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BellaOnline's Gynecology Editor

Painful Intercourse

Sexual intercourse should not hurt. The female anatomy is designed to withstand the thrusting of a penis without discomfort. If it wasn’t, the human race would have died out a long time ago or at the very least there wouldn’t be 6.8 billion people living on the planet. Although painful intercourse was at one time thought to be primarily a psychological condition, it is now recognized that it can be physically or psychologically based, or sometimes a combination of both.

Diagnosing the Cause

Diagnosing the cause of painful intercourse (medical term: dyspareunia) should always start with a complete medical checkup. Your physician will want to know where the pain is and when you experience it. Does it occur deep inside, in your vagina, or around the opening of your vagina? Is it a sharp pain or a dull ache? Does it occur only during intercourse or does it linger for hours afterward? Have you always experienced pain or is this something new? Do you experience pain every time you have intercourse?

What It Might Be

The causes of painful intercourse may often be determined by the location of the pain.

If the pain is felt deep inside the causes may be:

• Infections of the uterus, fallopian tubes and cervix;
• Medical conditions such as a prolapsed uterus, inflammatory bowel diseases, fibroids and cystitis;
• Scar tissue from surgeries such as a hysterectomy or medical treatments for cancer, and some abdominal surgeries;
• Deep and vigorous penetration by your partner.

If the pain is felt upon entry into the vagina the causes may be:

• Vaginal dryness. The lining of the vagina becomes irritated and sore when lubrication is low. This may result from insufficient foreplay or a drop in estrogen levels. A number of medications can also cause the vagina to produce inadequate amounts of lubrication. Some medications inhibit sexual desire which in turn inhibits the natural vaginal excretions that occur when aroused. These medications include anti-depressants, blood pressure medications and some birth control pills. Many over-the-counter drugs can also affect secretions and arousal, including cold and allergy medications and sleep aids;
• The presence of yeast infections, bacterial infections or bladder infections;
• Scar tissue resulting from surgery, infection or a sexually transmitted disease such as herpes;
• Atrophy of the vaginal wall due to low estrogen levels or radiation therapy;
• Skin irritations from eczema, or allergic reactions to oils, foams and jellies, and latex condoms;
• Cervical caps and diaphragms that have not been properly sized or inserted;
• Vaginusmus, reflexive contracting of the muscles of the vagina;
• Vestibulitis, an idiopathic (unexplained) stinging or burning sensation at the opening of the vagina.

Emotional factors can also play a part. If you are feeling depressed or worried, have body image issues or problems in your relationship, have been sexually abused, or have previously experienced pain with intercourse, your anxiety and apprehension may manifest itself as pain.

How to Fix It

Speak with your doctor. You might feel uncomfortable at first, but remember, most doctors have seen and heard it all. And your health and well-being are much more important than a few brief moments of embarrassment.

Diagnosing the Problem

Your doctor will ask you questions about the pain, such as, when does it occur, how intense is it, where is it. You may be asked questions about your sexual history. You will probably have a pelvic exam. A culture might be taken to test for infection. Your blood and urine might be tested. You may have to have an ultrasound or a more thorough pelvic exam such as a laparoscopy (a minor surgical procedure that allows the doctor to view your organs from the inside using a type of camera inserted through a small incision in your abdomen.)

The Treatment

Most physical and emotional causes of painful intercourse can be treated. As well as medical interventions such as antibiotics, hormone replacements and in some cases surgery, there are also things you can do to alleviate the pain.

• Try changing the position in which you have intercourse. If you are experiencing deep pain, switch to a position that doesn’t allow for deep penetration such as lying on your back with your buttocks raised and your legs over your partners shoulders;
• If the pain is at the opening or inside the vagina, try using lots of lubrication such as K-Y Jelly or other lubricants that can found on the drugstore shelves. Vaseline and baby oils are not recommended as they are difficult to remove from your vagina and may cause irritation and infection;
• There are other ways to experience sexual pleasure besides intercourse. Speak with your partner and devise new and different ways to enjoy each other that don’t involve penetration;
• If it is determined that your pain originates from an emotional cause, find a sex therapist or counsellor. Be open and honest with your partner and seek their help by discussing ways that you might have a more comfortable sexual experience. It is to your partner’s benefit that you begin to take pleasure from intimacy.

If you are experiencing painful intercourse, don’t despair. It is estimated that up to 60% of women experience some kind of genital pain during sex, so you are not alone and the good news is that most issues can be resolved. It is imperative that you seek medical attention to rule out serious health issues. It is also important for your self-esteem, your intimate and emotional relationship that you are able to have a pleasurable and fulfilling sexual experience each and every time.

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Content copyright © 2013 by Linda Reid. All rights reserved.
This content was written by Linda Reid. If you wish to use this content in any manner, you need written permission. Contact Dr. Denise Howard for details.

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