during childbirth or surgery can all cause pain on initial entry. Similarly, an infection or skin disorder can inflame the area and make sex sore.
Vaginismus: Sometimes the muscles of the vaginal wall go into spasm, which makes penetration extremely painful.
Vestibulitis: This is a condition in which there is inflammation of the tissues surrounding the entrance to the vagina. Any pressure can cause intense pain. There may also be stinging and soreness in the area.
Birth abnormalities: Some women are born with a problem that can make sex difficult. The hymen may only have a small opening or the vagina may not have developed properly.
Deep pain (deep dyspareunia)
Deep pain usually happens after initial penetration and can be worse with thrusting or in certain positions.
Endometriosis: In endometriosis, the type of tissue that normally lines the womb starts growing outside the uterus. If this develops behind the vagina or the lower womb, it can be agonising during sex. The thrusting can pull the patches of endometriosis, triggering pain that can last for hours or even days.
Pelvic Inflammatory Disease: PID is caused by sexually transmitted infections such as chlamydia. It can cause aching pelvic pain and dyspareunia. It can be assessed and treated without judgement at your local GU clinic.
Fibroids: These are benign growths that develop in the walls if the uterus. They can cause heavy periods and pain during sex.
Adhesions: Inflammation, surgery or endometriosis can cause the organs in the pelvis to be stuck together and pulled from their normal position. This can cause deep pain on intercourse
Prolapse: Childbirth and weakness of the pelvic floor can make the womb droop into the vagina. Pelvic floor exercises can help but surgery may also be needed.
What will happen at my appointment?
Getting the full story: Your gynaecologist will discover the details of your pain and positions that trigger it. You’ll be asked about medications, medical problems, surgeries and childbirth. Don’t be embarrassed. This is something that your gynaecologist deals with daily and they’ll be sympathetic and unshockable.
Pelvic Examination: Your doctor will look for infection, inflammation and developmental issues. An internal examination with a speculum and fingers can locate the pain and identify any swellings. Even the most gentle examination may hurt. Try and relax, let your doctor know if you’re in pain. Remember that you are in control and can stop the exam at any time.
Tests: Sometimes your gynaecologist will arrange an ultrasound scan or a laparoscopy to further investigate the cause of your pain.
With sex, the physical symptoms and emotions become entwined. One painful experience can cause anxiety and tension which increases pain, it’s a vicious circle.